Apixaban Side Effects

Medically reviewed by Drugs.com. Last updated on Dec 18, 2023.

Applies to apixaban: oral tablet.

Important warnings This medicine can cause some serious health issues

Oral route (tablet)

Premature discontinuation of apixaban or any oral anticoagulant increases the risk of thrombotic events.

Consider an alternative anticoagulant if apixaban treatment is discontinued for any reason other than pathological bleeding or treatment completion.

In patients undergoing neuraxial anesthesia or spinal puncture, epidural or spinal hematoma risk is increased and could result in long-term or permanent paralysis.

The optimal timing between dosing apixaban and neuraxial procedures is unknown.

Monitor patients for signs and symptoms of neurologic impairment and treat urgently.

Consider the benefits and risks of neuraxial intervention in patients who are or need to be anticoagulated.

Serious side effects of apixaban

Along with its needed effects, apixaban may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking apixaban:

Rare side effects

• blood in the eyes
• blood in the urine
• bloody or black, tarry stools
• bruising or purple areas on the skin
• confusion
• constipation
• coughing up blood
• decreased alertness
• difficulty swallowing
• dizziness
• fainting
• fast heartbeat
• headache
• hives, itching, skin rash
• joint pain or swelling
• nausea and vomiting
• nosebleeds
• puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
• redness of the eye
• severe stomach pain
• shortness of breath
• tightness in the chest
• unusual tiredness or weakness
• vomiting of blood or material that looks like coffee grounds

For healthcare professionals

Applies to apixaban: oral tablet.

General adverse events

The most common adverse events were related to bleeding. Common adverse reactions were anemia, hemorrhage, and nausea.^[Ref]

Hematologic

• Very common (10% or more): Minor bleed (11.7%)
• Common (1% to 10%): Anemia postoperative, clinically relevant nonmajor bleed, hemoglobin decreased, anemia, hemorrhage
• Uncommon (0.1% to 1%): Postprocedural hemorrhage, hemoglobin decrease of 2 g/dL or more, transfusion of 2 units or more red blood cells, fatal bleed, thrombocytopenia, hemorrhagic anemia
• Rare (less than 0.1%): Bleed at critical site^[Ref]

Patients with diabetes had more bleeding events than non-diabetic subjects. Hemorrhage includes hematoma, and vaginal and urethral hemorrhage. Postprocedural hemorrhage includes postprocedural hematoma, wound hemorrhage, vessel puncture site hematoma, and catheter site hemorrhage.^[Ref]

Gastrointestinal

• Very common (10% or more): Nausea (14.1%)
• Common (1% to 10%): Constipation, vomiting, diarrhea, abdominal pain upper, abdominal pain, dyspepsia, gastritis, gastroenteritis, toothache, gingival bleeding, rectal hemorrhage, dyspepsia, gastrointestinal hemorrhage (including hematemesis and melena),
• Uncommon (0.1% to 1%): Major gastrointestinal bleed, hematochezia, hemorrhoidal hemorrhage, hematemesis, melena, anal hemorrhage, occult blood positive, occult blood, intra-abdominal hemorrhage, mouth hemorrhage
• Rare (less than 0.1%): Retroperitoneal hemorrhage^[Ref]

Cardiovascular

• Common (1% to 10%): Hypotension, peripheral edema, atrial fibrillation, cardiac failure, hypertension, deep vein thrombosis, tachycardia, cardiac failure congestive, palpitations, thrombosis, angina pectoris, bradycardia, blood pressure increased, procedural hypotension, unstable angina, tachycardia^[Ref]

Nervous system

• Common (1% to 10%): Dizziness, headache, fatigue, syncope, ischemic stroke, vertigo
• Uncommon (0.1% to 1%): Somnolence, cerebrovascular accident, transient ischemic attack, major intracranial bleed, brain hemorrhage, other intracranial or intraspinal hemorrhage (including subdural hematoma, subarachnoid hemorrhage, and spinal hematoma)
• Frequency not reported: Stroke^[Ref]

Local

• Common (1% to 10%): Hematoma, wound hemorrhage, wound secretion
• Uncommon (0.1% to 1%): Incision-site hemorrhage, operative hemorrhage, traumatic hematoma, injection site hematoma, vessel puncture site hematoma, application site bleeding, traumatic hemorrhage^[Ref]

Ocular

• Common (1% to 10%): Cataract, conjunctival hemorrhage, eye hemorrhage
• Uncommon (0.1% to 1%): Major intraocular bleed, periorbital hematoma, conjunctival hemorrhage, retinal hemorrhage
• Frequency not reported: Ocular hemorrhage^[Ref]

Respiratory

• Common (1% to 10%): Nasopharyngitis, dyspnea, epistaxis, bronchitis, cough, upper respiratory tract infection, influenza, pneumonia, sinusitis, chronic obstructive pulmonary disease, lower respiratory tract infection, hemoptysis, dyspnea exertional, respiratory tract infection
• Uncommon (0.1% to 1%): Dyspnea
• Rare (less than 0.1%): Pulmonary embolism, respiratory tract hemorrhage (including pulmonary alveolar hemorrhage, laryngeal hemorrhage, and pharyngeal hemorrhage)^[Ref]

Other

• Very common (10% or more): Procedural pain (10.3%)
• Common (1% to 10%): Pyrexia, chest pain, fall, asthenia, blood creatine phosphokinase increased, pain, body temperature increased, laceration, chest discomfort, tooth extraction
• Uncommon (0.1% to 1%): Herpes zoster^[Ref]

Genitourinary

• Common (1% to 10%): Urinary tract infection, menorrhagia
• Uncommon (0.1% to 1%): vaginal hemorrhage, metrorrhagia, menometrorrhagia, genital hemorrhage, blood urine present, red blood cells urine positive, abnormal vaginal hemorrhage, urogenital hemorrhage^[Ref]

Renal

• Common (1% to 10%): Hematuria, blood creatinine increased, renal failure^[Ref]

Musculoskeletal

• Common (1% to 10%): Arthralgia, back pain, pain in extremity, osteoarthritis, muscle spasms, musculoskeletal pain, myalgia, arthritis
• Uncommon (0.1% to 1%): Muscle hemorrhage, joint swelling^[Ref]

Metabolic

• Common (1% to 10%): Gout, diabetes mellitus, blood glucose increased, hyperglycemia, hypokalemia, decreased appetite^[Ref]

Hypersensitivity

• Uncommon (0.1% to 1%): Hypersensitivity (including drug hypersensitivity such as skin rash and anaphylactic reaction such as allergic edema)^[Ref]

Hepatic

• Uncommon (0.1% to 1%): Transaminases increased, AST increased, ALT increased, gamma-glutamyl transferase increased, liver function test abnormal, blood alkaline phosphatase increased, blood bilirubin increased^[Ref]

Psychiatric

• Common (1% to 10%): Insomnia, depression
• Uncommon (0.1% to 1%): Anxiety^[Ref]

Dermatologic

• Common (1% to 10%): Pruritus, contusion, rash, cellulitis, ecchymosis, erythema, blister
• Uncommon (0.1% to 1%): Skin hemorrhage, petechiae, skin rash^[Ref]

Oncologic

• Uncommon (0.1% to 1%): Basal cell carcinoma^[Ref]

Frequently asked questions

• Xarelto vs Eliquis: How do they compare?
• How do you reverse bleeding with Xarelto?
• What are biologic drugs and how do they work?

Further information

Apixaban side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

Medical Disclaimer