Eliquis

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Jul 14, 2022

Warnings

What are the risks of taking Eliquis (apixaban)?

Eliquis can cause serious health problems, especially in certain high-risk patients. Some of the risks of Eliquis therapy are described below.

RISKS ASSOCIATED WITH EARLY DISCONTINUATION OF ELIQUIS TREATMENT: Patients treated with Eliquis should not stop taking this medicine before their doctor says so. Stopping Eliquis too early can increase the risk of blood clots and heart attacks or stroke, particularly in patients with heart conditions like atrial fibrillation. If you are taking Eliquis to prevent stroke and systemic embolism and are interested in stopping this medication, talk to your healthcare professionals about switching to a different anticoagulant (blood thinner).
RISKS ASSOCIATED WITH SPINAL PROCEDURES: Patients treated with Eliquis who receive spinal anesthesia or spinal procedures like spinal punctures (spinal tap or epidural) are at greater risk of bleeding. This can lead to the formation of spinal hematomas (blood collection around the spinal cord). It is a serious condition that can lead to neurological impairment and permanent paralysis. The risk of neurological compromise and paralysis is higher in people with indwelling epidural catheters and those with a history of spinal surgery or traumatic or repeated epidural or spinal puncture. The risk is also higher in people taking nonsteroidal anti-inflammatory drugs or other blood thinners. If you are undergoing a spinal puncture, your healthcare provider will tell you how to stop taking Eliquis safely before your procedure. Call your doctor immediately if you notice symptoms such as pain, tingling, numbness, burning, muscle weakness, or inability to urinate.
CHALLENGES WITH ANTAGONIST THERAPY: It is more difficult to reverse the effects of Eliquis in an emergency compared to other blood thinners such as the oral anticoagulant warfarin. You should let all your healthcare professionals know that you are taking Eliquis. It might be a good idea to wear a medical bracelet that indicates you are on Eliquis.

Discuss the potential benefit versus risk of taking Eliquis with your healthcare provider. If you are at a high risk of complications from Eliquis use, your doctor or pharmacist can help you find other treatment options for your condition.

What should I tell my doctor before starting Eliquis (apixaban)?

Tell your healthcare provider if you have ever had an allergic reaction to Eliquis (apixaban) or any of the active or inactive ingredients in Eliquis tablets, other anticoagulants, or other drugs. Your pharmacy can give you a list of ingredients.

Give your healthcare provider a complete medical history. Eliquis may not be right for people with certain medical conditions. Tell your doctor if you have an artificial heart valve or have had bleeding problems in the past, such as heavy bleeding that could not be easily stopped. Also, tell your doctor if you have kidney disease, liver disease, or a condition called antiphospholipid syndrome, which is associated with abnormal blood clotting.

Give your doctor a complete list of your medications, including prescription drugs, over-the-counter medicines, vitamins, dietary supplements, and herbal products, especially St. John’s Wort. This can help avoid serious interactions between Eliquis and your other medicines.

Tell your doctor if you are pregnant, undertaking pregnancy planning, or breastfeeding.

What precautions should I take while on Eliquis (apixaban)?

Keep all your appointments with your healthcare professional while on Eliquis. Your doctor may need to perform dose adjustment.

Contact your healthcare professional without delay if you experience any unusual bleeding. Call your doctor or seek emergency medical attention if you suffer any injuries, especially a head injury, while on Eliquis.

Call your doctor if you become pregnant while on Eliquis.

Tell all your healthcare professionals you are on Eliquis. This is especially important before undergoing any invasive procedure or elective surgery, including dental surgery. Your doctor may ask you to stop taking Eliquis and put you on a different medication to prevent blood clots around the time of your procedure or surgery. Follow your doctor’s directions carefully about stopping and restarting Eliquis.

What drugs can interact with Eliquis (apixaban)?

Taking Eliquis with other medications can affect how much of the medication stays in your body and how it works. Some drug interactions can increase bleeding risk and other serious adverse effects, while others can make Eliquis less effective. Your physician may choose a different medication for you, change the dose or frequency of one or both medicines, and/or closely monitor you for side effects if there are known interactions between Eliquis and your other medications.

Concomitant administration of Eliquis and the following medications can cause problems:

Anti-seizure medications such as carbamazepine (Carbatrol, Tegretol) and phenytoin (Dilantin, Phenytek)
Antibiotics such as clarithromycin (Biaxin, in Prevpac) and rifampin (Rifadin, Rimactane, in Rifadin, in Rifater)
Antifungal agents like itraconazole (Onmel, Sporanox) and ketoconazole (Nizoral)
Antiviral drugs like ritonavir (Norvir, in Kaletra)
Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft), fluoxetine (Prozac, Sarafem, Selfemra, in Symbyax), citalopram (Celexa), paroxetine (Brisdelle, Paxil, Pexeva), and fluvoxamine (Luvox) and serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor), duloxetine (Cymbalta), milnacipran (Fetzima, Savella), and desvenlafaxine (Khedezla, Pristiq)

This list may not describe all possible Eliquis interactions. Give your healthcare professionals a complete list of your medications, including prescription drugs, over-the-counter medicines, vitamins, dietary supplements, and herbal products, especially St. John’s Wort. Also, tell your health care provider if you smoke, drink alcohol, or use illegal drugs because some of these substances can cause serious health complications when used with prescription drugs.

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