Can Xarelto (rivaroxaban) or Eliquis (apixaban) cause burning sensations in the feet?

Burning Feet Sensation and Direct Oral Anticoagulants (DOACs)

Rivaroxaban (Xarelto) and apixaban (Eliquis) are not typically associated with burning sensations in the feet as a common side effect. The burning sensation in feet is more likely related to other conditions that should be evaluated.

Possible Causes of Burning Feet Sensation

• Erythromelalgia: A rare disorder characterized by episodic burning pain with erythema and warmth of extremities, particularly affecting feet and hands 1

• Peripheral neuropathy: Small fiber neuropathy is a common cause of burning feet sensation, often associated with diabetes or prediabetes 2

• Burning feet syndrome (BFS): A clinical entity that can occur as an isolated symptom or as part of various clinical conditions, especially common among elderly patients 3

• Medication-induced reactions: Some medications can cause palmar-plantar erythrodysesthesia syndrome (PPES), but this is primarily associated with certain chemotherapy agents rather than DOACs 1

DOAC Side Effect Profile

• Rivaroxaban (Xarelto) and apixaban (Eliquis) have well-documented side effect profiles that primarily include bleeding complications 1

• Common side effects of DOACs include:

  • Increased risk of bleeding events (major and minor) 4
  • Gastrointestinal symptoms 5
  • Potential for rare complications such as hemopericardium 6

• Neither drug has burning sensation in the feet listed as a recognized side effect in clinical guidelines or major studies 1

Differential Diagnosis to Consider

If experiencing burning feet while on DOACs, consider:

• Peripheral neuropathy: Particularly if diabetic or pre-diabetic 2

• Erythromelalgia: Characterized by episodic burning pain with redness and warmth, often triggered by exercise or increased ambient temperature 1

• Superficial vein thrombosis (SVT): Can cause pain and erythema, though typically presents with visible cord-like veins and tenderness along the vein path 1

• Drug hypersensitivity reactions: Though rare with DOACs, some medications can cause cutaneous reactions 1

Management Approach

1. Do not discontinue anticoagulation without medical consultation as this could increase thrombotic risk 1

2. Seek medical evaluation to determine the underlying cause of burning feet sensation 1, 3

3. Consider neurological assessment to evaluate for peripheral neuropathy 2

4. Document temporal relationship between medication initiation and symptom onset 6

5. Rule out other common causes of burning feet sensation before attributing to DOAC therapy 3, 2

Key Considerations

• If burning sensation is accompanied by redness, swelling, or warmth, consider erythromelalgia or superficial thrombophlebitis 1

• Smoking status may influence burning sensation in feet (independent of DOAC use) 2

• If symptoms persist or worsen, discuss with healthcare provider about potential alternative anticoagulants if appropriate 4, 5

• The risk-benefit profile of continuing anticoagulation should be carefully weighed against the severity of symptoms 1