7 Potential Eliquis Side Effects You Need To Be Aware of & How to Manage Them

Eliquis (apixaban) is a popular prescription drug used to treat blood clots, which helps with blood thinning. But, like other medicines, it has some potential side effects. Eliquis side effects can range from minor bruising to severe ones, like severe bleeding. Understanding all the risks can help with the safe and effective use of Eliquis. Let's explore the blog and learn about this medicine's side effects, and also how to manage or avoid them.

7 Potential Side Effects of Eliquis (Apixaban) 

Eliquis (apixaban) comes with common and sometimes severe side effects. The following are the adverse effects of Eliquis:

1. Bruising Easily

As Eliquis is made to prevent blood clotting, it takes a longer time for the broken blood vessels to stop bleeding or leaking. This continuous bleeding can contribute to easier bruising. 

2. Nausea

Taking Eliquis without food or on an empty stomach can lead to nausea sometimes. Moreover, in certain cases, nausea can be a symptom of internal bleeding and an allergic reaction. 

3. Anemia: As Eliquis prevents blood clotting, it leads to more bleeding, which contributes to the loss of red blood cells that result in anemia. Additionally, it causes nausea and iron deficiency (due to long-term bleeding), which are the common reasons for developing anemia.

4.  Allergic Reactions

A tiny percentage of people could develop an adverse response to Eliquis. The following are some signs of allergic reactions to Eliquis:

• Itchy skin

• A hot flash

• Skin rash or hives

• Sudden tightness in the chest

• Sudden facial or tongue swelling

• Feeling lightheaded or weak

• Wheezing

• Difficulty breathing

It is rare, but allergic reactions could be fatal in some cases. Emergency medical care is necessary for severe allergic reactions.

5. Severe Bleeding

Some individuals may experience severe bleeding as Eliquis reduces the ability of the body to form clots, which increases severe bleeding if it stays for a longer time. The chances of bleeding are around 3% or less. Seek emergency medical help immediately if you experience these symptoms of severe bleeding: 

• Bleeding that doesn't stop and lasts longer

• Gum bleeding

• Severe or frequent nosebleeds

• Abnormal vaginal bleeding or heavy menstrual periods

• Pink, brown, or red urine

• Bloody stools

• Bloody vomit

• Headaches or dizziness

• Coughing up blood 

Note: Call 911, an emergency number in case of severe symptoms, or go to emergency clinics near your location.

6. Fatigue

Although fatigue wasn't a side effect noted during clinical trials, several people say they felt lethargic after taking the medication. The other potential adverse effects of taking Eliquis, such as anemia, blood loss, nausea, or vomiting, are likely the causal factors.

7. Fainting

Fainting, also called syncope, can be another severe side effect that happens because of potential complications, such as reduced blood pressure and severe bleeding. When there is not enough blood flow to the brain due to severe bleeding, it can lead to temporary loss of consciousness. 

When to Be Concerned About Bleeding Due to Eliquis?

• Minor bleeding due to the use of Eliquis frequently does not harm and also does not necessitate immediate medical attention. Consider these things to prevent bleeding: Apply a fresh cloth to the wound for 10-15 minutes if bleeding heavily from a cut.

• Try standing up straight, pinching your nostrils, and leaning forward to stop a nosebleed. 

• Put an ice pack on the affected area.

However, excessive bleeding is among the adverse effects of Eliquis that might be the most dangerous, especially if the bleeding occurs inside the body. If you notice any of the symptoms of severe bleeding, contact your doctor immediately. Also, make sure to avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, aspirin, and naproxen with Eliquis as it increases the risk of bleeding. 

Tips to Avoid Eliquis Side Effects

Follow these measures to avoid the side effects of Eliquis:

• Take as Prescribed: Eliquis should ideally be taken on a regimen established by your doctor that is typically taken twice a day, either with or without food.

• Change Dose Under a Doctor’s Guidance: Patients are strongly advised to get permission from their doctor before changing their dose. Sudden adjustments to the dosage might have serious negative effects.

• Be Cautious with Certain Medications: Avoid NSAIDs such as aspirin and ibuprofen and some supplements (e.g., fish oil) to prevent the risk of bleeding.

• Monitor Your Diet: Maintaining a healthy diet helps reduce potential side effects and promote overall health. Consume a consistent amount of vitamin K-rich foods and avoid alcohol to lower the effectiveness of Eliquis.

• Stay Hydrated and Active: Proper movement and hydration levels aid in effective movement and reduce the risk of blood clots.

• Look for Bleeding Signs: If you notice unusual bruising, bloody stool or urine, and prolonged bleeding, immediately report them to a doctor. 
  

• Discuss your Pre-existing Medical Problems: Before using this drug, tell your pharmacist or healthcare provider about allergies, pre-existing medical problems, or recent operations. Your healthcare practitioner can tell you what to avoid and what warning signals to watch out for if your body reacts poorly to the medication.

When to Consult a Doctor?

Even though Eliquis is an excellent drug, some adverse effects necessitate urgent medical treatment. If you experience any of the following symptoms, call your doctor straight away:

• A severe bleeding issue that persists

• Repeatedly bleeding noses that continue for more than ten minutes

• Pink, red, or brown pee with blood in it

• Tarry or bloody stools

• Unexpected vaginal bleeding

• Vomit that is bloody or resembles coffee grounds

• Painful headaches

• Fainting or vertigo

• Exhaling blood

• Having trouble breathing

These signs can indicate that it's time to stop taking Eliquis and try taking warfarin or heparin instead.

Warnings and Precautions

Consider these Eliquis precautions and warnings to prevent complications when using Eliquis:

1. Thrombotic Events due to Premature Discontinuation: If you discontinue the use of Eliquis before its prescribed course for other reasons other than completion of the treatment or pathological bleeding, it can increase the chances of thrombotic events. In general, a thrombotic event is the formation of blood clots inside the blood vessels or a heart chamber.

2. Spinal or Epidural Hematoma: It is a collection of blood in the area that surrounds your spinal cord, which occurs in people who are undergoing spinal puncture or receiving neuraxial anesthesia. This can lead to permanent paralysis. These factors raise the chances of spinal or epidural hematomas:

• Indwelling epidural catheter use

• simultaneous use of other medicines like NSAIDs, platelet inhibitors, and certain other anticoagulants that impact hemostasis

• a history of repeated or traumatic spinal or epidural punctures

• a history of spinal surgery or spinal deformity

• appropriate timing between ELIQUIS administration & neuraxial procedures is unknown

3. Prosthetic Heart Valves: Eliquis use is not recommended for patients with prosthetic heart valves. This is because research on the effectiveness and safety of Eliquis has not been done in these individuals.

4. Acute Pulmonary Embolism (APE) in Hemodynamically Unstable Patients or Patients who Need Pulmonary Embolectomy or Thrombolysis: Eliquis is not advised for these patients as this medicine increases the bleeding risk, which prevents the rapid blood flow to the lungs.

5. High Risk of Thrombosis in Individuals with Triple Positive Antiphospholipid Syndrome (APS): Eliquis is not recommended as it can significantly lead to recurrent thrombotic events. Vitamin K antagonists such as warfarin are the preferred anticoagulant options because it has been studied to be safe and effective in this specific patient population.

Other Safety Information You Need to Know

Make sure to be cautious about these factors:

1. Avoid if You're Allergic to Ingredients: Individuals who have allergies to any of the ingredients of Eliquis, such as apixaban, should not take it. Ask the pharmacist about all the ingredients.

2. Avoid Taking If Not Prescribed: Do not take this medicine if not recommended by your doctor. This can lead to severe bleeding risk and even death (in rare cases). Also, do not share with others as it can cause harm to them.

3. Temporary Discontinue it Before Surgery: Discontinue Eliquis for about 48 hours before invasive procedures or elective surgeries to reduce the risk of major bleeding. The medicine can be resumed after the surgical procedures when enough hemostasis is achieved.

4. Know about its Drug Interactions: Avoid combining Eliquis with these drugs, as they reduce the effectiveness of Eliquis and increase the bleeding risk:

• P-gp and Strong CYP3A4 Inhibitors like ritonavir, ketoconazole, or itraconazol

• P-gp and Strong CYP3A4 Inducers such as carbamazepine, rifampin, or phenytoin

• Anticoagulants and Antiplatelet Agents like aspirin, fibrinolytics, heparin, and chronic NSAIDs.

5. Be Cautious During Pregnancy and Breastfeeding: This medicine may increase the risk which can cause complications during pregnancy and delivery. There are also potential risks to the fetus. Additionally, it is not advised during the breastfeeding phase as its levels can increase in breast milk.

What You Need to Discuss With a Doctor Before Taking Eliquis?

Discuss the following things with your doctor to prevent the risk of side effects or any complications in the future:

• Past & Current Health Issues: Speak to your doctor if you have kidney, liver, or blood-related problems or antiphospholipid syndrome (which can cause abnormal clotting).

• Other Medicines & Supplements: Tell about your over-the-counter (OTC) or prescription medications, herbal products, vitamins, and mineral supplements, etc. that you are using to prevent negative interactions.

• Pregnancy: It is unknown if and how this medicine can impact pregnancy. So, if you're planning for pregnancy, discuss the risk of uterine bleeding with your gynecologist.

• Breastfeeding: The effect of Eliquis on breast milk is also not known. Your gynecologist will decide whether to stop using Eliquis or avoid breastfeeding. 

What to Do In Case of Overdose and Missed Dose?

• Overdose: If you accidentally exceed the dose and experience overdose symptoms like unusual bruising or bleeding, pink, brown, or red urine, black or red, tarry stools, and bloody vomit, visit the nearest emergency room. You can also call 911 (an emergency number for severe symptoms) or 1-800-222-1222 (Poison Center for overdosing emergencies).

• Missed Dose: Take the dose as soon as you remember. But avoid taking more than 1 dose at the same time, or double the dose to cover the missed dose. 
  

Is Taking Eliquis Safe?

Eliquis is a prescription-based medication, which suggests that it is safe when used as directed. It can pose a major health hazard, which is bleeding that, if left untreated, can be dangerous. However, like other blood-thinning medications, Eliquis has less risk of major bleeding and also doesn't need frequent blood monitoring. It's crucial to follow the instructions of your doctor, report symptoms to them, and avoid medicines that increase the risk of bleeding. 

Is Xarelto a Better Option than Eliquis?

Eliquis and Xarelto are quick and efficient treatments for people at risk of blood clotting. However, according to a study, Eliquis is a better option than Xarelto, especially in people with non-valvular atrial fibrillation, with a lower risk of major bleeding and effectiveness in preventing stroke & systemic embolism. Both medications interact with other medications in various ways because they are anticoagulants. As a result, patients should exercise caution while combining Xarelto and Eliquis with other drugs.

Is Eliquis Bad for the Kidneys?

Many leading cardiac doctors believe Eliquis is a better alternative to other blood thinners because the kidneys break down only around 25% of it. Although this may be encouraging for elderly people with kidney issues, the FDA is still investigating Eliquis to ascertain all of its effects on the liver and kidneys.

Final Takeaway

The common Eliquis side effects include bruising, nausea, and anemia, and severe effects include severe bleeding, allergic reactions, fatigue, and fainting. However,  if any side effects worsen or last longer, seek medical help immediately, especially in case of serious side effects. To avoid potential side effects, make sure to use as prescribed, avoid combining with other drugs and alcohol, eat healthy food, discuss your pre-existing health issues, and change dose only under a doctor’s supervision.