Can you take Lexapro (escitalopram) and Eliquis (apixaban) at the same time?

Concurrent Use of Lexapro (Escitalopram) and Eliquis (Apixaban)

Yes, you can take Lexapro (escitalopram) and Eliquis (apixaban) at the same time, but there is a potential for increased bleeding risk that should be monitored.

Understanding the Interaction

Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) used to treat depression and anxiety disorders. Eliquis (apixaban) is a direct oral anticoagulant (DOAC) that inhibits factor Xa and is used to prevent stroke in atrial fibrillation and treat/prevent venous thromboembolism.

The potential interaction between these medications involves:

1. Pharmacodynamic interaction: SSRIs like escitalopram can affect platelet function, which may enhance the anticoagulant effect of apixaban
2. Pharmacokinetic interaction: Unlike some other SSRIs, escitalopram is not a significant inhibitor of CYP3A4 (the enzyme that metabolizes apixaban)

Clinical Evidence

Research suggests that while there is a theoretical increased bleeding risk when combining SSRIs with anticoagulants, escitalopram specifically poses less risk than other SSRIs that inhibit CYP3A4 (like fluoxetine, paroxetine, or sertraline) 1.

A study examining the combination of rivaroxaban (another factor Xa inhibitor similar to apixaban) with SSRIs found that non-CYP3A4 inhibiting SSRIs like escitalopram had a lower bleeding risk profile compared to CYP3A4-inhibiting SSRIs, particularly at higher anticoagulant doses 1.

Monitoring Recommendations

When taking both medications concurrently:

1. Watch for bleeding signs: Unusual bruising, nosebleeds, bleeding gums, blood in urine/stool, or unusually heavy menstrual bleeding
2. Regular monitoring: Follow up with your healthcare provider for routine assessments
3. Medication timing: Take both medications exactly as prescribed without skipping doses

Special Considerations

For Surgical Procedures

If you require surgery while on both medications, special management is required:

• For low bleeding risk procedures: Eliquis should be discontinued at least 24 hours before the procedure 2
• For high bleeding risk procedures: Eliquis should be stopped 3 days before the procedure (longer if you have kidney problems) 2
• Do not restart Eliquis until at least 6 hours after the procedure, assuming adequate hemostasis 2

For Elderly Patients

Elderly patients may have increased sensitivity to both medications and may require closer monitoring due to:

• Decreased kidney function affecting apixaban clearance
• Higher risk of falls and subsequent bleeding
• Potential for multiple drug interactions with other medications 2

When to Seek Medical Attention

Contact your healthcare provider immediately if you experience:

• Severe or unusual bleeding
• Signs of stroke (facial drooping, arm weakness, speech difficulties)
• Severe headache
• Dizziness or fainting
• Unusual bruising or petechiae (small red or purple spots on the skin)

Bottom Line

While escitalopram and apixaban can be taken together, the combination requires vigilance for potential bleeding complications. Escitalopram is one of the preferred SSRIs to use with apixaban due to its minimal effect on the CYP3A4 enzyme system that metabolizes apixaban.