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What is Apixaban and How is it Abused?


Apixaban, also known by the brand name Eliquis, is an anticoagulant medication designed to prevent blood clots by thinning the blood for people suffering from atrial fibrillation (AF) in an effort to minimize the risk for strokes and dangerous blood clots. Eliquis is also prescribed to help treat deep vein thrombosis (DVT) and pulmonary embolism (PE), and to lower the risk of reoccurrence. In addition, Eliquis can be prescribed to a person after a hip or knee replacement to reduce the risk for DVT and subsequent PE.

Eliquis is considered a novel oral anticoagulant (NOAC) medication that works as a direct Xa inhibitor factor in the bloodstream. As published in the journal Core Evidence, AF is a common condition that affects the elderly population, and apixaban is one of the newest NOAC medications approved to treat this common form of cardiac arrhythmia.

The medication can be highly effective and medically beneficial; however, it does have some pretty serious risk factors as well. Eliquis prescribing information carries a black box warning, the strongest type of warning issued, letting people know about an increased risk for excessive and potentially irreversible bleeding, a possible spinal hematoma that can lead to permanent paralysis in people who have a spinal puncture, and an increased risk for stroke when the medication is stopped suddenly or too soon. Abuse of a drug like Eliquis can increase the odds for a dangerous side effect and potentially fatal outcome.

Risk Factors and Signs of Abuse

The National Survey on Drug Use and Health (NSDUH) reports that at the time of the 2016 survey, there were 6.2 million American adults currently (within the previous month) misusing a prescription psychotherapeutic medication. Prescription medications are abused for a variety of reasons and in many different ways. Any time a prescription medicine is taken outside of its intended and prescribed manner, as indicated by a medical professional for a legitimate medical need, it is considered drug abuse.

Apixaban may be abused in the following ways:

  • Taking a higher dosage of the drug than is prescribed at one time
  • Continuing to take Eliquis after a prescription runs out or is no longer medically necessary
  • Taking Eliquis in between doses
  • Chewing Eliquis tablets or crushing them to snort, smoke, or inject the resulting powder
  • Going to different doctors, or doctor shopping, to try and obtain more prescriptions of Eliquis

As much of the population that is suffering from AF and in need of an anticoagulant medication, such as apixaban, is aged 65 or older, the elderly may be at an increased risk for apixaban abuse. The National Council on Alcoholism and Drug Dependence (NCADD) publishes that around 2 million senior citizens in the United States struggle with substance abuse or addiction.

As people age, a lot in life changes. Metabolism slows down, social circles shrink, family moves away, housing situations change, and spouses and peers pass away. All of these can contribute to issues related to alcohol and drug abuse. Elderly drug abuse can often be misdiagnosed, overlooked intentionally or simply missed.

Abuse of apixaban can be extremely hazardous, especially if it is mixed with other drugs or alcohol. Mixing substances like this can greatly raise the risk for a negative outcome that may even potentially be life-threatening. There is no direct antidote for Eliquis that can reverse excessive bleeding. Due to the way the medication works in the blood, dialysis doesn’t work to reverse a potential overdose or adverse reaction either.

A person can overdose on apixaban by taking more than the recommended and therapeutic dose. The drug can overwhelm the system and become toxic in the bloodstream, potentially leading to excessive bleeding and death.

The U.S. National Library of Medicine (NLM) lists the following as possible side effects of apixaban that can indicate a serious problem and need for immediate medical attention:

  • Headache
  • Rash
  • Nosebleeds
  • Heavy menstrual flow
  • Stools that are tarry and red or black in color
  • Pink, red, or brown urine
  • Bleeding gums
  • Breathing difficulties
  • Coughing up blood
  • Vomiting material that resembles coffee grounds
  • Chest pain or tightness in the chest
  • Swelling of tongue and/or face
  • Wheezing
  • Swelling of joints and/or joint pain
  • Feeling lightheaded or faint
  • Dizziness


Eliquis works to prevent blood from clotting, so it can also mean that cuts will bleed for longer than normal, and a person can bruise more easily than they normally would. As a blood thinner, there can be serious complications if Eliquis is mixed with alcohol, recreational drugs, or medications like selective serotonin reuptake inhibitors (SSRIs), aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDS), serotonin norepinephrine reuptake inhibitors (SNRIs), medications containing heparin, or other blood clot-prevention medications.

Apixaban is not a drug that should be stopped suddenly, the American College of Cardiology (AAC) warns, as it can increase a person’s risk for rapid blood clot formation after the drug processes out of the body. This can cause a potentially life-threatening or brain-damaging stroke.

Serious withdrawal symptoms may also include possible nerve damage, headache, mood swings, sleep problems, back pain, nausea and stomach upset, heart palpitations, high blood pressure, dizziness and feelings of being lightheaded, dry mouth, and weakness in extremities.

Prolonged use or abuse of apixaban can result in a person’s inability to control how much and how often they take the medication, and compulsive drug-seeking and drug-using behavior is a signifier of addiction. Addiction is a brain disease wherein a lack of control over drug use is apparent even though the person may want to stop and may make several unsuccessful attempts to do so. A specialized addiction treatment program can help individuals to learn new coping mechanisms and encourage sustained recovery.

What Options are Available for Treatment?

Eliquis has a half-life of around 12 hours when taken orally as directed. This means that it is cleared from the body in about 24 hours, which is when withdrawal symptoms can begin. Due to the potentially serious nature of the risks associated with suddenly stopping Eliquis, it is not usually recommended to just discontinue the drug “cold turkey” without medical oversight.


A medical detox program can offer continuous medical supervision and support as the drug processes safely out of the body. Apixaban may be tapered off – the dosage can be lowered slowly in a controlled manner over a set period of time, in order to minimize risks and manage withdrawal symptoms. Eliquis may also be replaced with a different blood thinning medication during medical detox, and additional medications can be beneficial in managing specific withdrawal symptoms.

A medical detox program is generally part of a complete addiction treatment program that will also include behavioral therapies, supportive care, relapse prevention techniques, stress management skills, adjunctive methods, and other tools for improving quality of life and enhancing long-lasting recovery. Comprehensive addiction treatment programs manage co-occurring medical and mental health disorders in an integrated fashion, aiming to treat the whole person to promote overall health and wellness.

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