Atrial fibrillation (AF), a condition that the journal Core Evidence reports is common in the elderly population, is regularly treated with a novel oral anticoagulant (NOAC) medication such as apixaban, which is marketed under the brand name Eliquis. NOAC drugs interact with the way the blood clots normally, therefore thinning the blood and preventing potentially dangerous blood clots that can cause a stroke. A stroke can have lasting brain damage and even be fatal.

Eliquis is prescribed to prevent strokes in people struggling with AF. It is also used to prevent deep vein thrombosis (DVT) in people who have just had hip or knee replacement surgery and as a method to treat DVT and pulmonary embolisms (PEs). As these conditions regularly affect older people, senior citizens may have more access to Eliquis, which can make them more susceptible to abuse the medication.
Elderly person taking prescribed pills
Nearly 2.5 percent of the American population misused a prescription psychotherapeutic medication in the month leading up to the 2016 National Survey on Drug Use and Health (NSDUH). According to the National Council on Alcoholism and Drug Dependence (NCADD), about 2 million elderly people in the United States struggle with substance abuse or addiction.

Apixaban is a medication that can be medically beneficial and safe when used as intended under the direction of a medical professional. It does have many potentially dangerous side effects, the risks of which are elevated with misuse and abuse.

Physical Indicators of Apixaban Abuse and Addiction

When a person is taking an anticoagulant drug such as apixaban, they may bruise more easily than normal and bleed for longer when they have a cut or scratch as the blood does not clot as well. One of the potential risk factors of Eliquis, as indicated by the black box warning in the prescribing information, is the danger of experiencing a spinal hematoma that can lead to long-term or permanent paralysis while taking this medication. This is generally caused by a puncture to the spinal cord, which can be the result of a surgical or anesthesia procedure.

Stopping Eliquis prematurely and suddenly can actually increase a person’s risk for stroke. Excessive internal bleeding that may be irreversible is another possible side effect of apixaban that can be hazardous and have long-range and potentially permanent consequences.

Other possible side effects to watch for when a person is taking apixaban, as listed by the U.S. National Library of Medicine (NLM), include:

  • Nosebleeds
  • Urine that is pink, red, or brown in color
  • Bleeding gums
  • Stools that are tarry and red or black in color
  • Wheezing
  • Feeling faint or lightheaded
  • Dizziness
  • Joint pain and possible swelling
  • Headache
  • Rash
  • Chest pain or tightness in the chest
  • Coughing up blood
  • Vomiting material that looks like coffee grounds
  • Heavier than normal menstrual or vaginal bleeding
  • Difficulties breathing
  • Swelling of the tongue or face

Someone who is misusing Eliquis may be taking the drug in a manner other than as prescribed and may crush the drug to snort, smoke, or inject the powder. Powdery residue may be evident on clothing, their face, hands, or flat surfaces. Drug paraphernalia used to crush the drug, smoke it, snort it, or dissolve it into liquid and inject it may also be evidence of Eliquis abuse.
women with psychological issues from drug abuse
When abuse becomes compulsive and an individual can no longer control how much and how often they take apixaban, loved ones may notice more empty pill bottles than usual in trash cans or find the medication in easy-to-reach locations in a person’s room or personal space. Weight can fluctuate as appetite and eating patterns often change as a side effect of addiction. Nutrition is often put on the back burner when a person struggles with addiction, and care about personal appearance and hygiene can decline as well. Sleep patterns can become erratic, and a person may sleep at strange times and more or less than is normal for them. Physical health can also decline as a result of drug abuse and addiction.
Other possible indicators of Eliquis addiction include drug cravings for the medication, physical dependence on the drug, and drug withdrawal. The American College of Cardiology (AAC) warns that stopping Eliquis suddenly without replacing it with another anticoagulant medication increases the odds for a potentially life-threatening stroke.
Eliquis has a half-life of around 12 hours, meaning that the drug stops working within about a day after taking it. This means that if a person has been taking it for a while and then stops, withdrawal symptoms can begin in the first 24 hours. Further Eliquis withdrawal symptoms include mood swings, back pain, sleep disturbances, weakness in the extremities, heart palpitations, high blood pressure, fatigue, dry mouth, quick and easy bruising, and gastrointestinal upset.

Drug dependence and withdrawal symptoms can be indicators of apixaban addiction. Eliquis withdrawal can be life-threatening, and the medication should not be stopped suddenly without medical care and intervention.

Psychological Signs of Apixaban Addiction

Addiction is a brain disease that has many physical, social, emotional, and interpersonal ramifications and indicators. When a person battles addiction, they may take more of the drug at a time than they meant to or keep taking it for longer than necessary. Many attempts are often made to stop taking the drug and a desire to stop is present, but controlling use becomes an issue.

The American Society of Addiction Medicine (ASAM) calls addiction a chronic disease that impacts brain circuitry and therefore interferes with normal emotional responses. Mood swings, irritability, restlessness, and even a shift in personality can be noticeable in someone struggling with addiction. A person may become secretive and socially isolated, spending most of their time taking drugs, recovering from the effects of drugs, and then working on how to get more drugs.
Social circles often change and issues crop up with family members, friends, and coworkers. Trouble at work or school can also become evident, and individuals are liable to shirk personal responsibilities and not consistently fulfill school, familial, home, and occupational obligations. Grades can drop and/or work production can be negatively impacted. Finances can then become strained, either due to unemployment or the excessive amounts of money spent on drugs.
Criminal and legal issues can also be the result of drug abuse and addiction. Someone struggling with addiction involving apixaban will likely continue to take the drug in situations where there is personal physical hazard involved, when they know that taking it will cause more physical or emotional problems, or with the knowledge that taking the drug is going to lead to social and psychological issues.

Addiction impacts people of all generations and demographics, and it is often overlooked in the elderly population especially. It can be missed by medical professionals and loved ones, as some of the signs of addiction can also be symptoms of other diseases and disorders that are common in senior citizens. Things like cognitive impairment, mood swings, and physical ailments may all be passed off as other things. Older adults are often more socially isolated, and loved ones may not be around as much to notice some of the possible signs of drug abuse and addiction.
Fortunately, addiction is a treatable disease at any age. There are specialty programs for all demographics aimed at improving overall quality of life and promoting long-term recovery.