Like all medicines, apixaban can cause side effects, although not everyone gets them.
Bleeding and what to do about it
While apixaban has enormous benefits, the downside is that it can make you bleed more than normal.
This is because while you're taking apixaban your blood will not clot as easily.
Less serious bleeding
It's usual to bleed more easily than normal while you're taking apixaban.
The kind of bleeding you might have includes:
- periods that are heavier and last longer than usual
- bleeding for a little longer than usual if you cut yourself
- occasional nosebleeds (that last for less than 10 minutes)
- bleeding from your gums when you brush your teeth
- bruises that come up more easily and take longer to fade than usual
This type of bleeding is not dangerous and should stop by itself.
If it happens, keep taking the apixaban, but tell your doctor if the bleeding bothers you or does not stop.
Things you can do to help yourself:
- Cuts – press on the cut for 10 minutes with a clean cloth.
- Nosebleeds – sit or stand upright (do not lie down), pinch your nose just above your nostrils for 10 to 15 minutes, lean forward and breathe through your mouth, and place an icepack (or a bag of frozen peas wrapped in a teatowel) at the top of your nose.
- Bleeding gums – try using a soft toothbrush and waxed dental floss to clean your teeth.
- Bruises – these are harmless, but can be unsightly. It might help to make them fade more quickly if you put an ice pack wrapped in a towel over the bruise for 10 minutes at a time several times a day.
What you can do to prevent bleeding
While you're taking apixaban, be careful when you do activities that might cause an injury or a cut or bruising.
It can help to:
- stop playing contact sports or other activities than can cause an injury, such as football, rugby, hockey and horse riding
- wear gloves when you use sharp objects like scissors, knives and gardening tools
- stop wet shaving or removing hair with wax – use an electric razor or hair-removing cream instead
- take dentures (false teeth) or retainers out for a few hours a day, if you wear them, to give your gums a rest – do not wear dentures or retainers that do not fit properly
- tell your doctor, dentist or nurse that you take apixaban before you have any medical or dental procedures or surgery – this includes vaccinations and routine appointments with the dental hygienist
Other common side effects
These common side effects of apixaban happen in more than 1 in 100 people. There are things you can do to help cope with them:
Tiredness and lack of energy
If you're tired and lack energy, feel like you're short of breath, have noticeable heartbeats (heart palpitations) and paler than usual skin, these can be signs of anaemia. Talk to your doctor, who may arrange a blood test.
Feeling dizzy or light-headed
If apixaban makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so you do not faint, then sit until you feel better. Do not drive, cycle or operate tools or machinery until you feel OK.
If the dizzy feeling does not go away or keeps happening, speak to your doctor. They may arrange a blood test to see if you have anaemia.
A mild rash
It may help to take an antihistamine, which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you. If the rash does not go away within a few days, speak to your doctor.
Feeling sick (nausea)
Stick to simple meals and do not eat rich or spicy food. It might help to take your apixaban after you have eaten.
If this advice does not help and any of these side effects bother you or do not go away, tell your doctor or pharmacist.
Serious side effects
Serious bleeding
Occasionally, you can have heavy bleeding from taking apixaban. This can be dangerous and needs urgent medical attention.
Urgent advice: Contact 111 for advice now if:
- you have red pee or black poo
- you get bruises that happen for no reason, or bruises that are larger than you'd expect or keep growing in size
Go to 111.nhs.uk or call 111
Immediate action required: Go to A&E now if:
- you get nosebleeds that last longer than 10 minutes, despite trying to stop it
- you have blood in your vomit or you're coughing up blood
- you get severe headaches
- you have any bleeding from a cut or injury that will not stop or slow down
These are symptoms of serious bleeding. If you get serious bleeding, stop taking apixaban.
Bleeding in the brain
Very rarely, apixaban can lead to bleeding in the brain.
Immediate action required: Call 999 or go to A&E if:
you get any of these symptoms:
- sudden severe headache unlike anything you've experienced before
- fits or seizures
- sudden loss of vision or blurred vision
- a feeling of numbness or tingling in your arms or legs
You may also feel very tired, weak or sick.
Do not drive to A&E. Ask someone to drive you or call 999 and ask for an ambulance.
Bring all the medicines you take with you.
Serious allergic reaction
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to apixaban.
Immediate action required: Call 999 now if:
- your lips, mouth, throat or tongue suddenly become swollen
- you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
- your throat feels tight or you're struggling to swallow
- your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
- you suddenly become very confused, drowsy or dizzy
- someone faints and cannot be woken up
- a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)
You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.
These can be signs of a serious allergic reaction and may need immediate treatment in hospital.
Do not drive yourself to A&E.
The person you speak to at 999 will give you advice about what to do.
Other side effects
These are not all the side effects of apixaban. For a full list, see the leaflet inside your medicine packet.
Reporting side effects
You can report any suspected side effect using the Yellow Card safety scheme.
Visit the Yellow Card website for more information about reporting side effects.