Is it safe to undergo laser hair removal while taking amlodipine (Norvasc) and Eliquis (apixaban)?

Safety of Laser Hair Removal While Taking Amlodipine and Eliquis (Apixaban)

Laser hair removal is generally safe for patients taking amlodipine and apixaban (Eliquis), but timing considerations should be made for apixaban due to potential bleeding risk.

Medication Considerations

Amlodipine

• Amlodipine is a dihydropyridine calcium channel blocker that has been shown to be safe even in patients with severe heart failure 1
• Unlike non-dihydropyridine calcium channel blockers (diltiazem and verapamil), amlodipine does not have significant negative inotropic effects that would contraindicate its use 1
• Amlodipine has minimal impact on platelet function, with studies showing only slight reduction in platelet aggregation 2
• There are no specific contraindications to laser hair removal while taking amlodipine

Apixaban (Eliquis)

• Apixaban is a direct oral anticoagulant (DOAC) that inhibits factor Xa and increases bleeding risk 1
• For procedures with low bleeding risk (like laser hair removal), guidelines recommend:
  • No need to discontinue apixaban for low bleeding risk procedures 1
  • If concerned about bleeding, the last dose can be taken the morning of the day before the procedure (for twice daily regimen) 1
  • Resume apixaban at least six hours after the procedure if there is no active bleeding 1

Laser Hair Removal Safety Assessment

Bleeding Risk Classification

• Laser hair removal is generally considered a procedure with low hemorrhagic risk 3, 4
• The most common side effects are transient and include:
  • Erythema and perifollicular edema (very common)
  • Temporary pigmentary changes (hyperpigmentation or hypopigmentation)
  • Crusting and vesiculation (less common)
  • No significant risk of deep bleeding or hematoma formation 4, 5

Recommendations for Procedure

1. For patients on amlodipine only:

   • No modification of medication regimen is necessary
   • Proceed with laser hair removal as normally indicated

2. For patients on apixaban:

   • For routine laser hair removal:
     • Can continue apixaban without interruption as this is a low bleeding risk procedure 1
     • If concerned about minor bleeding, consider skipping one dose before the procedure
   • For extensive laser hair removal or treatment of sensitive areas:
     • Consider taking the last dose of apixaban the morning of the day before the procedure
     • Resume apixaban at least six hours after the procedure if no active bleeding 1
   • Do not bridge with heparin or LMWH as this is unnecessary and may increase bleeding risk 1

3. Precautions during procedure:

   • Inform the laser technician about medications being taken
   • Use appropriate cooling methods during treatment to minimize risk of thermal injury
   • Select appropriate laser parameters based on skin type to minimize adverse effects 3, 6
   • Monitor for any excessive bleeding or bruising during and after the procedure

Post-Procedure Care

• Apply cool compresses if needed for discomfort
• Avoid sun exposure and use sun protection on treated areas
• Watch for signs of excessive bleeding or bruising
• Resume normal medication schedule as recommended above
• Follow up with healthcare provider if unusual bleeding, bruising, or other concerning symptoms develop

Special Considerations

• Patients with darker skin types (Fitzpatrick IV-VI) should be treated with longer wavelength lasers (Nd:YAG) to minimize risk of pigmentary changes 4, 5
• Multiple treatment sessions are typically required for optimal hair reduction, with 30-50% clearance typically reported after a full treatment course 3

By following these guidelines, patients on amlodipine and apixaban can safely undergo laser hair removal with minimal risk of complications.