What are the common side effects of Eliquis (apixaban)?

Common Side Effects of Eliquis (Apixaban)

Bleeding is the most significant side effect of apixaban, occurring in various forms including major bleeding, clinically relevant non-major bleeding, and minor bleeding events. 1, 2

Major Side Effects

• Bleeding complications: As a direct factor Xa inhibitor, apixaban's primary adverse effect is increased bleeding risk, which can manifest as:

  • Major bleeding (1.3% of patients in clinical trials) 3
  • Intracranial hemorrhage (though less common than with warfarin) 2
  • Gastrointestinal bleeding 4

• Allergic reactions: Can range from skin rash to severe allergic reactions requiring immediate medical attention, with symptoms including:

  • Chest pain or tightness
  • Facial or tongue swelling
  • Breathing difficulties or wheezing
  • Dizziness or fainting 1

Common Minor Side Effects

• Bruising: Increased tendency to bruise due to the anticoagulant effect 1
• Nosebleeds: More frequent or prolonged than usual 1
• Gum bleeding: Particularly during brushing or flossing 1
• Prolonged bleeding from cuts: Even minor cuts may bleed longer than expected 1

Special Considerations

• Renal impairment: Patients with kidney dysfunction may experience higher blood levels and longer half-lives of apixaban, potentially increasing side effect risk 5, 6
• Hepatic impairment: Use with caution in patients with liver problems as apixaban is partially metabolized by the liver 6, 7
• Drug interactions: Medications that affect CYP3A4 or P-glycoprotein pathways can alter apixaban levels and increase bleeding risk 4, 1
• Age-related concerns: Elderly patients (>75 years) may be more susceptible to adverse effects 5

Monitoring and Prevention

• Monitor for signs of bleeding, including:

  • Unusual bruising or bleeding that doesn't stop
  • Pink, red, or dark brown urine
  • Red or black tarry stools
  • Coughing up blood or coffee ground-like material
  • Vomiting blood or material that looks like coffee grounds 1

• Report falls or injuries, especially head injuries, to healthcare providers immediately as these may increase bleeding risk 1

• Avoid activities with high risk of injury while taking apixaban 1

Clinical Context

• Apixaban has been shown to have a more favorable bleeding profile compared to warfarin, particularly regarding intracranial hemorrhage 2
• In the ARISTOTLE trial, apixaban was associated with fewer overall strokes and major bleeding events compared to warfarin 4
• Unlike warfarin, apixaban does not require regular INR monitoring and has fewer food and drug interactions 4, 7

Important Warnings

• Never stop taking apixaban without consulting your healthcare provider, as this may increase stroke risk in patients with atrial fibrillation 1
• Ensure continuous supply of medication to avoid missing doses 1
• Inform all healthcare providers, including dentists, about apixaban use before procedures 1