In this drug factsheet:
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- bleeding or oozing from the surgical wound
- signs of bleeding (e.g., bloody nose, blood in urine, coughing blood, cuts that don't stop bleeding, bleeding in the rectum or from hemorrhoids, bleeding gums, black stools)
- signs of bleeding in the stomach (e.g., bloody, black, or tarry stools, spitting up of blood, vomiting blood or material that looks like coffee grounds)
- symptoms of anemia (e.g., tiredness, paleness)
- symptoms of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools, itching)
- symptoms of unidentified bleeding (e.g., weakness, paleness, dizziness, headache, unexplained swelling or bruising)
- symptoms of low blood pressure (e.g., fast heartbeat, dizziness, fainting)
Stop taking the medication and seek immediate medical attention if any of the following occur:
- allergic reaction (rash, hives, swelling of the face, lips, tongue, or throat, difficulty breathing)
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Increased bleeding risk: If you have any medical conditions that may cause an increased risk of bleeding, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. These conditions include uncontrolled very high blood pressure; a problem with the blood vessels in the back of the eye called retinopathy; current or past ulcer of the stomach or intestines; recent stroke; or recent surgery of the brain, spinal column, or eye.
Heart valves: The safety and effectiveness of apixaban have not been established for people with prosthetic heart valves or severe rheumatic heart disease. Apixaban is not recommended for use by people with these conditions.
Kidney disease: This medication is not recommended for people with severely reduced kidney function or those who are receiving dialysis. If you have kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Liver disease: If you have liver disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Apixaban is not recommended for people with severe liver problems.
Spinal or epidural catheters: This medication should not be taken by people who have spinal or epidural catheters in place or for 5 hours after their removal. It should not be taken by people receiving pain medications through an epidural catheter.
Pregnancy: The safety and effectiveness of apixaban have not been established for pregnant women. Apixaban is not recommended during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: It is not known if apixaban passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children and adolescents: The safety and effectiveness of apixaban have not been established for children and adolescents less than 18 years of age. Apixaban is not recommended in this age group.
Seniors: People over the age of 75 are at an increased risk of bleeding. Report any unusual bruising or bleeding to your doctor immediately.
What other drugs could interact with this medication?
There may be an interaction between apixaban and any of the following:
- abiraterone acetate
- acetylsalicylic acid (ASA)
- aminosalicylic acid
- "azole" antifungals (e.g., itraconazole, ketoconazole, voriconazole)
- calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
- estrogens (e.g., conjugated estrogen, estradiol, ethinyl estradiol)
- grapefruit juice
- herbal products that can increase bleeding (e.g., cat's claw, chamomile, dong quai, garlic, ginger, ginseng)
- HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delaviridine, efavirenz, etravirine, nevirapine)
- HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
- low molecular weight heparins (e.g., dalteparin, enoxaparin, tinzaparin)
- macrolide antibiotics (e.g., clarithromycin, erythromycin)
- nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., naproxen, ibuprofen, diclofenac)
- omega-3 fatty acids
- progestins (e.g., dienogest, levonorgestrel, medroxyprogesterone, norethindrone)
- St. John's wort
- selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, duloxetine, fluoxetine, paroxetine, sertraline)
- tyrosine kinase inhibitors (e.g., dabrafenib, dasatinib, imatinib)
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.