Unsure if I took Eliquis

Hi all,

If I'm unsure if I took Eliquis tonight, is it better to skip the dose? I'm sure I took it this morning. My dosage is 5mg twice daily.

My CHADS score is very low (no risk factors) and I'm currently in sinus.

Thanks



Edited 1 time(s). Last edit at 05/11/2022 03:59AM by Que.

I think your supposed to skip the dose your unsure of, and resume the next scheduled dose, as if you had taken it. The risk of adverse effects from a double dose outweigh missing a dose.

First thing I do each morning is to put 2 Eliquis in a little container, along with my supplements for the day. Just a tip.
I wouldn’t worry too much about missing one dose.

😊

I also count out my daily meds and put them into a container. Once my IWatch alarm started to ring for my rx alert reminder (I space my drug dosing all day) and I was distracted and instead of taking my arrhythmia drug, I swallowed an Eliquis within hours after my last Eliquis dose. That’s 10mg in two hours. I called up poison control who told me not to worry and to wait 12 hours for my next dose. I also emailed Carey as well (thanks Carey) afterwards who I think said in the trials patients were taking more than 5mg and I should be ok.

Poison control-a pharmacist answered my phone call —if you have an urgent emergency question -
+1 (800) 222-1222

For the vast majority of people here, just taking the next dose at the scheduled time is the thing to do, as others have pointed out.

But for the few of you who have an isolated LAA from an ablation and didn't meet the minimum requirements of LAA pumping activity in your 6-month TEE (you know who you are), you should take the missed dose immediately unless it's really close to the time for the next dose. For example, if at 2pm I realized I might have forgotten my 9am dose, I would go ahead and take it even if it might be a double. But if I realized it at 7pm that night, I would just take my normal next dose right away and then resume my normal dosing tomorrow morning. Missing a dose is dangerous for you, but taking a double probably isn't.

Eliquis and the other DOACs are generally pretty safe with over-dosages. Taking a double dose isn't likely to harm anyone.

Thank you, everyone!

I called my health insurance 24/7 nurse (which is a great resource if you don't know of that). Most plans have one. We reasoned it was better to skip the dose too given my CHADS score of 0 and that Eliquis has a 1/2 life of 12 hours. One pill lasts in the system for 24 hours.

Can't say I slept well though!

I bought a 7-day, twice daily pill box too!

There is also a good App called Medisafe. You enter your prescriptions and the times and it harasses you until you mark them taken.

If you have an iPhone you can set alarms as well to name each drug. The alarm is relentless too.

If you decide on an app, may I throw “pill reminder” into the rink? Not only does it bugs you with alarm reminders, you can set up under medical info or notes to remind you which supplements or drugs interact. An example is Prilosec and B12 should be spaced and not taken together.

Drugs.com interaction. It’s only a mild interaction but still no harm not to pop both together:

“ Interactions between your drugs
Minor
omeprazole cyanocobalamin
Applies to: Prilosec (omeprazole), Vitamin B12 (cyanocobalamin)
By reducing or suppressing gastric acid secretion, H2-receptor antagonists and proton pump inhibitors may interfere with the gastrointestinal absorption of vitamin B12, a process that is dependent on the presence of gastric acid and pepsin. Clinical studies have shown that dietary (i.e., protein-bound) vitamin B12 malabsorption can occur during treatment with these agents, particularly proton pump inhibitors, although the likelihood of developing clinically significant deficiency over time is unknown. There has been one reported case of vitamin B12 deficiency with megaloblastic anemia in a patient who received omeprazole at a minimum of 40 mg/day for 4 years. Also uncertain is whether acid reduction or suppression can affect the absorption of vitamin B12 ingested in the form of oral supplements such as cyanocobalamin. Non-oral routes of administration (e.g., parenteral, intranasal, sublingual) are generally preferred in the treatment of B12 deficiency-related anemia.”

Or Eliquis and Omega 3, which I put on the app reminder not to take together:
[www.drugs.com]

“Interactions between your drugs
Moderate
omega-3 polyunsaturated fatty acids apixaban
Applies to: Omega-3 (omega-3 polyunsaturated fatty acids) and Eliquis (apixaban)
MONITOR: Omega-3 fatty acids (e.g., fish oil) may potentiate the pharmacologic effects of anticoagulants and other drugs that affect hemostasis such as platelet inhibitors, thrombin inhibitors, thrombolytic agents, dextran, and nonsteroidal anti-inflammatory drugs (NSAIDs). The exact mechanism of interaction is unknown. Omega-3 fatty acids may possess mild antiplatelet and hypocoagulant activities. In some studies, these substances have been shown to reduce thrombin generation and plasma levels of fibrinogen, prothrombin, and coagulation factors V, VII, and X. Prolongation of bleeding time has been demonstrated, although it did not exceed normal limits and did not produce clinically significant bleeding. The interaction was suspected in a case report of a 67-year-old woman treated with warfarin for 1.5 years who exhibited an increase in INR from 2.8 the previous month to 4.3 approximately one week after doubling her fish oil dosage from 1000 to 2000 mg/day. Prior to the increase, her INR had been stable and therapeutic for 5 months on warfarin 1.5 mg/day. The patient was advised to reduce her fish oil consumption to 1000 mg/day, while her warfarin dose was withheld for one day and then reduced to 1 mg alternating with 1.5 mg per day. Eight days later, her INR was subtherapeutic at 1.6, so the warfarin dosage was increased back to 1.5 mg/day. The patient's INR subsequently returned to therapeutic range.

MANAGEMENT: In general, patients should consult a healthcare provider before taking any herbal or nutritional supplements. Patients using omega-3 fatty acids in combination with anticoagulants or other drugs that affect hemostasis should be advised of the potential for increased risk of bleeding complications.”



Edited 1 time(s). Last edit at 05/12/2022 03:46PM by susan.d.

Thanks everyone does are great suggestions. Is that really too true? Eliquis and omega-3 fish oil have a bad interaction?

It's just a modest interaction. Unless you have a high bleed risk or you take fish oil by the bucket, I wouldn't worry about it. I've been taking fish oil daily along with anticoagulants for 12 years now. All my EPs know and not a single one has ever even mentioned it.

Incidentally, I don't take it for heart health reasons (I'm not convinced it has much value in that regard). I take it because it prevents chalazions, which I started getting in my 40s. They are NOT styes and they don't involve eye lashes, so don't believe google. Also, I've never found a single medical source that mentions fish oil as a preventative. I learned about it from some woman's blog who suffered from them chronically. I haven't had a single one since I started taking fish oil, so I wasn't going to give up fish oil easily.

I’m sure EPs or GPS may not mention it. A pharmacist who takes CE classes on NOACs may know or a Pharmacotherapy specialist.
[www.bpsweb.org]

Happy to hear omega 3 helps your eyes.

You don't need to be a pharmacist to answer this question. The literature is readily available, and the literature says it's a modest interaction that shouldn't be a problem for most patients taking reasonable doses of fish oil.

The literature doesn’t mention the other drugs you are taking (pharmacists you may ask have it) that may affect one’s absorption and metabolism of Eliquis. What’s the big deal? Space them and call it a day. Drugs.com call it “moderate”. That poses a higher potential risk than “mild” to play games with one’s body.



Edited 1 time(s). Last edit at 05/13/2022 10:08PM by susan.d.

Susan, we're not talking about other drugs. The only question here is fish oil with Eliquis, and the answer is known. We don't need to obsess about consulting pharmacists.

Thank you, Drugs.com also say Vit D and Calcium are a concern.

That's in my routine (those 2 supplements).

Any thoughts on that, please?

Also, curcumin and ginger are a concern with Eliquis.

Thank you

And this is the rabbit hole you go down when you start looking up drug interactions.

All your drugs interact with all your other drugs and everything you eat and drink. Unless you find things with actual warnings about combining them, you're going to drive yourself insane worrying about things that just don't matter.

All things in moderation. Stick to that and you'll probably be just fine.