Safety of Concurrent Eliquis (Apixaban) and Lexapro (Escitalopram) Use
Yes, you can generally take Eliquis and Lexapro together, but there is an increased bleeding risk that requires awareness and monitoring for bleeding symptoms.
Key Safety Consideration: Increased Bleeding Risk
The primary concern with combining these medications is an additive bleeding risk. While escitalopram (Lexapro) is not a direct anticoagulant, SSRIs like escitalopram can impair platelet function and increase bleeding tendency when combined with anticoagulants like apixaban 1.
- A documented case report describes a limb-threatening hematoma in an 85-year-old patient taking citalopram (a closely related SSRI to escitalopram) with apixaban, demonstrating the potential severity of this interaction 1
- The mechanism involves synergistic anticoagulant effects between the two drug classes 1
Pharmacokinetic Interaction Assessment
Importantly, there is minimal direct pharmacokinetic interaction between these two drugs:
- Escitalopram has negligible inhibitory effects on CYP3A4, CYP2C19, CYP2D6, and P-glycoprotein, meaning it will not significantly alter apixaban blood levels 2
- Apixaban is metabolized primarily by CYP3A4 and is a P-gp substrate 3, 4, but escitalopram does not meaningfully affect these pathways 2
- This lack of pharmacokinetic interaction distinguishes this combination from more problematic drug pairs that actually increase apixaban concentrations 5, 6
Clinical Monitoring Recommendations
You should monitor for the following bleeding signs:
- Unusual bruising or easy bruising 4
- Nosebleeds or bleeding gums 4
- Blood in urine or stool
- Prolonged bleeding from cuts
- Heavier than normal menstrual bleeding (if applicable) 4
- Any unexplained swelling or pain in limbs 1
Additional Safety Considerations
Avoid adding other medications that increase bleeding risk:
- Do not use NSAIDs (ibuprofen, naproxen) without medical supervision, as they further increase bleeding risk with apixaban 7
- Avoid aspirin or aspirin-containing products unless specifically prescribed by your physician 7
- Do not take supplements with antiplatelet effects like ginkgo biloba, high-dose vitamin E, or garlic supplements 4
When to Seek Immediate Medical Attention
Contact your healthcare provider immediately if you experience:
- Severe or uncontrolled bleeding
- Blood in vomit or stool (black, tarry stools)
- Severe headache or dizziness
- Unusual swelling or severe pain in any body part 1
Important Precautions
- Never stop apixaban abruptly without consulting your physician, as this increases stroke risk in atrial fibrillation patients 4
- Ensure your prescribing physician and pharmacist are aware you are taking both medications 5
- Regular monitoring of renal function is advisable, as changes could affect apixaban clearance 3