Drug General Information (ID: DDIDEY4JHC)
Drug Name			Bismuth subsalicylate		Drug Info		Apixaban		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antidiarrheals				Anticoagulants/Factor Xa Inhibitors
Structure

Mechanism of Bismuth subsalicylate-Apixaban Interaction (Severity Level: Moderate)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Bismuth subsalicylate				Apixaban
Mechanism		Risk of bleeding Antiplatelet effects				Risk of bleeding Anticoagulant
Key Mechanism Factor 1
		Factor Name		Bleeding
		Factor Description		Patients may be at risk for bleeding when the outcome of a disease or disease treatment confounds the standard mechanisms for maintaining hemostasis. Signs or symptoms of abnormal bleeding include: bleeding that takes a long time to stop (including nosebleeds, bleeding gums, bleeding from cuts and abrasions, and menstrual bleeding); severe unexplained bruising, or bruising that becomes larger; blood in the urine or stool, etc.
Mechanism Description		Increased risk of bleeding by the combination of Bismuth subsalicylate and Apixaban

Recommended Action
Management		Until further data are available, products containing salicylates, especially if given chronically or in high dosages, should preferably be avoided in patients receiving anticoagulants. Close clinical and laboratory observation for bleeding complications is recommended if concurrent therapy is necessary. The same precaution should be observed with the use of salicylate-related agents such as salicylamide because of their structural and pharmacological similarities.

References
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