Eliquis side effects and how to avoid them

Eliquis side effects | Minor vs. severe bleeding | Fatigue | Allergic reactions |  Warnings | Interactions | How to avoid side effects | When to see a doctor | Discontinuing Eliquis | Xarelto vs. Eliquis

Eliquis (apixaban) is a brand-name blood thinner that reduces the risk of a stroke or blood clots in people with a condition known as atrial fibrillation (a type of irregular heartbeat). It also helps reduce blood clots in those who’ve recently had hip or knee replacement surgery. Your healthcare provider may prescribe Eliquis to treat or prevent pulmonary embolism (PE), which are blood clots in the lungs, or deep vein thrombosis (DVT)—blood clots most commonly in the legs. As a blood thinner, Eliquis is associated with some serious side effects. Your healthcare provider will determine whether it’s right for you, but here are some Eliquis side effects to be aware of.

RELATED: What is Eliquis? | Save on Eliquis refills

Common side effects of Eliquis

Eliquis is an FDA approved prescription drug, but some side effects may occur. Common side effects are typically mild and resolve quickly. However, you should speak with your doctor if the following side effects don’t go away:

• Bruising easily
• Persistent bleeding (in the case of nosebleeds or minor cuts and scrapes)
• Nausea
• Anemia, causing you to feel tired and weak

Serious side effects of Eliquis

The following are severe side effects that require medical attention, according to the manufacturer of Eliquis, Bristol-Myers Squibb:

• Severe headaches
• Dizziness
• Muscle weakness
• Joint pain
• Severe, uncontrollable, or unusual bleeding (bleeding gums, frequent nosebleeds, heavier than usual menstrual bleeding)
• Low platelet levels (thrombocytopenia)
• Coughing blood
• Vomiting blood or vomit that looks like coffee grounds
• Red or black tarry stool
• Pink, red, or brown urine
• Hypersensitivity reactions 
• Low blood pressure
• Fainting
• Spinal or epidural blood clots (hematoma)
• Increased risk of blood clots or stroke if Eliquis is discontinued abruptly

Minor vs. severe bleeding

Because Eliquis doesn’t allow your blood to clot normally, it’s usual for patients to bleed more. Minor bleeding is often harmless and doesn’t require emergency medical attention. If you have a cut that’s bleeding persistently, you can apply a clean cloth over the wound for 10 to 15 minutes. For a nosebleed, try standing upright while pinching your nostrils and leaning forward. 

Although bruises are harmless, they aren’t visually appealing; you can make them less noticeable by applying an ice pack over the affected area.  

One of the most dangerous Eliquis side effects is excessive bleeding, especially if the bleeding is inside the body. This may present as bloody pink/red/brown urine, bloody red/black tarry stool, bloody vomit or vomit that looks like coffee grounds, coughing up blood, prolonged nosebleeds (longer than 10 minutes), and severe headaches. If you experience any of these symptoms after taking Eliquis, contact your doctor immediately.  

Your risk of bleeding is even higher if you take certain medications with Eliquis, such as nonsteroidal anti-inflammatory drugs (NSAIDs). This includes common over-the-counter pain relievers like ibuprofen, aspirin, and naproxen.

General fatigue

Although tiredness wasn’t a reported side effect during clinical trials, several patients report a noticeable lack of energy after taking the drug. The causality is likely due to other possible side effects from taking Eliquis, such as anemia, blood loss, or nausea/vomiting. 

Allergic reactions

Like most medications, a small number of patients may experience an allergic reaction to Eliquis. However, this is generally less than 1% who have been prescribed this medication. Some symptoms of an allergic reaction to Eliquis are:

• Itchy or irritated skin
• Hot flashes
• Hives/skin rash
• Sudden chest pain/tightness
• Sudden swelling of face or tongue
• Feeling dizzy or faint
• Wheezing
• Trouble breathing

Life-threatening allergic reactions are seldom but do occur. Severe allergic reactions require emergency medical attention.

Eliquis warnings

Although Eliquis is extremely effective, it’s not suitable for everyone. The drug is only recommended for adults older than 18. Before taking Eliquis, talk to your healthcare provider if you:

• Previously had an allergic reaction to Eliquis or other similar medications in the past
• Have an artificial heart valve
• Are pregnant or trying to conceive a child since Eliquis is harmful to babies
• Are breastfeeding or plan to breastfeed since it’s unknown if Eliquis passes into breast milk
• Have been diagnosed with liver problems
• Are recovering from surgery or a spinal cord injury
• Have an open wound or an injury that’s currently bleeding a lot
• Use other medications to prevent blood clotting 
• Have antiphospholipid syndrome or any other condition that causes blood clots

Is Eliquis safe?

Eliquis is considered a high-alert medicine, which means that it’s safe as long as it’s taken correctly. If mistreated, it can lead to many serious health risks, including stroke and severe bleeding. Therefore, people need to be extremely cautious when taking Eliquis.

Eliquis and a few other medications are a part of a series of direct oral anticoagulants (DOACs). DOACs are meant to be a better alternative to other blood-thinning medications, such as Coumadin (warfarin) since they don’t require as many diet restrictions or monitoring.

However, in some settings, Eliquis, and most DOACs can cause more severe bleeding than warfarin. There haven’t been enough clinical studies to show the chance of serious side effects for those with certain conditions, like hemodialysis.

Is Eliquis hard on the kidneys?

Since only about 25% of Eliquis is broken down by the kidneys, several top heart doctors claim it’s a better alternative to other blood thinners. While this could be good news for older patients with kidney problems, the FDA is still looking into Eliquis to determine all of the effects it has on both the liver and kidneys. Refer to the FDA for more drug information.

Eliquis interactions

Drug interactions can hinder the effectiveness of your medication and increase the chance of severe side effects. The list below only contains some more serious drug-drug interactions with Eliquis. So if you’re taking any medication or supplements not listed below, bring them to your doctor so they can give a thorough recommendation.

Major interactions

These medications can cause harmful side effects when taken with Eliquis. Speak with your doctor for more information if you’re taking:

• Tipranavir
• Betrixaban
• Inotersen
• Nonsteroidal anti-inflammatory drugs
• Thrombolytics—drugs that prevent or treat blood clotting

Acute interactions

These medications are never to be taken with Eliquis. Speak with your doctor for more information if you’re taking:

• Mifepristone
• Alipogene Tiparvovec

Antiplatelets and Eliquis 

Antiplatelet drugs cause little compounds in your blood called platelets to become less sticky. Although both drugs work to prevent blood clots, their inner-workings are much different. Therefore, patients who take Eliquis along with antiplatelets might experience more severe bleeding. 

Some common antiplatelet drugs are:

• Aspirin
• Prasugrel (Effient)
• Ticagrelor (Brilinta)

Herbal supplements and Eliquis

Certain herbal supplements are known to reduce the effects of Eliquis. St John’s wort can reduce the amount of Eliquis in your system, ultimately making the drug less effective. Therefore, most doctors will recommend you stop taking St John’s wort while you take Eliquis. 

Another common herb that could hinder the results from Eliquis is turmeric. Turmeric is a common herbal supplement because of its anti-inflammatory properties. Since several anti-inflammatory medications interact negatively with Eliquis, doctors generally advise patients not to take them while using the drug.

Alcohol and Eliquis

Drinking alcohol (especially binge drinking) is incredibly dangerous while taking Eliquis. The alcohol can amplify the side effects, such as excessive bleeding, and lead to severe health problems. Moderate drinking (one drink per day) won’t likely cause any issues. However, it’s strongly recommended that you do not drink while taking this medication. 

Eliquis and food interactions

Grapefruit: The only food that seems to have a negative interaction with Eliquis is grapefruit. Studies show that if you consume grapefruit or grapefruit juice while taking Eliquis, you have a higher chance of experiencing bruising or bleeding.

Lack of appetite: One significant correlation between Eliquis and food is how it can drastically reduce your appetite. The lack of hunger is usually a result of an upset stomach, diarrhea, or bloating. If you notice a sudden lack of appetite or weight loss after taking Eliquis, consult with your doctor for more information. 

How to avoid Eliquis side effects

1. It’s best to take Eliquis according to a schedule set by your healthcare provider. In most cases, Eliquis is taken twice daily, with or without food.
2. Patients are strongly recommended not to change their dose without otherwise being told by their doctor. Sudden changes in dosing can lead to severe and possibly life-threatening side effects. Call your healthcare provider or refer to the medication guide if you miss a dose of Eliquis to find out when to take your next dose.
3. Inform your pharmacist and healthcare provider of allergies, previous medical conditions, or recent surgeries before taking this medication. Your healthcare provider can inform you about all things to avoid while taking this medication and what warning signs to look out for if your body is having a negative reaction to the drug.

When to see a doctor for Eliquis side effects

While Eliquis is an effective medication, certain side effects will require immediate medical attention. Call your doctor right away if you are experiencing:

• Severe bleeding that won’t stop
• Recurring nosebleeds that last longer than 10 minutes
• Bloody pink, red, or brown urine
• Bloody or black tarry stool
• Abnormal vaginal bleeding
• Bloody or coffee ground-like vomit
• Potent headaches 
• Dizziness or fainting
• Coughing up blood
• Difficulty breathing

Experiencing any of the above side effects you must contact your doctor immediately and it might also be a good indicator that it’s time to stop taking Eliquis and consider alternative medications, such as warfarin or Heparin.

Can you ever get off Eliquis?

Eliquis is designed to reduce the risk of stroke by preventing blood clots. If you suddenly stop taking it, you are at a higher risk of experiencing a stroke or blood clots. Therefore, you should always consult with your doctor before you stop taking Eliquis. Your doctor will typically prescribe another medication to prevent blood clots. 

Some situations, like an upcoming surgery or dental procedure, might require you to stop taking Eliquis. In that case, your doctor can determine what the best temporary solution is.  

Which is safer: Xarelto or Eliquis?

Xarelto and Eliquis are both quick and effective treatment options for those at risk of blood clotting. However, since they are fast-acting, they also wear off quickly, causing potentially serious complications. Xarelto only requires a single dose each day, where Eliquis requires two, increasing the chance of a missed dose. 

Both medications share similar side effects. The most common similarity is sudden bruising and bleeding. However, Eliquis seems to have a lower risk of bleeding than Xarelto. Since both medications are anticoagulants, they share many of the same interactions with other drugs. Therefore, patients should be cautious when taking other medications with both Eliquis and Xarelto. 

To determine which one is safer, you would need to speak with a healthcare professional. Only they can provide the right medical advice for your condition.