How long does Eliquis stay in your system?

In this article:

• How Eliquis works in the body
• Eliquis half-life: Why it matters
• How long does Eliquis 2.5 mg stay in your system?
• How long does Eliquis 5 mg stay in your system?
• Factors that influence how long Eliquis stays in your system
• How to stop taking Eliquis

In this article

• How Eliquis works in the body
• Eliquis half-life: Why it matters
• How long does Eliquis 2.5 mg stay in your system?
• How long does Eliquis 5 mg stay in your system?
• Factors that influence how long Eliquis stays in your system
• How to stop taking Eliquis

Blood clotting is an essential part of the body’s healing process. But when those clots appear in the wrong places—like inside the arteries—they can cause major problems. Eliquis (apixaban) is a blood thinner that’s approved by the Food and Drug Administration (FDA) to reduce the risk of blood clots and stroke in patients with atrial fibrillation (AFib), plus treat pulmonary embolism and deep vein thrombosis (DVT). It comes in doses of 2.5 mg and 5 mg. If you’ve been told to stop taking Eliquis, whether because of an upcoming surgery or another reason, you may wonder how long it stays in your body. The exact timeframe depends on several factors that affect how it works in the body. 

How Eliquis works in the body

Eliquis works by binding to a specific enzyme called Factor Xa, which plays a significant role in blood coagulation. Factor Xa helps turn a protein called prothrombin into thrombin, which then creates fibrin—the building block of clots within blood vessels. By inhibiting Xa, Eliquis doesn’t give the body a chance to start that process, hindering its clotting ability.

Once it’s in the body, Eliquis works fairly quickly. Some research suggests it can work as fast as one to two hours after ingestion for some people, although it often takes around three to four hours to reach peak levels in the bloodstream.

Eliquis half-life: Why it matters

As the name suggests, half-life is the amount of time it takes for a substance to reduce by half. So knowing a drug’s half-life is essential to determining how long it stays in the body, and a large majority of drugs take four to five half-lives to completely disappear from the bloodstream.

Eliquis’s half-life is approximately 12 hours. This is important for the dose and dosage schedule since effective treatment depends on a steady concentration in the bloodstream. Doctors use the drug’s half-life to develop a schedule that maintains this concentration, and when a patient doesn’t follow it, that concentration could fluctuate, potentially making treatment less effective.

Compared to other anticoagulant drugs, Coumadin (warfarin) has a half-life of 20–60 hours, Arixtra’s (fondaparinux) is 17 hours, Xarelto’s (rivaroxaban) is around five to nine hours, and intravenous heparin’s is around one and a half hours.

How long does Eliquis 2.5 mg stay in your system?

Since it typically takes four to five half-lives for drugs to completely leave the body, a single dose of Eliquis 2.5 mg will remain in your system for around two to three days. However, according to Michael Beshir, Pharm.D., assistant professor in the Marshall B. Ketchum University College of Pharmacy, “Its efficacy wanes after roughly 12 hours and its impact as a blood thinner is no longer reliable. This is why we don’t wait until a given dose has completely cleared the body before the next dose is given.”

How long does Eliquis 5 mg stay in your system?

Just like a 2.5 mg dose, the body takes around two to three days to completely eliminate a 5 mg dose of Eliquis. 

Factors that influence how long Eliquis stays in your system

It might seem like a higher dose of Eliquis would last longer, but that’s not always true. While 5 mg of Eliquis will have a higher blood concentration than 2.5 mg, studies have shown that the half-life of apixaban remains around 12 hours, regardless of the dose.

However, that doesn’t mean the half-life is always constant. There are various factors that can influence how fast the body eliminates Eliquis:

• Liver function: Eliquis is primarily eliminated by the liver, so liver disease can cause it to remain in the body longer.
• Kidney function: The kidneys play a role in eliminating Eliquis, too, so renal impairment could extend its half-life.
• Age: The body’s metabolism slows as people get older, which can reduce the rate at which  medications are eliminated.
• Volume of distribution: This is essentially how widely a drug spreads throughout the body’s tissues. The more it spreads into other tissues, the longer it takes to eliminate. So, Eliquis’s half-life could be higher for people with more body fat.
• Drug interactions: “Medications like rifampin, carbamazepine, and phenytoin can significantly reduce Eliquis levels in the blood, whereas some antifungals and HIV medications can increase Eliquis levels in the blood,” says James Lyons, MD, a healthcare provider at Synergy Houses.
• Alcohol: Per Dr. Lyons, “Excessive alcohol consumption can interfere with the effects of Eliquis and increase bleeding risk.”
• Certain foods: Grapefruit and grapefruit juice may increase the concentration of some drugs in the bloodstream, including Eliquis. Limes, pomelos, and orange marmalade may have similar effects.
• Some herbal supplements: These might not change how long Eliquis lasts, but ginger, ginkgo biloba, turmeric, and some Chinese herbs may cause an increased risk of bleeding if taken with blood-thinning medications. Additionally, St. John’s Wort can decrease the effectiveness of Eliquis, so they shouldn’t be taken together.

Since half-life influences your dosing schedule, which influences the prescription drug’s effectiveness, it’s important to discuss any pre-existing medical conditions and other medications (including herbal supplements) you’re taking with your healthcare provider. “Generally, patients over the age of 80, those with impaired kidney or liver function, and those who weigh less than 60 kg can be more sensitive to the anticoagulant effects of Eliquis,” Dr. Beshir says. “For some of these patients, a dose reduction may be warranted, and closer monitoring is advised.”

How to stop taking Eliquis

It’s important to talk to your healthcare provider before stopping Eliquis. They’ll offer recommendations based on your reason for stopping it, whether it’s because of an upcoming surgery, switching to another blood thinner, or other factors. 

Switching from Eliquis to another blood thinner

“Most anticoagulants begin to take effect within the first minutes to hours,” Dr. Beshir says. “For those agents, switching is straightforward, and the patient is instructed to start the new drug at the time the next scheduled Eliquis dose would be due.” The exception, he says, is warfarin. Since it’s slower to begin working, patients will often need to continue taking Eliquis for four to five days before discontinuing it when switching over to warfarin.

Stopping Eliquis because of cost, side effects, or other factors 

If you’re considering stopping Eliquis because of side effects, costs, or other reasons, don’t stop cold turkey. “There are no withdrawal symptoms when stopped suddenly, but the risk of blood clots may increase within the first few days off Eliquis,” Dr. Lyons says. As the drug label states, stopping Eliquis abruptly can give you a higher risk of stroke as well.

Stopping Eliquis before surgery  

Eliquis is great at preventing blood clots, but that also means it presents an increased risk of bleeding, which can be dangerous for anyone undergoing surgery. That’s why surgeons will often advise patients to stop taking Eliquis two to three days before minor surgery, or as many as four to five days before major surgery (like back surgery or a knee replacement). Some patients may receive a shorter-acting medication instead, but that’s up to the healthcare provider and surgeon.

SingleCare medical reviewer’s clinical perspective:

“Since there is a risk of bleeding during any endoscopic procedure, including upper endoscopy and colonoscopy, we specifically tell our patients to stop their blood thinner two to four days before their procedure, depending on which medication they are taking. In this situation, it is very important to carefully go over these instructions with the patient beforehand and write them down on their instruction sheet as well. Additionally, the patient should be made aware of the small but real risk of stopping their medication temporarily, as this could result in a blood clot or worse.” — Jesse P. Houghton, MD, medical director of gastroenterology at Southern Ohio Medical Center

Dental procedures may be treated differently. According to the American Dental Association, patients can usually continue taking anticoagulant drugs prior to dental procedures, since the risks of discontinuing them far outweigh the risk of bleeding during treatment. However, patients with a higher bleeding risk may need to stop taking Eliquis before certain procedures. Tell your dentist if you’re taking Eliquis or another anticoagulant, and they can offer medical advice based on your specific situation.

Consult a healthcare professional before discontinuing your Eliquis treatment. They can guide you through the process, find suitable alternatives, and come up with a safe and effective transition for you.