Moderate
Apixaban × Fluconazole
Direct oral anticoagulants (factor Xa inhibitors)×Antifungals, triazole derivatives
Mechanism
Fluconazole is a moderate CYP3A4 inhibitor. Apixaban AUC rises moderately (by 30–40%), increasing 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 fluconazole courses (single 150 mg dose or 5–7 days), do not change apixaban. For longer therapy (over 14 days) in older patients and creatinine clearance below 50 mL/min, consider reducing apixaban to 2.5 mg twice daily. Alternatives: nystatin (not systemically absorbed) or clotrimazole for superficial candidiasis.
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.