Safety of Taking Eliquis (Apixaban) with Lexapro (Escitalopram)
You can safely take Eliquis with Lexapro—there is no significant drug interaction between these medications, and you should not be scared to use them together.
Why This Combination Is Safe
No Metabolic Interaction
- Escitalopram does not interfere with apixaban's metabolism. Escitalopram has negligible inhibitory effects on CYP enzymes and P-glycoprotein, meaning it is unlikely to cause clinically significant drug-drug interactions 1.
- Apixaban is metabolized primarily by CYP3A4, CYP2C19, and CYP2D6, and is a substrate for P-glycoprotein 2. Since escitalopram doesn't meaningfully inhibit these pathways, it won't increase apixaban levels in your blood 1.
Bleeding Risk Context
- While there is one published case report of a limb-threatening hematoma in an 85-year-old patient taking citalopram (a closely related medication to escitalopram) with apixaban 3, this represents an extremely rare event and involved the racemic mixture citalopram, not escitalopram specifically.
- SSRIs like escitalopram can theoretically increase bleeding risk through their effect on platelet serotonin, but this is a general consideration with all anticoagulants, not a specific contraindication 3.
- Studies examining SSRIs with direct oral anticoagulants found that non-CYP3A4 inhibiting SSRIs (which includes escitalopram) do not significantly increase bleeding risk compared to CYP3A4-inhibiting SSRIs like fluoxetine or paroxetine 4.
What Makes This Different from Problematic Combinations
The guidelines you might have read about apixaban interactions focus on strong P-glycoprotein and CYP3A4 inhibitors like:
- Cancer medications (selpercatinib, tepotinib, osimertinib) 5
- Cardiovascular drugs (amiodarone, diltiazem) 6
Escitalopram is NOT in this category and does not have these inhibitory properties 1.
Practical Monitoring Recommendations
- No dose adjustment of either medication is needed based on the drug interaction profile 2, 1.
- Be aware of general bleeding precautions while on apixaban: watch for unusual bruising, blood in urine or stool, or prolonged bleeding from cuts 2.
- Ensure your kidney function is monitored regularly, as apixaban clearance depends on renal function 2.
- Avoid NSAIDs (like ibuprofen or naproxen) which DO significantly increase bleeding risk with apixaban 7.
Bottom Line
The combination of Eliquis and Lexapro is considered safe and does not require special precautions beyond standard monitoring for any patient on anticoagulation. Your fear is understandable given general warnings about drug interactions, but this specific combination lacks the metabolic interaction pathways that would make it dangerous 1.