Can you take Paxlovid with Eliquis?

In this article:

• Can you take Paxlovid with Eliquis?
• What happens if you take Eliquis and Paxlovid together?
• How long should I wait to take Paxlovid after taking Eliquis?
• Is it safe to mix Eliquis and Paxlovid?

In this article

• Can you take Paxlovid with Eliquis?
• What happens if you take Eliquis and Paxlovid together?
• How long should I wait to take Paxlovid after taking Eliquis?
• Is it safe to mix Eliquis and Paxlovid?

Eliquis (apixaban) is a prescription drug approved by the U.S. Food and Drug Administration (FDA) to prevent or treat blood clots that could become serious medical complications. Paxlovid (nirmatrelvir/ritonavir) is an antiviral prescription medicine developed by Pfizer that a healthcare provider may prescribe to treat mild to moderate COVID-19 in people at a higher risk of developing a more severe infection.

You can take Paxlovid with Eliquis, but there’s a higher risk of complications when mixing these drugs. You may need dosage adjustments or close monitoring for potential drug interactions.

Can you take Paxlovid with Eliquis?

Sazan Sylejmani, Pharm.D., the owner and pharmacy manager of Westmont Pharmacy, says it is okay to take Paxlovid and Eliquis, but close monitoring is recommended.

Jessica Iroanya, Pharm.D., BCMTMS, an RPh adviser at CVS Health, says there are exceptions where taking Paxlovid and Eliquis isn’t recommended.“When Paxlovid is combined with Eliquis, increased anticoagulation effects can occur, which could lead to excessive bleeding in patients on these medications,” she says.

Anticoagulants or blood thinners like Eliquis stop blood from clotting or thickening. Paxlovid can decrease the metabolism of anticoagulants, increasing their levels to a point where they are unsafe to use.

Dr. Iroanya says that because of the risks, combining Paxlovid with Eliquis should be avoided entirely and that other methods should be considered if possible. “Consider alternative treatments that do not interact with anticoagulants Eliquis,” she adds. “In some cases, dose adjustments or temporary discontinuation may be feasible.”

Although Paxlovid may increase the effects of Eliquis, Dr. Sylejmani says that some people may need to take this combination of drugs. “For high-risk COVID patients, Paxlovid’s benefits often outweigh the risks,” he says.

Aside from Eliquis, there are other Paxlovid drug-drug interactions to be aware of. These medications include:

• Benign prostatic hyperplasia (BPH) treatments like alfuzosin and silodosin
• Cardiovascular medications like amiodarone, amlodipine, cilostazol, clopidogrel, digoxin, diltiazem, disopyramide, dofetilide, dronedarone, eplerenone, felodipine, flecainide, ivabradine, nifedipine, propafenone, quinidine, ranolazine, ticagrelor, verapamil, and vorapaxar
• Pulmonary hypertension medications like avanafil, sildenafil, tadalafil, and vardenafil
• Anticonvulsants like carbamazepine, phenobarbital, phenytoin, and primidone
• Anti-infectives like glecaprevir/pibrentasvir
• Immunosuppressants like everolimus, sirolimus, tacrolimus, and voclosporin
• HMG-CoA reductase inhibitors or statins like atorvastatin, lovastatin, rosuvastatin, and simvastatin
• Antibiotics like rifampin (Rifadin, Rimactane)
• Antipsychotics like clozapine, lurasidone, midazolam, and pimozide
• Miscellaneous medications and supplements, like colchicine, bosentan, ergot derivatives, lumacaftor/ivacaftor, St. John’s wort, and tolvaptan

If you are taking other medications, alert your healthcare provider or pharmacist before starting Paxlovid.“It’s best practice to discuss all prescription and over-the-counter (OTC) medicines you take with your healthcare provider to determine the appropriate course of action,” Dr. Iroanya says. 

What happens if you take Eliquis and Paxlovid together?

As mentioned by Dr. Iroanya, taking Paxlovid and Eliquis may increase your chances of bleeding, as ritonavir may increase the blood levels of apixaban. If left untreated, this could potentially lead to adverse events requiring hospitalization.

Aside from side effects that may arise from the contraindications, both medications have individual side effects that may worsen when they are taken together.

Taking Eliquis may cause the following side effects:

• Bruises
• Nausea 
• Spinal or epidural blood clots (hematoma)
• Blood in urine (hematuria)
• Postprocedural hemorrhage (bleeding that occurs after a surgical procedure)
• Rectal hemorrhage
• Nosebleed
• Coughing up blood from your lungs (hemoptysis) 
• Allergic reactions, such as hives, rashes, itching, and difficulty breathing
  

Common side effects of Paxlovid include the following:

• Altered sense of taste
• Diarrhea
• Headache
• Vomiting
• Nausea
• Abdominal pain
• High blood pressure
• Feeling generally unwell

More serious side effects of Paxlovid include severe allergic reactions (anaphylaxis) and liver problems. If you’re experiencing serious side effects while taking Paxlovid and Eliquis individually or combined, please seek immediate medical attention from a healthcare provider.

The National Institutes of Health (NIH) COVID-19 Treatment Guidelines recommend that healthcare providers reduce the dose or extend the dosing interval of concomitant drugs like Eliquis when taken with Paxlovid. Concomitant drugs are prescription medications that a participant in a clinical trial may take in addition to another drug under investigation. With Paxlovid being a newer drug, it is still going through clinical trials to determine its effectiveness in treating COVID-19. If the dose of the concomitant medication cannot be adjusted, the drug should be withheld, or an alternative concomitant medicine or COVID-19 therapy should be used. If needed, Eliquis alternatives include Pradaxa (dabigatran), Xarelto (rivaroxaban), Savaysa (edoxaban), Ciumadin or Jantoven (warfarin), and HeparinOther COVID-19 therapies your healthcare provider or pharmacist may recommend as a replacement for Paxlovid include Veklury (remdesivir) or Lagevrio (molnupiravir). 

Additionally, if you have certain medical conditions, it may be unsafe to take the COVID-19 drug Paxlovid. “ People with severe liver (hepatic) impairment (Child-Pugh Class C) should avoid mixing these medications due to the risk of liver toxicity,” Dr. Iroanya says.

The FDA also recommends that Paxlovid should be avoided or closely monitored if you:

• Have kidney problems (a different dose may be necessary)
• Have HIV (Paxlovid may cause some HIV medicines to be less effective)
• Are pregnant or planning to become pregnant (it is unknown if Paxlovid can harm an unborn child)
• Are you breastfeeding or plan to breastfeed (it is unknown if Paxlovid can pass through breast milk)
  

If you have to take Eliquis and Paxlovid simultaneously, make sure you take the necessary precautions to lower your chances of adverse events. “Patients should follow up frequently with their healthcare provider, report side effects immediately, and know that dosage adjustments may be needed,” Dr. Sylejmani says.

How long should I wait to take Paxlovid after taking Eliquis?

In most cases, Paxlovid can be taken with Eliquis. According to Dr. Iroanya, you should wait at least 24 hours after stopping Eliquis before starting Paxlovid. 

The safest or preferred dosing schedule for each medication varies depending on the recommended dosage, any medical conditions you may have, your age, and body weight. 

Dr. Iroanya says the standard dose for Paxlovid is 300 milligrams (mg) of nirmatrelvir with 100 mg of ritonavir administered by taking three tablets together twice daily (in the morning and before bedtime) for five days. 

If you have moderate-level renal or kidney impairment, dose reduction may be necessary to prevent or reduce complications while taking Paxlovid. Dr. Iroanya suggests the 150 mg dose pack, in which you would take one 150 mg nirmatrelvir tablet with one 100 mg ritonavir tablet twice daily for five days.

She adds that Paxlovid is not recommended for people with severe renal impairment.

Regarding Eliquis, the standard oral dosage ranges depending on what condition is being treated.

Below are the Eliquis dosages for different cardiovascular (heart) conditions:

• Deep venous thrombosis (hip replacement surgery): 2.5 mg two times a day for 35 days
• Deep venous thrombosis (knee replacement surgery): 2.5 mg two times a day for 12 days
• Prevention of recurrent deep vein thrombosis and pulmonary embolism: 2.5 mg two times a day
• Prevention of strokes and blood clots in people with nonvalvular atrial fibrillation: 5 mg two times a day
• Deep venous thrombosis and pulmonary embolism treatment: 10 mg two times a day

Dr. Iroanya notes that other factors can affect Eliquis dosages. “In patients with at least two of the following characteristics: age greater than or equal to 80 years, body weight less than or equal to 60 kilograms (kg), or a serum creatinine of greater than or equal to 1.5 milligrams by per deciliter (mg/dL), the recommended dose is 2.5 mg orally twice daily,” she explains.

Your healthcare provider will prescribe the proper dosages for the co-administration of Eliquis and Paxlovid for your health needs. 

Is it safe to mix Eliquis and Paxlovid?

Taking Eliquis and Paxlovid can pose many health risks due to their drug-drug interactions. The main side effect of mixing these drugs is increased bleeding. These medications also have their individual side effects, including bruising, nausea, vomiting, diarrhea, allergic reactions, and many others. 

Despite the risks, there are instances where some people may benefit from taking both drugs. For example, those diagnosed with COVID-19 and are at a higher risk of developing a more serious infection may need to take Paxlovid to treat the virus, alongside Eliquis.

It is important to understand possible Paxlovid and Eliquis interactions so that you can notify your healthcare provider if you’re experiencing severe side effects. “To ensure the best outcome for patients taking these medications and to reduce the risk of any adverse interactions and effects, it’s best practice to consult with your healthcare provider,” Dr. Iroanya says.