From the Guidelines
Dextromethorphan should be used with caution when taking Eliquis or SSRIs due to potential interactions that can increase the risk of bleeding or serotonin syndrome. When considering the use of dextromethorphan with Eliquis, there is a theoretical risk of increased bleeding as both medications may be metabolized by the same liver enzymes (CYP3A4), potentially increasing Eliquis levels in the bloodstream 1. However, the most significant concern is the interaction between dextromethorphan and SSRIs, as combining these medications can increase the risk of serotonin syndrome, a potentially serious condition characterized by agitation, confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, and in severe cases, seizures or loss of consciousness 1. Some key points to consider when taking dextromethorphan with Eliquis or SSRIs include:
- The risk of bleeding may be increased when taking Eliquis with dextromethorphan, as seen with other anticoagulants like warfarin when combined with certain psychotropic drugs 1
- The interaction between dextromethorphan and SSRIs can lead to serotonin syndrome, which is a medical emergency requiring immediate attention 1
- If you must take dextromethorphan while on these medications, consult your healthcare provider first, use the lowest effective dose of DXM, and be alert for symptoms of serotonin syndrome or unusual bleeding
- Alternative cough suppressants might be safer options if you're taking either Eliquis or an SSRI It's essential to prioritize caution and consult with a healthcare provider before taking dextromethorphan with Eliquis or SSRIs to minimize the risk of adverse interactions and ensure the best possible outcome in terms of morbidity, mortality, and quality of life.
From the Research
Interaction between Dexyramethorphan and Eliquis or SSRI
- Dexyramethorphan is known to potentiate serotonin levels and lead to serotonin syndrome, especially when combined with selective serotonin reuptake inhibitors (SSRIs) 2.
- There is no direct evidence of an interaction between dexyramethorphan and Eliquis (a direct oral anticoagulant).
- However, concomitant use of SSRIs and oral anticoagulants (including Eliquis) may increase the risk of major bleeding 3.
- The risk of bleeding associated with SSRI use is a concern, particularly when combined with other medications that may interact with SSRIs, such as dexyramethorphan 4, 5.
- A meta-analysis of observational studies found a significant association between SSRI use and the risk of bleeding, with an increased risk of at least 36% 5.
- The use of dexyramethorphan with SSRIs may increase the risk of serotonin syndrome, and patients taking both medications should be monitored closely 2, 6.