Does Eliquis Cause Significant Dizziness?
Dizziness is listed as a potential side effect of Eliquis (apixaban) in the FDA labeling, but it occurs in less than 1% of patients and is not considered a common or significant adverse reaction. 1
FDA-Approved Safety Information
The official FDA prescribing information for Eliquis specifically mentions "feeling dizzy" as a warning sign in two contexts:
- As a symptom of serious bleeding: Dizziness may indicate internal bleeding requiring immediate medical attention, particularly when accompanied by headaches or weakness 1
- As part of allergic reactions: Dizziness can occur as part of anaphylactic reactions, though hypersensitivity reactions overall were reported in less than 1% of patients 1
Clinical Trial Data
In the major clinical trials (ARISTOTLE and AVERROES) evaluating Eliquis for atrial fibrillation, dizziness was not reported as a distinct adverse event category in the primary safety analyses. 2, 3 The most significant adverse reactions were bleeding-related complications, not neurological symptoms like dizziness. 1
Case Report Evidence
One case report documented reversible neurological symptoms including "non-vertiginous dizziness" in an 80-year-old woman taking apixaban, which resolved within 72 hours of discontinuation. 4 This patient had apixaban plasma concentrations 4 times higher than normal, suggesting the symptoms were related to supratherapeutic drug levels rather than a typical side effect at standard dosing. 4
Clinical Context
If a patient on Eliquis reports dizziness, prioritize ruling out bleeding complications first - particularly intracranial hemorrhage, gastrointestinal bleeding, or severe anemia from occult blood loss. 1 Check for accompanying symptoms such as:
- Headache, confusion, or weakness (suggesting intracranial bleeding)
- Black/tarry stools or red urine (suggesting GI or urinary bleeding)
- Unusual bruising or prolonged bleeding from minor cuts 1
In elderly patients or those with renal impairment, consider measuring apixaban plasma concentrations if dizziness persists, as supratherapeutic levels may cause neurological symptoms. 4, 5 Dose adjustment based on therapeutic drug monitoring can optimize outcomes in high-risk elderly patients. 5
Bottom line: Dizziness is not a significant or common side effect of Eliquis at appropriate therapeutic doses, occurring in less than 1% of patients. 1 When it does occur, investigate for bleeding complications or drug accumulation rather than attributing it to a benign medication effect.