Q. I have been taking Coumadin (warfarin) for years, however, my doctor recently recommended that I switch to Xarelto or Eliquis. I am looking for more information on Eliquis to evaluate the pros and cons. Your help will be greatly appreciated.

A. We have consulted a cardiologist at the Cleveland Clinic who deals with atrial fibrillation (AFib) on a regular basis. He is cautious about the new medications because he says it is hard to assess their effectiveness in any given patient.

Unlike with warfarin, there is no easy blood test to tell when you have achieved the optimal blood thinning effect. He also pointed out that it is hard to reverse the anticoagulant effect. There is no “antidote” to an overdose that might lead to hemorrhage.

Many patients may do quite well on Eliquis, but we would hope that a knowledgeable cardiologist would be involved in such a decision and provide adequate oversight. The drug should never be stopped suddenly.

ELIQUIS (APIXABAN) SIDE EFFECTS & INTERACTIONS: 

  • The most serious complication is bleeding. Patients can bruise or bleed more easily when on this drug. Notify your doctor promptly if this occurs. Dark or tarry stools would be a possible warning sign of digestive tract bleeding. If you throw up and detect blood or anything that looks vaguely like coffee grounds, that would be a sign that there might be bleeding in the stomach.
  • Let your doctor know if your gums bleed after brushing or flossing your teeth or if you experience nosebleeds or pink, red or brown urine. A bad headache or a feeling of dizziness should also be discussed immediately as these could be signs of bleeding in the brain.
  • Swelling of the joints or joint pain could signal bleeding in that area. Report such a side effect promptly to the prescriber
  • Skin Rash could signal a serious allergic reaction. Report such a symptom immediately. Swelling of tongue or face or trouble breathing also requires emergency treatment.

INTERACTIONS WITH OTHER DRUGS:

Do not take any other drugs without checking first with your prescriber.

  • Aspirin (may increase the risk of bleeding while taking Eliquis)
  • NSAIDs (all anti-inflammatory drugs including ibuprofen, naproxen, diclofenac, etc) could increase the risk of bleeding)
  • Other anticoagulants such as clopidogrel or warfarin may increase bleeding risk when combined with Eliquis
  • Antiseizure drugs such as carbamazepine and phenytoin may reduce the effective of Eliquis. St. John’s wort may also have this effect.
  • Antifungal medications (ketoconazole and itraconazole) may increase the risk of toxicity and bleeding. Dosage modifications are essential.
  • Antibiotics such as clarithromycin may also increase the risk of side effects associated with Eliquis.

Bottom line: be vigilant for signs of bleeding and always check about drug interactions before adding an herb, an OTC drug or another prescription medication to Eliquis.

 

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  1. charlene h.
    Canada
    Reply

    I’m on elequis and metropolol. I’m having sore muscles and joint pain and a very painful lower back and so stiff I can hardly get up and down off a chair. I’m beside myself any feedback would be greatly appreciated.

  2. Joe S.
    North Carolina
    Reply

    Eliquis is the worst drug I’ve ever taken in my life. After only six days I developed all of the following side effects:

    1. SEVERE exhaustion. Couldn’t even walk to the mailbox.

    2. SEVERE breathlessness.

    3. Hypotension (low blood pressure)

    4. Blurred vision.

    5. SEVERE cognitive failure. Felt like my head was stuffed with cotton.

    6. Periods of rapid heart beat.

    7. Insomnia.

    8. BPH (benign prostatic hyperplasia)

    9. Ravenous appetite; absolutely craved carbs. Would have to get up in the middle of the night and eat.

  3. Gerri
    Long Beach, ny 11561
    Reply

    I suffered an acute Ischemic CVA in 11/12. I was given tPA, and was put an anti stroke medication Aggrenox. In Feb and May of 2014 I had a TIA and was put on Plavix 75 mg. and removed the Aggrenox. I am on many medication for Crohn’s Disease which has been quiet for the last few years…

    On 2 occasions over the past month had a pulse rate in the high 130’s. It lasted for an hour and I took .5mg of Klonopin, and within 1 hour my pulse went back to normal. Very often when I am at the doctor’s office he finds my pulse slow.. I went to see my cardiologist yesterday and he put me on Eliquis 5mg. Although I was on a heart monitor for a week several months and it was negative. The doctor thinks I may have AFIB. I am wondering if I would be better off on Coumadin?

    • Gerri
      Reply

      I did not mention that the doctor put me on Eloquis 5 mg and still on the plavix.

  4. Maria V.
    Brooklyn, NY
    Reply

    My mother was put on Eliquis following what was suspected to be a TIA but was never confirmed through various tests. She’d had an aortic valve replacement and bypass in 1995. When I heard they were considering giving her the drug, I asked about the FDA’s warning. I couldn’t speak with her doctor directly but his assistant had not heard about the warnings. At least that’s what he claimed. When I did see her doctor durings rounds, he told me that he did not want her on the drug and planned to just keep her on the low dose aspirin. And yet later that day she did get the Eliquis. I asked why and was told that was the doctor’s order. Again his assistant said that he’d look into it and then got back to me that he’d changed his mind and felt that it was safe enough for my mother.

    Let me stress a few points here. Mom always bruised easily but what she went through that final week of her life looked as though she’d been tortured. Bruises on every single part of her body. Obviously signs of bleeding. Then she had bloody stools. Finally they took her off the Eliquis. That was 6 days later. Pain in her abdomen. Kidneys began shutting down. Signs of cirrohsis in her liver. She had not eaten or drank anything substantial in nearly two weeks. They had been flooding her with fluids and told me that they may need to intubate her because of her breathing.

    The breathing was another issue that I was extremely vocal about. She couldn’t get enough air. Gasping, choking, coughing. All the while they were insisting that her lungs were clear and her oxygen was very good (98-100%). And yet with the kidneys failing and the liver dying, her stomach bleeding, hypotension and A-Fib, they continued to pump in the fluids. Pushing Bi-Carb did nothing. Finally they took her to ICU and her kidneys failed. Kidney specialist told me she didn’t want to put my mom on dialysis because her heart wouldn’t take it. She’d bleed out. As it was, they’d given her 5 blood transfusions while she was in the ICU.

    She died less than 36 hours after being brought down to ICU. Now I’ve asked for all of her medical records and I can clearly see that her tests showed severe heart, liver and kidney problems from the word go. Why in the world was she given Eliquis? Three of the main warnings given by the FDA were against patients with artificial heart valves, kidney and liver problems and A-Fib. Her aortic valve was described as tortuous and her mitral valve had been leaking for some years.

    At 94, having just suffered double pneumonia in July, did she really seem like a good candidate for Eliquis just one month later?

  5. CASEY
    calgary
    Reply

    Have been on Coumadin and Dilantin for 15 years. It works for me and my once a month or so blood tests give me piece of mind. While initially agreeing with my GP, who suggested I switch to Eloquis, I am staying on Coumadin and Dilantin.
    Why fix something that isn’t broken?

  6. wrb
    Reply

    Arbee
    my husband has pneumonia like condition and is tired and weak most of the time sleeps a lot too on the amiodarone legs hurt all the time. what meds are your husband taking now for fib?

  7. lhe
    Reply

    Amiodarone can do serious harm… my husband was in hospital at least 6 times in a year from it and he hasn’t really recovered his health even now, 3 years later. It can cause a condition that acts like pneumonia but they can’t find any germ, and the only way treat it is steroids. Every time the steroids were tapered off the pneumonia like condition came back. It took at least 6 rounds of treatment (maybe more, hard to recall) before he could get off the steroids without getting the lung problems again. amiodarone stays in the body a long time after you stop taking it.
    The damage comes on so gradually that you just think maybe the a fib is the problem and maybe the amiodarone isn’t working or the dose isn’t high enough. And you feel tired and weak and sleep a lot… it has a lot of iodine in it too that does a job on your thyroid (he takes thyroid meds now) if your hubby isn’t doing noticeably better on the amiodarone ask your dr if he can go back to some other med… search up amiodarone pulmonary toxicity and thyroid effects and take the results with you.

  8. Arbee
    Reply

    Since taking apixaban my husband has developed numbness in his arms, sever pain in his hands and neck. No help from the medico except prescription for steroids – which have helped. He now sleeps. Will he ever be able to stop taking this cocktail? He is also on amiodarone and motoprocol. He has AF.

  9. JC
    Reply

    I was prescribed Dabitgatran when clots were found on my damaged heart muscle after a routine MRI. I had very bad gut reactions and was eventually switched to apixaban. A month after taking this I started with psoriasis. That was a year ago and despite all manner of treatments is no better and indeed my hands and feet bleed and are very sore.
    I have just started a course of drugs for the psoriasis but if anything it’s worse. Whilst I am told by my dermatologist that the psoriasis is genetic I have always had excellent smooth skin and it seems curious that at 71 I should suddenly develop a ‘genetic’ skin condition a month after taking apixaban. Has anyone else suffered a similar side effect after using this drug?

  10. fbl
    Reply

    Cindy MB, before I went off the Xarelto I called our local pharmacy and he said that because the med stays in the system there is no problem going off it cold turkey. He cautioned me to call my Dr. ASAP though.
    For the rest of you too let me state that I’m still off all blood thinner meds and am doing fine with the natural remedies I posted above. My family Dr. has been following with blood tests.
    Stents are dangerous and I would hope that folks would give IV chelation therapy a try before they did something that cannot be reversed. Yes, I have fist hand experience with it as the shoulder harness damaged my heart in a 2006 car accident and my “widow maker” artery was blocked 70%.
    Although I was supposed to do follow up sessions of chelation I haven’t because of other life events (cancer) but when checked about a month ago I’m still at only 20% blockage. This is incredibly good for seven years of neglect and nothing to worry about according to my cardiologist.
    Yes, I do intend to get some follow up chelations because once a vessel is damaged it tends to clog again and I don’t want to have to go through 30 sessions again. A few times a year sounds good compared to having to start over again.

  11. Des L
    Reply

    I was put on Xarelto (Rivaroxaban) and suffered severe muscle pain in my right leg together with hip joint pain and pimples.
    After 3 weeks I was changed to Dabigatran and within a day I suffered terrible abdominal pain lasting 2 days.
    I was then put on to Eliquis(Apixaban) and suffered exactly the same problems as Rivaroxaban. After 3 weeks of walking pain I have today gone back to Warfarin. I am hoping that no permanent damage has been done.

  12. Bonnie G.
    Reply

    I have been taking Eliquis for about three weeks now and I have not had any muscle problems so far.

  13. SAM
    Reply

    I am taking Eliquis and am suffering severe joint pain and swelling which I did not have before taking the blood thinner. I am wondering if Eliquis is the cause. My Dr. dismisses my concerns. Anyone else have the same trouble with this drug?

  14. TL
    Reply

    Started on Eliquis 5 mg for A Fib…………..had good B/P all along but NOW (6 weeks into this Rx), my B/P is exceptionally LOW.
    Has anyone had this happen?? No one has an answer for me.

  15. Bob K 1941
    Reply

    In 06 I had a stent installed and was put on aspirin and Coumadin, I kept getting big bruises on different parts of my body all the time after quite awhile on that my doctor changed it to Pradaxa when it first came out (I had the 2nd prescription) and baby asprian and I personally have not had a problem ever since and stay pretty active.

  16. Cindy M. B.
    Reply

    My situation is identical… I was on Coumadin (which I hated) for ~2 years, then my dr. switched me to Eliquis. HOPEFULLY, it’s only for 3 more months if I continue to heal well from my 2nd cardiac ablation, and I think I am.
    The drug is terribly expensive, and I got $$help because I am so low-income. Otherwise, it costs more than $300.00 per month which is impossible.
    Just prior to the 2nd ablation I finally went off the beta blocker, which caused SERIOUS muscle weakness and great fatigue and sleepiness for me. I am so much better now!
    fbl says that Eliquis caused the same thing for her; so I can only say that once I get off Eliquis, I may be ready to try out for the Olympics, as I have worked out so stringently trying to counteract the effects of the beta blocker..
    My main worry about Eliquis is: they say you CANNOT stop it on your own as “stopping suddenly causes significant risk of a stroke.” I have yet to find out if this is just a generic warning (i.e., OF COURSE if your blood gets thicker and you still have any AFib, you may get a clot)….. vs. that there’s something pharmacological in Eliquis that may actually trigger a stroke if it’s suddenly withdrawn.
    I have a funny feeling it may be the latter, which doesn’t make me too happy…. I guess the answer is to taper off very slowly.

  17. fbl
    Reply

    I took Xarelto for less than two months and had such sharp stabbing pains in my legs that I had to stop. It also gave me diarrhea and muscle wasting, which didn’t stop even months after stopping the drug.
    Now over 1 1/2 years later I still have such weak leg muscles that it takes me time to walk after getting out of bed in the morning. After sessions of acupuncture some of my muscle has come back but I still get a weird feeling as if my muscle cells are gasping for breath. My muscles are still weak and hurt.
    The only thing that has stopped the runs is a suggestion I got from this email newsletter-using Metamucil. It works! Now I don’t have to take the max dose of Imodium plus Pepto-bismo to go out. Nausea has also been a constant problem and I keep candied ginger readily available. Even in the glove box of my car.
    I tried to post on the FDA web site over a year ago and it never went through and I finally gave up.
    I am now taking nattokinase, vitamin E, gingko biloba and cayenne. My blood tests are great without any drugs.

  18. RC1956
    Reply

    My brother is on Plavix and aspirin (81 mgs.) due to heart attacks with multiple stents. He bleeds easily even with small injuries like a dog scratch, or rubbing the arm on a door frame. It takes a long time for the bleeding to stop. This is not a lot of bleeding but a serious injury would be problematic.
    He was told to add the aspirin to the plavix, and his blood is evidently quite thin.
    Be careful with blood thinners, particularly with the new ones that are not as well known for their reactions.

  19. Gayla H.
    Reply

    Don’t switch if you value your life!
    My husband was approved by both his internist and cardiologist to switch from Coumadin after many years of taking it for atrial fibrillation to Pradaxa.
    He started it in July and died the first week in October.
    Both doctors said it was not a heart attack! However, it could have been something else, but we’ll never know. The main artery from his heart was blocked and it could have been a pulmonary embolism.
    If Coumadin works for you – keep taking it!

    • Andrea
      Reply

      I just switched to Eliquis after two years on Coumadin. No side effects from Coumadin but my INR was rarely in “therapeutic” range and always affected by antibiotics and prednisone taken for hives, at times.

      I took my INR on my machine and it was a 1.0 which is. Or supposed to be relevant for Eliquis. I had my pulmonary emboli with an INR OF 1.1.
      I seem too short of breath as I have been doing housework, shampooing carpets today etc. shortness of breath is listed as severe reaction to Eliquis but I may have had this for three weeks.

      Can anyone advise? Going to doc tomorrow…do no want to go to ER.

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