Can you take apixaban while breastfeeding?
What LactMed says
The National Library of Medicine’s own summary, quoted in full. We do not write a verdict of our own on this question, and we do not compress theirs into a label.
Information from four mothers indicates that apixaban levels in milk are high, potentially resulting in infant anticoagulation and bleeding, which was confirmed with a pharmacokinetic model. An alternate drug is preferred, especially while nursing a newborn or preterm infant.
Quoted from Apixaban — Drugs and Lactation Database (LactMed®), National Institute of Child Health and Human Development, revised May 15, 2026.
What LactMed would consider instead
LactMed ends this record by naming the drugs it would consider in place of apixaban. Whether any of them fits depends on what you are treating — this is the database’s list, not a recommendation from us.
- Acenocoumarol
- Dabigatran
- Dalteparin
- Enoxaparin
- Heparin
- Rivaroxaban
- Warfarin
How much apixaban gets into breastmilk
Maternal Levels. A nursing mother who was 23 months postpartum received 2 doses of 5 mg of oral apixaban 12 hours apart. Blood and milk samples were obtained before the first dose and at 3.5, 7, 12 (before the second dose), 16, and 24 hours after the first dose. Peak apixaban milk levels of about 230 mcg/L occurred at 3.5 to 4 hours after each dose. The average milk level over 24 hours was 113.6 mcg/L, which corresponds to a daily infant dosage of 17 mcg/kg daily and a relative infant dose of 12.8% of the maternal weight-adjusted dosage.
Three lactating women were taking 5 mg of apixaban twice daily by mouth and were at steady-state. They extracted milk and provided samples at 0, 1, 2, 4, 6, 8, 10, and 12 hours after a dose. Peak milk levels of apixaban occurred at 1 hours after the dose in one woman and 2 hours after the dose in the others two. Peak levels ranged from 0.2 to 0.25 mg/L and average milk levels ranged from 0.134 to 0.16 mg/L. The absolute infant dosage was calculated to be 10 mcg/kg every 12 hours, which amounted to weight adjusted infant RID values of 14%, 20% and 21% in the three infants.
A physiologically based pharmacokinetic (PBPK) model was constructed to simulate breastmilk and infant serum apixaban concentrations and compared to published data. The model predicted peak milk levels of 212 and 416 mcg/L for dosages of 2.5 and 5 mg twice daily, respectively. Results indicate that the worst-case relative infant dosage in infants would be about 140%.
Another PBPK model that used experimentally derived values for protein binding and transmembrane passage was developed. Simulated RID values were about 11.9% using the average milk concentration and 25.9% using the peak concentrations as a worst-case value.
Infant Levels. Relevant published information was not found as of the revision date.
What has been seen in breastfed infants
Relevant published information was not found as of the revision date.
Effects on milk supply
Relevant published information was not found as of the revision date.
Frequently asked questions
Can you take apixaban while breastfeeding?
What the NIH's Drugs and Lactation Database says about Apixaban while breastfeeding — quoted in full. The full record is quoted on this page, and the decision is one to make with the person who prescribed it — LactMed itself states it is not a substitute for professional judgement.
What can I take instead of apixaban while breastfeeding?
LactMed lists Acenocoumarol, Dabigatran, Dalteparin, Enoxaparin, Heparin, Rivaroxaban, Warfarin as alternate drugs to consider. That is the database's own list for this drug — whether any of them suits you depends on what you are treating.
Does apixaban pass into breastmilk?
LactMed's measured drug levels for apixaban are quoted in full on this page, under "How much gets into breastmilk".
Do I need to pump and dump after taking apixaban?
LactMed does not frame its records that way — it reports measured drug levels in milk and what has been observed in breastfed infants, which is what this page quotes. "Pump and dump" advice for a specific drug and dose should come from your clinician or a pharmacist, not from a general rule.
More on apixaban
LactMed states that the information it presents is not a substitute for professional judgement, and that you should consult your healthcare provider for breastfeeding advice related to your particular situation. Nothing on this page is medical advice.