Weight loss - Apixaban

Has anyone else had weight loss problems after starting on Apixaban?

Elderly male, was on Rivaroxaban (Xarelto) but changed due to nose bleeds and leg weakness. Apixaban solves those problems but getting worried about quite severe weight loss.

Has anyone else experienced severe weight loss with Apixaban?

Hi Nick - I had just the opposite effect. Nothing else changed except for Eliquis and the pounds started packing on.
Somewhat better with the half-dose, but it's a battle. I also have recurrence of muscle weakness and leg pain so while Eliquis is certainly convenient and I'm much more compatible with it versus warfarin, it's apparent it has negative side effects for me.

Jackie

Hi Nick,

In doing a search for increased weight loss 'potentially associated' with starting, or long duration, taking Eliquis from the FDA Adverse events reports, there is not much evidence to support that association that I can find. So far, I saw a report of 280 people reporting inadvertent weight loss after starting Eliquis out of some 22,066 people or so. that is roughly a rate off reporting of 1.2% from early 2013 when Elquis started to roll out into North America through end of March 2017.

There was also a roughly statistically similar small number of reports of weight gain associated with Eliquis reported, so this highlights the fact that, while with a fairly new drug like this we cannot categorically rule out a direct causal relationship between any one person's weight loss or weight gain being caused by starting Eliquis ... nevertheless the evidence so far makes it very hard to support such a conclusion ... at least statistically speaking.

While that does not mean any given person's weight gain/loss is not connected with starting Eliquis, it does tend to argue that other factors are more likely to have a more closely associated connection with the weigh gain or loss than Eliquis. Ideally, a person could then do their own trial of starting and stopping the drug over appropriate time spans to allow clearance of the drug between on and off periods to see if the weight normalized again off the drug and then was lost or gained as the case maybe after restoring it again keeping all over variables as stable as possible. If one can repeatedly confirm a definite weight gain or loss connected with starting and stopping any drug in such a fashion it makes for a much stronger suggestion that there may well be a connection.

However, with an oral anticoagulant like Eliquis I would never advise such a trial period in a person who obviously needs OAC therapy for stroke/TIA prevention! And certainly not without close supervision by your prescribing cardiologist or EP!!

It is still possible there is a connection between Eliquis and certain individual's weight gain or loss, at least based on the data I have seen to date, yet the odds are much higher that there is some other cause entirely, or perhaps a combination of associated connections that might include starting Eliquis as well.

In any event, whatever the facts turn our to be in your case, this review does underscore the need to be cautious in jumping too quickly to certain 'cause and effect' conclusions when we start a new medication or undergo a procedure. We humans are, by nature and understandably, more prone to draw such connections more quickly than might be prudent and accurate, and it may make a lot of common sense that there must be such a connection, even when there may not be.

In cases where doing such an 'experiment of one' trial on and off the given drug has no real negative downsides, then doing your own experiment of one is a often a good idea .. just not with an oral anticoagulant for which you have a compelling diagnostic reason requiring you to take the medication religiously every day for your own safety.

So while it is possible that Eliquis 'might' be playing some part in your severe weight loss, I would clearly carefully rule in, or out, a host of other possible reasons first well before coming to the conclusion that Eliquis really is part of your own weight loss equation. Plus, it goes without saying you should at least include your Eliquis prescribing physician as a key member of your investigative team in trying to track down the cause(s) of your sudden weight loss.

Be well,

Shannon



Edited 1 time(s). Last edit at 05/03/2017 01:26PM by Shannon.

Thanks for the info Shannon.

I may be proved wrong but the severe weight loss wasn't noticed until soon after taking Apixaban and not before so it certainly feels to be strongly linked.

Problem is what alternatives are there? Rivaroxiban has been tried and caused nose bleeds and quite bad leg weakness.

Nick

You are welcomed Nick,

And as noted, though the ida are low that Eliquis is the sole cause of sudden weight gain or loss, statistically speaking, it does not mean that it is not contributing to your issue.

Since the direct trial and error method of sorting out the question by starting and stopping Eliquis and keeping a journal is not a good idea when you are in need of OAC, there is always warfarin which can work well for many folks too, especially when they are dedicated to doing once a week home testing to help insure a very high per d rate of time is doesn't with in the sweet spot of the therapudic INR range of 2 to 3.

I may have missed it but did you say you have had any experience with warfarin yet?

I'm heading off right now to Chicago for the next week to attend the Heart Rhythm Society's annual Scientific Sessions conference which is by far the largest EP focused medical conference in the world each year. It may take me a couple days to respond this week to any other questions you might have during this week.

Best wishes,

Shannon

Should point out that the patient is not myself but a relative, an 89 year-old male.

He has never been allowed to try Warfarin, only Rivaroxiban and now Apixaban. Warfarin is a good suggestion, didn't know home testing of INR was possible. However being in the UK that option might not be available, many good solutions to medical issues are not allowed in the UK.

I think there is home testing of Warfarin in the UK, but a UK afibber will surely let us know for sure? I could be mistaken, but I think it is available and it is worth checking out if your friend feels certain his weight loss is from Eliquis.

Shannon

Well quick update, he has have various tests and as far as we know the only things found were:

• Hiatus Hernia
• Gastritis - could be caused by Apixaban
• Cyst in one Kidney - however this has apparently been present for a while so not new.

Unfortunately weight loss is now getting extreme. Still eating like a horse but just not putting on any weight.

Now being allowed to stop Apixaban and replace it with Warfarin, lets see what happens?