Never Stop Eliquis Abruptly
Stopping Eliquis without a healthcare provider's direction is one of the most critical "don'ts" for anyone on this medication. Eliquis is often prescribed to prevent serious health issues like stroke in people with atrial fibrillation or to prevent deep vein thrombosis (DVT) and pulmonary embolism (PE). Its blood-thinning effect wears off relatively quickly, within two to three days after the last dose. Halting treatment suddenly can put you at a significantly higher risk for developing a dangerous blood clot or experiencing a stroke. If you need to stop Eliquis for any reason, such as a scheduled surgery, your doctor will provide clear, specific instructions on when to pause and when to restart your medication safely.
Don't double up on missed doses
If you happen to miss a dose of Eliquis, it is important to take it as soon as you remember on the same day. However, if it is almost time for your next scheduled dose, you should skip the missed one entirely. Taking a double or extra dose to compensate can dramatically increase your risk of bleeding. If you frequently forget doses, discuss strategies with your doctor or pharmacist, such as using a medication reminder app or a pill box.
Serious Medication Interactions to Avoid
Many common prescription and over-the-counter (OTC) drugs can interact with Eliquis, either increasing your bleeding risk or reducing the blood thinner's effectiveness. It is essential to inform all your healthcare providers, including pharmacists and dentists, that you are taking Eliquis before starting any new medication.
Avoid NSAIDs and other antiplatelet drugs
Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin increase the risk of bleeding when taken with Eliquis. Both Eliquis and NSAIDs affect blood clotting, and their combined effect can be dangerous. For pain relief, acetaminophen (Tylenol) is generally a safer alternative, but you should still consult your healthcare provider first. Other antiplatelet drugs, such as clopidogrel (Plavix), also significantly increase bleeding risk in combination with Eliquis.
Steer clear of other anticoagulants
Taking Eliquis with other prescription anticoagulants, including warfarin (Coumadin), heparin, or rivaroxaban (Xarelto), is generally avoided due to the severely elevated risk of major bleeding events. In cases where a switch between these medications is necessary, your doctor will carefully manage the transition to ensure your safety.
Watch out for other drug classes
Several other types of medications can cause interactions:
- Certain Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine and sertraline, and serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine, can increase bleeding risk when taken with Eliquis.
- Antifungal and Antiviral Drugs: Medications like ketoconazole, itraconazole, and ritonavir can increase Eliquis levels in the blood, heightening the risk of bleeding.
- Antiseizure Medications and Antibiotics: Certain seizure drugs (e.g., phenytoin, carbamazepine) and antibiotics (e.g., rifampin) can decrease Eliquis's effectiveness, which could increase your risk of a clot.
Dietary and Herbal Considerations
While Eliquis has fewer dietary restrictions than older blood thinners like warfarin (which is sensitive to vitamin K intake), certain foods and supplements still pose risks.
Limit alcohol consumption
Excessive or binge drinking can dangerously increase your risk of bleeding and liver strain when on Eliquis. Alcohol itself has blood-thinning properties, and combining it with an anticoagulant has an additive effect. While a moderate, occasional drink may be acceptable for some, it is best to discuss your alcohol consumption with your doctor.
Avoid grapefruit and other citrus fruits
Grapefruit and its juice can interfere with the enzyme that metabolizes Eliquis, causing higher drug levels in your bloodstream and increasing your bleeding risk. Other citrus fruits like pomelos, marmalades, and limes can have a similar effect.
Herbal supplements and spices
Many supplements can affect blood clotting and should be avoided or used with caution.
- Ginkgo biloba: Increases bleeding risk.
- St. John's wort: Decreases Eliquis's effectiveness.
- Turmeric, ginger, and garlic: May increase bleeding risk, especially in concentrated supplement form.
- Omega-3 or fish oil: High doses can also increase bleeding risk.
Lifestyle Precautions
Because Eliquis increases your risk of bleeding and bruising, you should take extra care during daily activities.
- Use an electric razor: Switch from a manual blade to an electric shaver to minimize the risk of nicks and cuts.
- Use a soft toothbrush: Opt for a soft-bristled toothbrush to protect your gums from bleeding.
- Handle sharp objects with care: Wear gloves when using tools, knives, or gardening equipment.
- Avoid high-impact sports: Activities like contact sports (e.g., football, rugby) or those with a high risk of falls (e.g., horse riding) should be avoided.
- Wear a medical alert: Carry an anticoagulant alert card or wear a medical ID bracelet to inform healthcare professionals that you are on Eliquis in case of an emergency.
Eliquis vs. Warfarin: What to Avoid
While both Eliquis and warfarin are anticoagulants, they have key differences in their safety profiles and patient management. Understanding these differences can help patients and caregivers navigate treatment more effectively.
| Feature | Eliquis (apixaban) | Warfarin (Coumadin) |
|---|---|---|
| Dietary Restrictions | Avoid grapefruit, limit alcohol; not significantly affected by vitamin K. | Strict monitoring of vitamin K intake is required; inconsistent intake can affect drug efficacy. |
| Monitoring | No routine International Normalized Ratio (INR) blood tests required. | Regular INR monitoring is essential to ensure the correct dose. |
| Bleeding Risk | Generally considered to have a lower risk of major bleeding compared to warfarin. | Higher risk of serious bleeding events compared to Eliquis. |
| Speed of Effect | Starts working within a few hours. | Takes several days to reach its full effect. |
| Common Drug Interactions | NSAIDs, SSRIs/SNRIs, antifungals, St. John's wort. | Many drugs and supplements, including some antibiotics and OTCs. |
Conclusion
For those on Eliquis, the most important rule is to maintain consistency and communication with your healthcare team. Never stop taking your medication unless advised by your doctor, and be mindful of potential interactions with other drugs, alcohol, and certain supplements. By following these guidelines, you can significantly reduce the risk of serious complications and ensure your anticoagulant therapy remains both safe and effective.
When to Seek Emergency Medical Attention
If you experience any signs of serious or uncontrolled bleeding, seek immediate medical help. These symptoms include:
- Bleeding from cuts that won't stop
- Frequent or prolonged nosebleeds
- Coughing up blood or vomit that looks like coffee grounds
- Urine that is red, pink, or brown
- Stools that are red, black, or tarry
- Unusual bruising or expanding skin discoloration
- Severe headaches, dizziness, or weakness
- Numbness or tingling in the legs or feet after a spinal procedure
If you fall or hit your head, it is also crucial to contact your doctor immediately for assessment.
Be Proactive About Your Health
Managing your anticoagulant therapy is a team effort. By being an active participant in your healthcare, you can ensure the best possible outcomes. Carry your medical alert information, review your medication list with your doctor and pharmacist regularly, and never hesitate to ask questions about your treatment plan.
