Does Eliquis (apixaban) cause constipation?

Does Eliquis (Apixaban) Cause Constipation?

Eliquis (apixaban) is not specifically associated with constipation as a common side effect, unlike some other anticoagulants and medications.

Gastrointestinal Side Effects of Apixaban

Apixaban's gastrointestinal safety profile is generally favorable compared to other direct oral anticoagulants (DOACs). The evidence shows:

• Apixaban has the most favorable GI safety profile among DOACs, with lower risk of GI bleeding compared to both dabigatran and rivaroxaban 1
• The primary GI concern with apixaban is bleeding risk rather than constipation 1
• Rare cases of GI complications like intramural hematoma have been reported, but these are uncommon 2

Comparison with Other Anticoagulants

When comparing apixaban to other anticoagulants for patients requiring anticoagulation:

• Apixaban is preferred for patients without gastric or gastroesophageal lesions 3
• For patients with gastric or gastroesophageal tumors, low molecular weight heparins (LMWHs) may be safer due to increased risk of hemorrhage with DOACs 3
• Among DOACs, apixaban may be safer than edoxaban or rivaroxaban for patients with gastric or gastroesophageal lesions 3

Medications Known to Cause Constipation

Several medications commonly used in patients who might also be taking anticoagulants are known to cause constipation:

• Opioid analgesics (all opioids cause constipation with tolerance not developing over time) 3
• Serotonin 5-HT3 receptor antagonists (antiemetics) slow colonic transit 3
• Vinca alkaloids have pronounced neuropathic effects and prolong gastrointestinal transit time 3
• Thalidomide commonly causes constipation 3
• Other medications with constipating effects include those with anticholinergic actions, anticonvulsants, antihypertensives, iron supplements, and diuretics 3

Management of Constipation if it Occurs

If a patient on apixaban experiences constipation (likely due to other factors), management options include:

• Polyethylene glycol (PEG) 17g daily is recommended as the best laxative for elderly patients with constipation 4
• Stimulant laxatives such as bisacodyl 10-15 mg daily to three times daily can be added 4
• Ensuring adequate fluid intake (at least 2.0 L daily unless contraindicated) 4
• Optimizing toileting schedule with attempts at defecation at least twice daily, usually 30 minutes after meals 4
• Aiming for adequate dietary fiber intake (25g daily) if appropriate 4
• Increasing physical activity if appropriate 4

Special Considerations

For patients with specific conditions:

• Patients with renal insufficiency should use magnesium-based laxatives with caution 4
• Elderly patients should start with lower doses of laxatives and be monitored more closely for dehydration and electrolyte disturbances 4
• For refractory constipation, prescription medications such as linaclotide (72-145 μg daily, can be titrated up to 290 μg) can be considered 4, 3

In conclusion, while constipation is not a commonly reported side effect of apixaban, patients taking this medication should be monitored for all potential side effects, with the primary concern being bleeding risk rather than constipation.