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.