Taking Eliquis and Metoprolol for A-fib: Concerned about side effects

Posted by damari @damari, May 25, 2020

Just diagnosed. Doctor prescribed Eliquis and Metoprolol. I was wondering what side effects common. I read there is a rare side effect of hair thinning for metoprolol. (take 25 mg 2x day) Also read that Eliquis can sometimes cause some stomach discomfort. (5 mg 2x day) Can either medications be taken in lesser amounts?

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@basslakebabe19

I take Eliquis ( for over two years now) and have no stomach issues. Hope this helps.

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I take Eliquis also with no problems.

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@predictable

Hi @damari. Glad to see you back with us, especially since the two of us are A-fib victims. Your reliance on Metoprolol and Eliquis is not uncommon. The first of these and its side-effects are discussed on Mayoclinic.org. Check out https://mayocl.in/2LTLhoP as well as https://mayocl.in/3d0JLx7 for starters. Search separately there for Eliquis or its generic name apixaban with a focus on the "oral route" (as opposed to the intravenous route). On your question about lesser amounts, be advised that changing the dosages on both drugs is possible, but only in direct coordination with your specialist or primary care physician. A lot of patients cut their dosages without consultation, causing side effects that are hard to tolerate. In my case, my similar drugs are Carvedilol (25mg morning and evening) and Coumadin (5.0 and 7.5 mg on alternating days).

The side effects you mentioned are on public lists for your drugs. Can you raise your questions about them with your doctor(s) or your pharmacist before any changes are made in dosage? Martin

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Have had A-fib for 16 yrs. Am now on Xarelto, Verapamil for that and Irbesartan for blood pressure. Was on Metoprolol and noticed hair loss. Asked cardiologist and he said he'd never heard of that. I printed out some reports and showed them to him. I don't know if he believed me or not. Would like to hear from anyone who has had Watchman implant, which can eliminate need for blood thinner.

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@predictable

Hi @elwood. I get your question frequently -- why do I stick with Warfarin as my anticoagulant? My answer is simple and to the point. There is a readily available antidote for Warfarin, but not for most other anticoagulants. Almost all hospitals (but with a few stupid exceptions) have the Warfarin antidote (a Vitamin K solution) on hand for use when it's needed. I have two personal experiences that drive my choice of Warfarin.

Three years ago, a neighbor on Warfarin fell off a ladder in his garage. I called 911 and the EMTs came and hauled him off to a hospital emergency room a mile away. An hour later, a medical helicopter picked him up and flew him to another hospital 20 miles away. Within another hour, he was pronounced dead from a hemorhaggic stroke -- an uncontrolled brain bleed. The first hospital had no Warfarin antidote on hand. It's sister hospital 10 miles away could not rush it over either. So they called for the helicopter. The second hospital administered the proper antidote, but by that time, it was too late. I sang at his funeral a week later.

Another episode just last week involved a friend with A-fib who also takes an anticoagulant, but not Warfarin. I reminded him about my neighbor's fate. He called the doctor, asked about his medication, and was told it is a lot less trouble than Warfarin -- lab tests, some diet restrictions, etc. In our pandemic environment, that's a bigger problem than before, risking the coronavirus to go to a medical laboratory for a periodic blood test required to remain safe under Warfarin. Even so, he is now looking for a doctor who will include Warfarin in his range of therapies for A-fib.

I remain upset about the death of my neighbor as a result of his treatment in a hospital that had no antidote for Warfarin on hand. As a result, my first question of doctors when I was rushed to the emergency room last Fall was "Do you have an antidote for Warfarin on hand?" They did. I resolved that I'll always ask that question when under treatment at any clinic or hospital, regardless of which anticoagulant I am taking at that time. I hope this gives you some options to consider and discuss with your doctors, hospital, and EMT services. Martin

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There are approved and available reversing agents for Eliquis and Xarelto since 2018.

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@darbybauer

There are approved and available reversing agents for Eliquis and Xarelto since 2018.

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@darbybauer, welcome. I noticed that you wished to post a URL to an article with your message. You will be able to add URLs to your posts in a few days. There is a brief period where new members can't post links. We do this to deter spammers and keep the community safe. Clearly the link you wanted to post are not spam, so allow me to post it here.

– FDA Clears First Reversal Agent for Rivaroxaban, Apixaban Anticoagulants https://www.dicardiology.com/article/fda-clears-first-reversal-agent-rivaroxaban-apixaban-anticoagulants

Darby, have you been prescribed an anticoagulant?

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Hi, not being a pill taker (except vitamins), I try to reduce dosages. I was put on Eliquis about 4 years ago when I was in severe heart failure. I had two blood clots in my heart when I finally got diagnosed and hospitalized at Phoenix Mayo Clinic. Grace of God held those two clots in place and were dissolved with Eliquis over about 3 months. So, even though I had a lot of joint pain at that time which I thought was a side effect of Eliquis, it has lessened quiet a bit with time. You know, it's always that story, which is worse, the illness or the side effects. After a series of attempts to get my heart to stay in rhythm, I was put on Metoprolol. This has worked well lowering my heart rate. It's amazing how much better I feel. Also, I take magnesium and vit C and potassium daily. I took Omega3 for awhile though eating salmon and walnuts does the same. Drink green drinks of home juicing, kale, carrots, celery, ginger, apple and lemon. Like to do this every 2 -3 days. Also, prayer, enjoyable activity such as gardening, and massage therapy. Just keep feeding yourself fulfilling and life sustaining activities. I'm 73, and that's how I maintain my health. Though a bit crazy, I live with a family that loves me.

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@davej

For me I found it slowed my heart down so when I biked or briskly walked I was out of breath and it took a while to get it caught up after sitting down.

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Yes, metoprolol slows the heart making you tired and winded. Yes, it is very annoying and frustrating when you are enjoying your activity.

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@darbybauer

There are approved and available reversing agents for Eliquis and Xarelto since 2018.

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It is important for Connect members to know a lot more about the reversing agent suggested by @darbybauer for serious bleeding when it is related to the anticoagulants Eliquis and Xarelto. The reversing agent is Andexxa, and it was indeed approved by the FDA in 2018. But Andexxa is not a pill to take with lunch. In the FDA news release announcing approval of Andexxa, you may find the following expert statement: "Andexxa's rapid reversal of the anticoagulating effects of rivaroxaban and apixaban will help clinicians treat life-threatening bleeds, where every minute counts."

Note the reference to the use by "clinicians treat(ing) life-threatening bleeds, where every minute counts." The crucial implications of that statement are 1) Andexxa is for intravenous application not an at-home antidote; 2) it is recommended for use by "clinicians" in a highly specialized treatment environment; 3) its use is recommended when a bleed is life-threatening. Be careful and be sure of the presence of a qualified medical professional when an antidote is needed for a bleed while taking Eliquis or Xarelto. Martin

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@predictable

It is important for Connect members to know a lot more about the reversing agent suggested by @darbybauer for serious bleeding when it is related to the anticoagulants Eliquis and Xarelto. The reversing agent is Andexxa, and it was indeed approved by the FDA in 2018. But Andexxa is not a pill to take with lunch. In the FDA news release announcing approval of Andexxa, you may find the following expert statement: "Andexxa's rapid reversal of the anticoagulating effects of rivaroxaban and apixaban will help clinicians treat life-threatening bleeds, where every minute counts."

Note the reference to the use by "clinicians treat(ing) life-threatening bleeds, where every minute counts." The crucial implications of that statement are 1) Andexxa is for intravenous application not an at-home antidote; 2) it is recommended for use by "clinicians" in a highly specialized treatment environment; 3) its use is recommended when a bleed is life-threatening. Be careful and be sure of the presence of a qualified medical professional when an antidote is needed for a bleed while taking Eliquis or Xarelto. Martin

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Excellent Post!

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Has ABLATION and a watchman device been considered? If not, why not?

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@ltssjs

Has ABLATION and a watchman device been considered? If not, why not?

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Ablation is a surgical procedure that is considered in therapy decisions of people with arrhythmic pulse and their medical team. Watchman is a medical device that also gets wide consideration at the level of physician-patient, taking into account the cost of the device and the willingness of health insurance companies to foot the bill. Journalism encounters resistance of patients and their medical teams to detailed questions that form the basis of publications; personal privacy is protected in these cases by medical professionals as well as by public laws prohibiting disclosure of personal health information.

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