Can You Take Lexapro And Eliquis Together?

In our latest question and answer, the pharmacist discusses the interaction between Lexapro and Eliquis.

Question

I take Eliquis twice daily. Can I take Lexapro while on Eliquis?

Asked by Liz On Dec 02, 2021

Answered by
Medical Content Reviewed By HelloPharmacist Staff

On Dec 03, 2021

Key points

  • The combination of Lexapro and Eliquis can increase the risk of bleeding,
  • While studies offer conflicting data on the severity of the interaction, it is important to be aware of the signs and symptoms of bleeding and be appropriately monitored by your doctor if you take both drugs together.

Hi Liz and thanks for contacting us!

Interactions concerning drugs that thin the blood (e.g. antiplatelets and anticoagulants etc...) can be extremely serious, so it's especially important to check with your doctor or pharmacist when combining them with other meds.

In regard to the drugs you mentioned in your question specifically, Lexapro (escitalopram) and Eliquis (apixaban), there is a potential interaction between them, and although they can (and often are) be used together, caution and monitoring are recommended.

Interaction Between Eliquis And Lexapro

Eliquis is classified as a direct oral anticoagulant (DOAC), and Lexapro is classified as a selective serotonin reuptake inhibitor (SSRI).

Since SSRIs on their own have been reported to increase the risk of bleeding in some individuals (predominately stomach bleeds), they should be used cautiously with other drugs that increase bleeding risk, and Eliquis certainly qualifies here.

In fact, the prescribing information for Eliquis specifically mentions SSRIs as increasing the risk of bleeding:

You may have a higher risk of bleeding if you take ELIQUIS and take other medicines that increase your risk of bleeding, including:
- aspirin or aspirin-containing products
- long-term (chronic) use of nonsteroidal anti-inflammatory drugs (NSAIDs)
- warfarin sodium (COUMADIN, JANTOVEN)
- any medicine that contains heparin
- selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs)
- other medicines to help prevent or treat blood clots

Why Does Lexapro Increase Bleeding Risk?

Lexapro is a selective serotonin reuptake inhibitor, and although it is used for the treatment of medical conditions like depression and anxiety, it also affects serotonin on our blood platelets.

Serotonin plays an important role in blood clotting, and SSRIs cause a lowering of serotonin on blood platelets, which increases overall clotting time.

How Serious Is The Interaction?

Most drug references and studies list the interaction between Lexapro and Eliquis as 'moderate' or 'intermediate' in terms of severity.

In real-world terms, these drugs can be used together, but individuals taking them together should be warned/counseled on the potential side effects that can happen (so they know what to look out for) and you should be monitored by your doctor for these side effects.

There have been several studies examining just how concerning this is, and most report there is only a small risk of increased bleeding.

One of the larger studies on the matter, published in the Journal of the American Heart Association, evaluated the risk of using an SSRI with Xarelto (rivaroxaban), a direct oral anticoagulant very similar to Eliquis. It reported no significant increase in risk. Per the study:

We found no significant increase in bleeding risk when SSRI s were combined with anticoagulant therapy, although there was a suggestion of increased bleeding risk with SSRI s added to warfarin. While physicians should be vigilant regarding bleeding risk, our results provide reassurance that SSRI s can be safely added to anticoagulants in patients with atrial fibrillation

It should be noted that not all studies come to the same conclusion.

One such study, published in the British Journal of Clinical Pharmacology, found that there was an increased risk of bleeding in those combining an SSRI and a direct oral anticoagulant, but many of the patients who experienced a bleed were already considered 'high-risk' (e.g. they had risk factors such as being overweight, elderly, used alcohol, etc...).

Overall, SSRIs and drugs like Eliquis are used together quite often, since the combination can be the best course of treatment for your health, as determined by you and your doctor.

As mentioned, it is just important for the individual taking both to be aware of the risks, and what to look out for while taking the combination (e.g. watch for easy bruising and bleeding, blood in the stool, etc).

You also shouldn't take any over-the-counter meds that put you more at risk for a bleed unless specifically recommended by your doctor (such as ibuprofen and naproxen).

Final Words & Video Summary

Thank you again for your question and please be sure to reach out in the future with any additional questions!

References

  • Selective Serotonin Reuptake Inhibitors and Bleeding Risk in Anticoagulated Patients With Atrial Fibrillation: An Analysis From the ROCKET AF Trial, PubMed
  • SSRI co‐medication with NOAC or VKA does not increase hospitalisation for bleeding: A retrospective nationwide cohort study in Austria 2010‐2015, PubMed
  • Risk of major bleeding among users of direct oral anticoagulants combined with interacting drugs: A population‐based nested case–control study, PubMed
  • Eliquis Prescribing Information, AccessFDA

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 11 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication related questions!

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