ModerateDirect oral anticoagulants (factor Xa inhibitors)×SNRI (serotonin-norepinephrine reuptake inhibitor)
Updated · Methodology
Mechanism
Venlafaxine (SNRI) moderately impairs primary haemostasis by inhibiting platelet serotonin reuptake. Additively with apixaban, GI bleeding risk rises.
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
The combination is acceptable. In patients over 65 or with prior peptic ulcer: pantoprazole 20 mg/day. Venlafaxine also raises blood pressure at doses above 150 mg/day — consider alternatives in arterial hypertension.
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.
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Sources
- FDA: Eliquis (apixaban) prescribing information (2014)– ; DailyMed setid e9481622-7cc6-418a-acb6-c5450daae9b0
- 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: Venlafaxina (nº registro 67542), sección 4.4 (2024)– AEMPS, CIMA, nº registro 67542, revisión 03/2024, sección 4.4