ModerateDirect oral anticoagulants (factor Xa inhibitors)×Fluoroquinolone antibacterials
Updated · Methodology
Mechanism
Ciprofloxacin weakly affects CYP3A4 and P-glycoprotein — the main clearance routes of apixaban. It also suppresses vitamin K-producing gut flora. Additive bleeding risk.
Symptoms
Gum bleeding, epistaxis, bruising without trauma, black or tarry stools, haematuria. Higher risk in older patients, prior peptic ulcer disease, and chronic kidney disease.
Management
For short ciprofloxacin courses (5–7 days), do not change the apixaban dose but monitor for bleeding signs. In patients over 75 or with creatinine clearance below 50 mL/min, choose an alternative antibiotic without P-glycoprotein effect — ceftriaxone, cefixime, amoxicillin-clavulanate.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Cipro (ciprofloxacin hydrochloride) prescribing information (2016)– ; DailyMed setid 888dc7f9-ad9c-4c00-8d50-8ddfd9bd27c0
- AEMPS: Ficha técnica de Eliquis 5 mg comprimidos recubiertos con película (apixabán) (2026)– AEMPS, CIMA (texto EMA), nº registro 111691009, secciones 4.4 y 4.5
- AEMPS: Ficha técnica: Ciprofloxacino (nº registro 62765), sección 4.5 (2025)– AEMPS, CIMA, nº registro 62765, revisión 11/2025, sección 4.5