Can Eliquis (apixaban) cause dizziness?

Can Eliquis (Apixaban) Cause Dizziness?

Yes, Eliquis (apixaban) can cause dizziness, though this is documented as an uncommon side effect in the FDA labeling, occurring in the context of allergic reactions or potentially related to bleeding complications. 1

Evidence from FDA Drug Labeling

The FDA-approved prescribing information for apixaban specifically lists "feeling dizzy or faint" as a potential symptom of severe allergic reactions to the medication. 1 Patients are instructed to call their doctor or get medical help right away if they experience:

• Chest pain or tightness 1
• Swelling of face or tongue 1
• Trouble breathing or wheezing 1
• Feeling dizzy or faint 1

Additionally, the FDA label advises patients to contact their healthcare provider if they fall or injure themselves while on apixaban, as the doctor may need to evaluate them—suggesting concern about bleeding-related complications that could manifest with dizziness. 1

Clinical Research Evidence

A case report documented reversible neurological adverse reactions to apixaban in an 80-year-old woman with atrial fibrillation who developed non-vertiginous dizziness along with imbalance, headache, confusion/disorientation, and asthenia within days of starting the medication. 2 Key findings included:

• Symptoms resolved within 72 hours after discontinuing apixaban 2
• Plasma apixaban concentration was 4 times higher than the laboratory upper limit of normal 2
• Symptoms did not recur when switched to rivaroxaban 2
• The authors noted that reversible neurological effects may occur particularly in patients with advanced age or chronic renal failure 2

Clinical Context and Risk Factors

Dizziness with apixaban should prompt immediate evaluation for:

• Bleeding complications: Major or minor bleeding can present with dizziness due to volume loss or intracranial hemorrhage 3
• Hypersensitivity reactions: As part of an allergic response requiring immediate medical attention 1
• Drug accumulation: Particularly in elderly patients or those with renal impairment where apixaban clearance may be reduced 2, 4

The pharmacokinetic profile shows that approximately 27% of apixaban clearance occurs via renal excretion, making patients with reduced creatinine clearance more susceptible to elevated drug levels. 4

Management Approach

If a patient on apixaban reports dizziness:

1. Assess for bleeding: Check for signs of major hemorrhage (hemoglobin drop ≥2 g/dL, transfusion requirement, bleeding in critical area) or intracranial bleeding 3
2. Evaluate for hypersensitivity: Look for accompanying rash, swelling, respiratory symptoms 1
3. Review renal function: Reduced creatinine clearance increases bleeding risk and may lead to drug accumulation 4, 3
4. Consider drug levels: Particularly in elderly patients or those with renal impairment where supratherapeutic levels may occur 2
5. Assess fall risk: Dizziness increases fall risk, which is particularly concerning in anticoagulated patients 1

Important Caveats

• While dizziness is not listed among the most common adverse effects in large clinical trials (which focused primarily on bleeding and thromboembolic outcomes), the FDA labeling and case reports confirm it can occur 1, 2
• The ARISTOTLE trial, which included 18,140 patients, demonstrated apixaban's superior safety profile compared to warfarin for major bleeding, but dizziness as an isolated symptom was not specifically reported in the primary safety analyses 3
• Dizziness may be a harbinger of more serious complications and should never be dismissed without appropriate evaluation 1, 2