Eliquis Side Effects

Eliquis is a brand name of the prescription drug Apixaban, which is utilized to cure severe blood clots from coalescing because of a particular abnormal heartbeat and after knee/hip replacement surgery. When atrial fibrillation occurs, a specific section of the heart doesn’t beat regularly. This can result in the formation of blood clots that can spread to various parts of the body like the legs and lungs or raise your risk of suffering from a stroke. Moreover, apixaban is also approved as a cure for several kinds of blood clots such as pulmonary embolus-PE and deep vein thrombosis-DVT, and stop them from developing again. Generally, Eliquis is considered as an anticoagulant that operates by preventing specific clotting proteins found in your blood. 

Side Effects

Eliquis side effects include easy bruising, nausea, or risk of bleeding – like bleeding from cuts or nosebleed. In case any of these continue and get worse, go to your doctor for medical advice and help immediately. Take note that if your doctor or physician prescribed you with Eliquis, he/she knows that the benefit you will get from the prescription medication is far more significant compared to the risk of side effects. Most people who utilize this don’t suffer from any severe side effects. 

Eliquis can result in prolonged and unusual bleeding if it dramatically impacts the protein responsible for your blood clotting. Go to your doctor right away if you’ve seen signs of severe bleeding such as:

  • swelling
  • pain
  • discomfort
  • abnormal bruising
  • frequent/persistent nosebleeds
  • prolonged bleeding from gums or cuts
  • abnormally prolonged/heavy menstrual flow
  • coughing up blood
  • dark/pink urine
  • fainting
  • unusual/persistent weakness or tiredness
  • black, bloody, or tarry stools
  • vomit that is bloody or looks just like coffee grounds
  • difficulty swallowing

Seek for immediate medical help if you experienced any of the cues of extremely severe bleeding, such as:

  • vision changes
  • slurred speech
  • confusion
  • joint pain on one part of the body

An extremely severe allergic reaction to Eliquis is one of the rare side effects of the medication. But, you need to seek prompt medical help whenever you notice any signs of a severe allergic reaction such as:

  • skin rash, swelling or itching in the throat, tongue, or face
  • severe dizziness
  • problem breathing or wheezing

This isn’t the full list of potential side effects of Eliquis. It is still better to go to your physician or doctor for medical advice about side effects of the said prescription medication. If you happen to experience these effects, get immediate medical assistance. 

Indication And Dosage

Eliquis is used to decrease the risk of systematic embolism or stroke among patients who have non-valvular atrial defibrillation or AF. It is prescribed as a treatment for Prophylaxis of deep vein thrombosis or DVT, which might result in pulmonary embolism or PE among patients who went through knee or hip replacement surgery. It is also used to decrease the risk of recurrent PE and DVT after initial therapy. Eliquis is in tablet form, and it comes in two strengths: 5 mg and 2.5 mg. Here’s the proper dosage when taking the medication.

Stroke Prophylaxis 

To stop stroke and systematic embolism among patients with nonvalvular fibrillation, take 5 mg PO BID. For renal impairment or nonvalvular atrial fibrillation:

  • Mild-to-moderate – no required dosage adjustment
  • Serum creatinine ≥1.5 mg/dL - reduce dosage to 2.5 mg BID in case the patient has one extra characteristic of age ≥80 years or weight ≤60 kg
  • ESRD maintained on hemodialysis - 5 mg BID; reduce dose to 2.5 mg BID in case of 1 additional feature of age ≥80 years or weight ≤60 kg is present

Postoperative Prophylaxis of DVT/PE

Prescribed right after a knee or hip replacement surgery.

  • Initial – The patient must take 2.5 mg PO 12-24 hours before replacement surgery.
  • Duration of therapy (knee replacement) – patient must take 2.5 mg PO BI for 12 days straight
  • Duration of treatment (hip replacement) - patient must take 2.5 mg PO BI for 35 days straight
  • The renal impairment that comes with ESRD on dialysis:
  • Deep Vein Thrombosis – no recommended dose adjustment; no clinical trials or studies regarding ESRD on dialysis or patients that have CrCl <15 mL/min; dosage requirements according to pharmacodynamic and pharmacokinetic (anti-FXa activity) information acquired in study subjects with ESRD maintained on dialysis

PE or DVT Treatment

Intended for treating pulmonary embolism or PE and deep venous thrombosis or DVT. 10 mg PO BID for seven days, then 5 mg BID after.

Decrease the risk for recurrent PE or DVT:

  • 2.5 mg PO BID - indicated to decrease the risk of recurrent PE or DVT right after the first six months of treatment for PE or DVT.

Renal impairment with ESRD:

  • Deep Vein Thrombosis – no recommended dose adjustment; no clinical trials or studies regarding ESRD on dialysis or patients that have CrCl <15 mL/min; dosage requirements according to pharmacodynamic and pharmacokinetic (anti-FXa activity) information acquired in study subjects with ESRD maintained on dialysis.

Dosage Modifications

Taken with dual inhibitors of P-GP and CYP3A4:

  • If the patient is consuming 2.5 PO BID, reduce the dosage by 50%.
  • If the patient is consuming 2.5 mg BID, don’t take it with potent dual inhibitors

Nonvalvular atrial fibrillation:

  • Reduce dosage to 2.5 mg PO BID if patients have any of the two characteristics: at least 80 years of age and at least 60 kg of weight. 
  • Serum creatinine – 1.5 mg/dL

Hepatic impairment:

  • Mild – doesn’t require any dosage modification
  • Moderate – patients might suffer from intrinsic coagulation abnormalities; pieces of evidence are limited, and recommendations are lacking
  • Severe – not recommended

Dosing Considerations

If you trade between Eliquis and anticoagulants aside from warfarin, stop using the one being consumed, and start the other at the incoming scheduled dosage. On the other hand, if you switch from warfarin and is now taking Eliquis, stop using warfarin and see to it that you initiate Eliquis when INR <2.0.

Trading from Eliquis to warfarin:

  • Eliquis impacts INR. That’s why accurate measurements when using it together with warfarin, might not tell the proper warfarin dosage.
  • If your doctor or physician prescribes that consuming both medications is necessary, stop using Eliquis and start taking both warfarin and a parenteral anticoagulant at the scheduled dosage for Eliquis.
  • Stop using parental anticoagulants if INR reaches the right level.

Procedures or surgery:

  • Stop taking for at least 48 hours before invasive procedures or elective surgery with a high or moderate risk of abnormal or clinically relevant bleeding.
  • Stop taking for at least 24 hours before invasive procedures or elective surgery with low risk of abnormal bleeding or in case the bleeding would take place in a non-critical and easily controlled area.

Drug Interaction

These medications should not be taken together with Eliquis since it could result in drug interaction, which alters how each drug works in the body. Talk to your healthcare professional, for example, a pharmacist or doctor, for more comprehensive information.

Serious Interactions: 

  • bivalirudin
  • celecoxib
  • cilostazol
  • clopidogrel
  • dabigatran
  • dalteparin
  • darunavir
  • abciximab
  • alteplase
  • anagrelide
  • antithrombin alfa
  • apalutamide
  • argatroban
  • desirudin
  • desvenlafaxine
  • diclofenac
  • Factor X, human
  • fenoprofen
  • flurbiprofen
  • heparin
  • dipyridamole
  • duloxetine
  • edoxaban
  • enoxaparin
  • eptifibatide
  • etodolac
  • ketorolac
  • lasmiditan
  • lepirudin
  • levomilnacipran
  • meclofenamate
  • mefenamic acid
  • meloxicam
  • milnacipran
  • ibuprofen
  • ibuprofen IV
  • idelalisib
  • indomethacin
  • ivosidenib
  • ketoconazole
  • ketoprofen
  • nabumetone
  • naproxen
  • nelfinavir
  • oxaprozin
  • phenobarbital
  • piroxicam
  • saquinavir
  • sulindac
  • tenecteplase
  • ticlopidine
  • tirofiban
  • tolmetin
  • venlafaxine
  • voxelotor
  • posaconazole
  • prasugrel
  • primidone
  • protein C concentrate
  • quinidine
  • reteplase
  • ritonavir
  • rivaroxaban

Severe Interactions

Severe side effects may be experienced with the following:

  • crofelemer
  • dabrafenib
  • daclatasvir
  • diltiazem
  • dronedarone
  • efavirenz
  • verapamil
  • vortioxetine
  • zanubrutinib
  • acalabrutinib
  • aspirin
  • caplacizumab
  • cenobamate
  • citalopram
  • elagolix
  • eliglustat
  • encorafenib
  • istradefylline
  • itraconazole
  • melatonin
  • mitotane
  • nintedanib
  • ombitasvir/paritaprevir/ritonavir
  • paroxetine
  • sarecycline
  • escitalopram
  • fedratinib
  • fish oil triglycerides
  • fluoxetine
  • fluvoxamine
  • glecaprevir/pibrentasvir
  • ibrutinib
  • iloperidone
  • imatinib
  • saw palmetto
  • sertraline
  • stiripentol
  • tecovirimat

Moderate Interactions:

The medicine is expected to have modest effects when taken with clarithromycin.

Warnings and Precautions

Eliquis side effects like bleeding can occur when the meds are taken longer than intended, or the patients receive a dose more than what was prescribed. It is intended for short-term use only and under strict medical supervision. Do not ignore signs and symptoms, unusually heavy bleeding.

Eliquis has a black box warning since it can cause a higher risk of stroke among patients with atrial fibrillation that discontinue consuming it. That’s why it is highly recommended that you don’t abruptly stop taking this medication without consulting your doctor.

Even if you already feel well, continue drinking Eliquis, and don’t miss any dosages. If you need to discontinue using the meds, your doctor might prescribe you with another blood thinner to combat the possibility of suffering from a stroke.

Furthermore, another black box warning for Eliquis is it can cause a severe blood clot in the areas of spinal cord if the patient has spinal anesthesia or spinal puncture, epidural, or spinal puncture while consuming it. This specific blood clot can result in long-term or permanent paralysis. Talk to your doctor if you presently have or had a history of having:

  • Spinal punctures
  • Spinal surgery
  • A spinal deformity
  • Epidural catheters

Another note, it’s also essential to update your doctor if you are using any prescription medication that might impact the way your blood clots, such as:

  • Agrylin (anagrelide)
  • Aggrastat (tirofiban)
  • Coumadin or Jantoven (warfarin)
  • prasugrel
  • Persantine (dipyridamole)
  • Pletal (cilostazol)
  • Brilinta (ticagrelor)
  • Heparin
  • Integrilin (eptifibatide)
  • Plavix (clopidogrel)
  • Ticlopidine
  • Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil or Motrin (ibuprofen), Indocin or Tivorbex (indomethacin), ketoprofen, and Aleve, Anaprox, or Naprosyn (naproxen)
  • Eliquis might also interact with particular medications that are usually taken whenever there’s a medical emergency. You or your family member must update your doctor whether or not you are taking Apixaban, in case of an emergency medical situation. Tell your doctor immediately if you experience any of these side effects while taking this medication:
  • Tingling or numbness, especially in the legs
  • Muscle weakness, especially in the feet or legs
  • Back pain
  • Loss of control of your bowels or bladder

Never consume Apixaban if you are suffering from active bleeding or an artificial heart valve. This medication might result in easy bruising or bleeding. As much as possible, avoid doing activities that might heighten your risk of injury or bleeding while taking Apixaban or Eliquis.

If you hurt yourself or are in pain, contact your doctor immediately, especially if you injure your head. Honestly tell your doctor or physician that you are taking Apixaban before going through any dental or medical procedure.

Before you start to use Apixaban, tell your healthcare provider if you have or had:

  • Liver disease
  • A stroke
  • Kidney disease
  • Bleeding problems
  • Allergies to medicines

Furthermore, tell your healthcare provider if you are 80 years old or older, or if your weight ranges from 132 pounds or less. Make sure you keep all your laboratory and doctor’s appointment while taking Apixaban. Your doctor will likely order frequent tests to find how your body reacts to the medication. 

Though Apixaban or Eliquis isn’t considered a hazard to an unborn child if consumed during pregnancy, it might raise the risk of bleeding during delivery or pregnancy. Consult your doctor and tell him/her if you are pregnant or planning to get pregnant while taking Apixaban. The possibility that this drug might pass on to breastmilk is not yet known. However, it is highly-suggested that breastfeeding mothers should stay away from Apixaban.

Overdose and Contraindications for Eliquis.

Signs of Apixaban overdosage include the following:

  • Abnormal bruising or bleeding
  • Brown, red, or pink urine
  • Coughing up blood or certain material that has the same appearance as coffee grounds
  • Red, black, or tarry stools

If you think you are experiencing overdosage, call an emergency room or poison control center right away. Do not wait to experience side effects or pain before going to see a doctor. Usually, bleeding or even a skin rash is a side effect and is an indication that something is wrong.

Apixaban is also contraindicated for utilization by patients that have extreme sensitivity to the medication. Be warned of the following contraindications when taking Apixaban. 

  • Bleeding – Apixaban is contraindicated among patients with present pathological bleeding since the use of this medication heightens the risk of bleeding and can result in severe and potentially dangerous bleeding.
  • Abrupt discontinuation – avoid sudden stoppage of using Apixaban without sufficient alternative anticoagulation. Stopping Apixaban places patients at a higher risk of thrombotic circumstances. Increased stroke was also discovered among patients who switch from apixaban to warfarin.
  • Prosthetic heart valves – the utilization of apixaban among patients who are diagnosed with prosthetic heart valves doesn’t have any clinical trials or studies yet. However, the usage of this drug among this group of patients is not suggested.
  • Surgery – the anticoagulant impact of apixaban lasts for approximately 24 hours right after the last dosage. Stop using apixaban 48 hours before invasive producers or elective surgery. Bleeding is a risk with this kind of medication.

Clinical Pharmacology

Factor Xa inhibitor restricts platelet activation by reversibly impeding the current location of factor Xa without allowing a cofactor, such as an antithrombin III since the activity prevents clot-bound and free factor Xa, as well as prothrombinase activity. It doesn’t have any direct impact on platelet aggregation. Yet, it indirectly prevents platelet aggregation caused by thrombin extrinsic and intrinsic passages that play a vital role in terms of blood coagulation flume.

Absorption

Bioavailability: shows long-term absorption Peak Plasma Concentration for specifically 3-4 hours

Distribution

  • Vdss: 21 L
  • Protein Bound: 87%

Metabolism

  • Mainly metabolized by CYP3A4
  • Metabolized with minor help from 2J2, CYP1A2, 2C9, 2C8, and 2C19
  • Primary biotransformation sires: hydroxylation and O-demethylation located at the 3-oxopirperidinyl moiety
  • Metabolites: doesn’t have any active circulating metabolites Substrate of BCRP and P-GP

Elimination

  • Half-life: 12 hours (apparent half-life with repeated dosage); 5-6 hours (dominant)
  • Dialyzable: No
  • Renal clearance: 27%
  • Excretion: 25% of Apixaban are secreted in urine and feces in the form of metabolites; direct and biliary excretion helps with the removal in the feces; renal excretion is about 27% of overall clearance.

Tilly Whittaker

Our Senior Editorial Pharmacist brings positivity and light banter during meetings. She is a walking encyclopedia of knowledge and explanations. You will rarely need to open a book when she's around. Her almost eidetic memory makes her an invaluable member of the group.

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