Can Eliquis (apixaban) cause dizziness?

Can Eliquis (Apixaban) Cause Dizziness?

Yes, Eliquis (apixaban) can cause dizziness, which is explicitly listed as a potential side effect in the FDA-approved drug label, though the mechanism appears related to its anticoagulant effects rather than direct neurological action. 1

Direct Evidence from FDA Labeling

The FDA-approved medication guide for apixaban specifically instructs patients to:

• Call your doctor or get medical help right away if you experience "feeling dizzy or faint" as part of potential allergic reactions or bleeding complications 1
• Watch for dizziness as a warning sign that may indicate spinal or epidural blood clots (hematoma), particularly in patients receiving neuraxial anesthesia or spinal puncture 1
• Seek emergent medical attention if dizziness occurs alongside other symptoms like headaches or weakness, as these may signal serious bleeding 1

Clinical Context and Mechanism

Dizziness with apixaban is primarily a secondary effect related to bleeding or hypotension rather than a direct central nervous system effect:

• Unlike medications such as carvedilol (which causes dizziness in 5.5% of patients through direct cardiovascular mechanisms), apixaban's dizziness is typically associated with bleeding complications or volume depletion 2
• The drug has no direct effect on arousal or sensory-perceptual functions that would independently cause dizziness, distinguishing it from medications like aminoglycosides (which cause vestibular toxicity) or tetracyclines like minocycline (which directly cause CNS dizziness and vertigo) 3

Important Clinical Pitfalls

When a patient on apixaban reports dizziness, you must immediately evaluate for:

• Active bleeding (gastrointestinal, intracranial, or other sites) - dizziness may indicate hemodynamic compromise from blood loss 1
• Orthostatic hypotension - check vital signs in supine and standing positions to assess volume status
• Spinal/epidural hematoma if the patient has had recent neuraxial procedures - this is a medical emergency requiring immediate imaging 1
• Drug interactions - particularly with medications that affect apixaban metabolism via CYP3A4 or P-glycoprotein pathways, which could increase bleeding risk 3

Management Approach

If dizziness occurs in a patient taking apixaban:

• Obtain orthostatic vital signs and assess for signs of bleeding (hemoglobin/hematocrit, stool guaiac, neurological examination) 1
• Review concomitant medications, especially antiplatelet agents (aspirin, clopidogrel), NSAIDs, or other anticoagulants that increase bleeding risk 1
• Consider renal function assessment, as apixaban clearance is 27% renal and impaired kidney function may increase drug exposure and bleeding risk 4
• Do not abruptly discontinue apixaban without consulting the prescribing physician, as this increases stroke risk in atrial fibrillation patients 1

Dosing Considerations

• Approximately 10% of patients receive reduced-dose apixaban (2.5 mg twice daily), and less than half of these meet appropriate dose-reduction criteria (age ≥80 years, weight ≤60 kg, creatinine ≥1.5 mg/dL) 5
• Inappropriate dosing may contribute to adverse effects including bleeding-related dizziness 5