Can You Take Lexapro (Escitalopram) and Eliquis (Apixaban) Together?
Yes, you can safely take Lexapro and Eliquis together, but this combination requires heightened awareness of bleeding risk and appropriate clinical monitoring. 1
Primary Safety Consideration: Bleeding Risk
The combination of escitalopram with apixaban carries a modestly increased bleeding risk that is real but manageable in clinical practice. 1 This pharmacodynamic interaction occurs because SSRIs like escitalopram can impair platelet function through serotonin depletion in platelets, which when combined with apixaban's anticoagulant effects, creates an additive bleeding risk. 1
The actual magnitude of this risk is relatively modest: non-CYP3A4-inhibiting SSRIs like escitalopram showed bleeding rates of 21% compared to 25.8% with CYP3A4-inhibiting SSRIs, with major bleeding occurring in only 5.3% of patients. 1 A case report documented a limb-threatening hematoma in an elderly patient taking citalopram (a closely related SSRI) with apixaban, highlighting that serious bleeding events can occur, though they remain uncommon. 2
No Dose Adjustments Required
You do not need to adjust the dose of either medication based on this drug interaction. 1 This is a critical distinction because:
- Escitalopram is not a strong CYP3A4 inhibitor or P-glycoprotein inhibitor 3
- Apixaban dose reduction is only required when combined with strong dual CYP3A4 and P-glycoprotein inhibitors, which escitalopram is not 4, 1
- Escitalopram has negligible inhibitory effects on CYP isoenzymes and P-glycoprotein, making clinically significant drug-drug interactions unlikely 3
Continue your standard dosing:
- Lexapro: Typically 10-20 mg once daily 5, 6
- Eliquis: Standard dose is 5 mg twice daily (approximately 12 hours apart), or 2.5 mg twice daily if you meet specific dose-reduction criteria 4, 1
Essential Monitoring and Precautions
You should monitor for bleeding signs, including: 1
- Unusual bruising or petechiae (small red/purple spots on skin)
- Gastrointestinal bleeding (black tarry stools, blood in vomit)
- Hematuria (blood in urine)
- Prolonged bleeding from minor cuts
- Severe headache or neurological symptoms (potential intracranial hemorrhage)
Important Clinical Caveats
Avoid adding antiplatelet agents (aspirin, clopidogrel) unless absolutely medically necessary, as this would substantially compound bleeding risk. 1
Verify your apixaban dose is appropriate by confirming whether you meet dose-reduction criteria (any 2 of: creatinine ≥1.5 mg/dL, age ≥80 years, body weight ≤60 kg). 4
Renal function matters independently: Apixaban is 27% renally excreted, and dose adjustments may be needed for renal impairment separate from any SSRI interaction. 4, 1 Apixaban is contraindicated with creatinine clearance <25 mL/min (or <30 mL/min per some guidelines). 4
This combination is NOT contraindicated, unlike strong CYP3A4/P-glycoprotein inhibitors (such as ketoconazole, ritonavir, clarithromycin) which require apixaban dose reduction or avoidance. 4, 1
Bottom Line for Your Situation
This combination does not require medication changes but does warrant heightened vigilance for bleeding complications. 1 You should be counseled about bleeding precautions and instructed to report any unusual bleeding promptly to your healthcare provider. 1 The benefits of treating both your condition requiring anticoagulation (likely atrial fibrillation or venous thromboembolism) and your depression typically outweigh the modest increase in bleeding risk, provided appropriate monitoring is maintained.