Can I take Apixaban and Tramadol together?

Why this happens

Tramadol can inhibit the reuptake of serotonin, which platelets need to clump together and form clots. Additionally, both drugs are processed by the same liver enzymes (CYP3A4), meaning tramadol could potentially slow down the breakdown of apixaban, leading to higher levels of the blood thinner in your system.

What you should do

Use this combination with caution. You should only take these together if specifically prescribed by your doctor. Watch closely for signs of bleeding, such as unusual bruising, blood in your urine or stools (which may look black and tarry), or persistent nosebleeds. If you experience a fall or a head injury while taking both, seek medical advice immediately even if you feel fine.

Important precautions

Active bleeding or high risk of bleeding

You must seek immediate medical attention if you have a serious fall or head injury, even if you feel fine, as apixaban increases the risk of internal bleeding which can be life-threatening.

Epilepsy or history of seizures

Tramadol can increase the risk of having a fit (seizure), even at normal doses. This risk is higher if you already have epilepsy or are taking certain antidepressants.

Concomitant use of NSAIDs (e.g. ibuprofen, naproxen)

Do not take anti-inflammatory painkillers like ibuprofen while on these medicines without medical advice. Combining them with apixaban significantly increases your risk of serious stomach bleeding.

Food and drink warnings

Alcohol

You must avoid drinking alcohol while taking tramadol. Both substances affect the central nervous system; combining them significantly increases the risk of dangerous side effects, such as extreme drowsiness, breathing difficulties, and loss of consciousness.

Using other medicines

Taking multiple medicines? Our Medicines Interaction Checker helps you check whether your prescriptions, over-the-counter medicines, and supplements are safe to take together. Simply search for your medicines to see potential interactions and what to do about them.

Disclaimer

This information is for general educational purposes only and should not be relied upon as a substitute for professional medical advice. Always consult your GP, pharmacist, or another qualified healthcare professional before making decisions about your medications. Individual circumstances may vary, and only a healthcare professional who knows your medical history can provide personalised guidance.