Apixaban and stomach: Can any apixaban takers... - AF Association

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Apixaban and stomach


Can any apixaban takers tell me if you find you need to take apixaban with some food, or if it's gentle enough on your stomach to have with just water? (I know the guidelines say don't need food but is that your experience?) With taking twice a day, I don't really want to have to eat early & late.

I've been on rivaroxaban for 3 months now and in the last week my stomach has started feeling irritated and sore. (I had duodenitis a couple of years ago.) I take it with a main meal. I'm wondering if I should ask my dr if I can swap to Apixaban, or if it's not likely to make any difference? Thanks!

70 Replies

At conference last year we were told that there is little difference between NOACs for side effects other than dabagatran but others may have different anecdotal evidence.

JaneFinn in reply to BobD

That's interesting - thanks Bob!

Hello Jane, normally I take mine at 8am which often coincides with breakfast, and 8pm around an hour after dinner with no problems. Often I have taken it some time from food and it has never been an issue either....

JaneFinn in reply to FlapJack

Thank you Flapjack- that's helpful to know... I can't keep very regular eating hours at either end of the day (though I've adjusted to regularly take my main meal at midday in order to be able to take rivaroxaban). Not sure of the best way forward... Just hoping one way or another that this burning /irritated stomach issue is resolved safely! Thanks for your input, much appreciated.

Plai in reply to JaneFinn

I don't have problems but was already on omeprazole acid reducing pills. I take one of those morning and evening with the apixaban. Might be worth trying.

JaneFinn in reply to Plai

That's helpful to know, thank you Plai. I used to be on omeprazole for erosive duodenitis, but came off them nearly a year ago. Can I ask if you're actually taking the omeprazole at the same time as the apixaban, or earlier? I seem to remember having to take it 30-60 mins before my other tabs. (Don't worry if you don't know what's best - I can ask a pharmacist. But just wondering what works for you!) Thanks :)

I normally take one with breakfast and the second later in the evening on an empty stomach.......no problems with either. Good luck!

JaneFinn in reply to daveboy99

Thank you Daveboy! That's good to hear.

Not an easy decision because your stomach issues may be caused by unrelated issues and also, we all react differently to medication. I guess there would be no harm in trying an alternative NOAC, many on this forum have changed successfully for one reason or another.....best of luck, John

JaneFinn in reply to FlapJack

Thank you :)

ive been on apixiban for one week only take first at 8am with breakfast then second at 8pm without food ate around 5pm

DEREK2210 in reply to DEREK2210

sorry meant to say ive had no probs but I am new

JaneFinn in reply to DEREK2210

Thanks Derek. That's good to hear! Hope it stays that way :)

Ten AM and Ten pm been on apixaban for 18 momths

JaneFinn in reply to souljacs4

Thanks Souljacs! Presumably not with food (necessarily) at those times? Glad it's not causing you any problems :)

souljacs4 in reply to JaneFinn

I take it with breakfast and about four hours after my evening meal.

JaneFinn in reply to souljacs4

Thanks :)

schachlate in reply to souljacs4

Have you had any episodes of A fib during this time?


JaneFinn in reply to schachlate

Thankfully no! A few fluttery runs and ectopicd only. (Sorry about the delayed reply, somehow I've only just received notification of recent posts.)

I've been taking apixaban - for just over 3 weeks - without food, but with a glass of water. No problems of any sort so far.

JaneFinn in reply to CaroleF

Great to hear, thanks Carole! Long may that last :)

Sue5453 in reply to CaroleF

I have been on apixaban 5 months take 6 o'clock on morning then have breakfast 1 hour later the 6 at night then tea 1 hour after and no problem so far

Hi Jane,

I take mine at 9am and 9pm with water. My meal times are 8am and 6pm. No problems encountered so far.

Best Wishes


JaneFinn in reply to Barry24

Great! Thanks so much, Barry.

Been on apixaban for 3years 7am 7pm no food never had a problem

JaneFinn in reply to Mazza23

Brilliant! That's very encouraging - thanks Mazza.

Sue5453 in reply to Mazza23

Your 7pm when do you have food befor and after and how many hours befor and after

Mazza23 in reply to Sue5453

Take it at 7am then brekky about 8am dinner6 pm pill 7pm no probs

Sue5453 in reply to Mazza23

When do you eat with you takeing apixaban at that times

I take mine 7am and 7pm the morning one is taken on an empty stomach.....no problems and no problems in the evening with my meal. So I do it both ways and never experienced any issues. Been taking Apixiban for 12 month's

JaneFinn in reply to RoyM

Thanks Roy - that's really helpful.

Apixaban for 2 yrs no problem. My Consultant and GP say Apixaban is the best NOAC - least side effects!

JaneFinn in reply to Annekw

Thanks, Anne! Interesting you should say that - my GP is adamant they're all the same, so he favours rivaroxaban - and doesn't want to change me. But the specialist nurse I saw said that the cardiologists all favour apixaban. Great you've had no problems, anyway!

CaroleF in reply to JaneFinn

When initially, about 9 months ago, I raised the issue of an anti-coagulant/NOAC rather than warfarin with my GP she said,"In this area we prescribe rivaroxaban" , but didn't explain why and I didn't pursue things further as at that point my AF was not confirmed. I thought it might well be something to do with cost.

More recently AF has been confirmed and I was prescribed apixaban during a brief stay in hospital (though not by a cardiologist). During the bedside chat one of the attending Drs. said that apixaban was "best" though I rather think he was comparing it with warfarin rather than other NOACs and I think he was referring to comparative risks of a bleed in the brain.

I was prepared to do battle with my GP if she refused to prescribe apixaban, but happily there's no problem and I didn't like to remind her that previously she had implied that the only NOAC she'd prescribe was rivaroxaban!

I can only conclude that (for whatever reason - new evidence/cost issues?) the view of the practice or local commissioning group has changed

Rellim296 in reply to CaroleF

I don't know about the relative costs among the NOACs but one difference is that apixaban is taken twice a day and it therefore has a shorter half life than once a day rivaroxaban and presumably one takes a smaller dose.

That's interesting, Carole - thank you! I wonder if it's partly because Apixaban is newer than rivaroxaban, so 9 months plus ago, the wisdom was to go with the more tried and tested one? We'll probably never know! But I'm definitely veering towards trying apixaban. (And I understand it's quite an easy switch between the two, both ways round.)

I thought I'd try to find out about the comparative costs of anticoagulants .... and bingo! I found this site:


You'll need to scroll down to find the anticoagulant section on page 12 (I would have clipped the relevant bit but I don't think you can upload files here).

As you will see, Apixaban is the most expensive (at October 2016 prices) at £691.60 pa (oh gosh! One way or another I am costing the NHS a small fortune!) whereas Rivaroxaban is £655.20 pa. (and just LOOK at how those prices compare with Warfarin - though of course there are savings when you consider no blood testing etc)

Food for thought here, I think.


JaneFinn in reply to CaroleF

Wow! Good detective work, there, Carole! It's a shocker how much it costs, isn't it? And yes my GP would DEFINITELY go for the cheaper alternative :)

CaroleF in reply to JaneFinn

At least you should have some facts and figures as well as anecdotal evidence from here to help when you meet your GP.

Eg " I do realise that Apixaban costs about £36 pa more than Rivaroxaban. On the other hand, I know that Apixaban is the anticoagulant now favoured by cardiologists and anecdotal evidence supports the view that it has the least side effects."

As an aside .... whilst in hospital briefly recently I was asked by the most senior of the Drs I saw if I had a medical background. I said no, but that I did belong to the AF Association and that they produced much helpful/informative literature. I assume she thought I might have been some sort of medic. since I used 'proper' terminology and asked pertinent questions. At any rate I got the distinct impression that I was being spoken to differently since I seemed to know what I was talking about.

Conclusion: Knowing what you're talking about gives one a bit of an 'edge' during any consultation. (added proviso: a little knowledge can be a dangerous thing)

Anyway .... I hope your GP will be willing to let you try apixaban. To be fair it must be a nightmare for them trying to balance costs vs potential benefits for the patient.


JaneFinn in reply to CaroleF

Thank you Carole. Really appreciate your advice... xx I'll let you know what happens!

CaroleF in reply to JaneFinn

Yes. Please do.

I have been taking apixaban for 14 months. No problems so far and have taken with or without food. Consultant Haematologist at anti -coagulant clinic favoured apixaban as she said it had the least side effects in her experience. I took some persuading to take an anti-coagulant but was reassured when my EP told me that apixaban has less bleeding risk than aspirin, which I had been taking for the 4 years previously.

JaneFinn in reply to Londonlass

Thank you, Londonlass - that's really good to hear. (I was the same re taking an anticoagulant - I was scared into it by horror stories and know that it's the best decision. But it's good to find as 'safe' a one as possible, isn't it?)

Absolutely and I can also say that I have been much more relaxed and far less anxious when AF strikes knowing that I am as protected as one can be.

I prefer rivaroxaban: If you forget to take one of the two daily tablets of apixaban (short half ) I would be warried for the stable proteccion. It seems that nobody else is.

JaneFinn in reply to Varina8

That's pretty much what my GP said, Varina! More chance of forgetting :)

I took Rivaroxaban for 3 months but started to have some stomach pain and as I have stomach/digestive problems, I did some research ( Royal Pharmaceutical Society) and discovered that Apixaban is gentler on the stomach. When I was due for a repeat prescription I asked my GP to switch me over to Apixaban, which he did quite happily and I have been on Apix for two weeks now. I take it without food, as it says this ok in the patient leaflet. I think that, in itself, shows that the medication is kinder to the stomach. If you feel that you would be happier on Apixaban, then ask to be swapped over.

Thank you lizzie - that's a good thinking - and really interesting, as it's so close to my experience. I'm very glad to hear you've been ok on apixaban.

I'll certainly ask. Tho my GP might not be as accommodating as yours - he's a bit stubborn and old school and HATES patients 'interfering' :) The research I'd done led me to ask for apixaban to begin with, but he pooh poohed the research. He also told me i could ignore the instruction to take Rivaroxaban with food (despite me showing the patient leaflet saying it's mandatory)!! But if he doesn't swap me, then I'll chat to my cardiologist in a few weeks...

Thank you :)

jane- I don't think I would have faith in a GP who contradicted what the manufacturers' instructions said about how to take a particular medicine.

Hope your cardiologist will swap you over to Apixaban. Is there another GP at your practice you could see?

I'm sure you're right! I think I have assertiveness issues (where it's for me - I'm better at battling for someone else!) I'm even nervous of asking to see another GP! Mine is the head of the practice and quite 'powerful'. But I'm just being stupid, I know... :)

I was under the impression that anticoagulants had to initially be prescribed by a cardiologist or an EP. Then repeat prescriptions via GP. Good luck that you can swap when you speak to your cardiologist.


Thanks so much, Ally :)

My GP did prescribe the anticoagulants initially - in fact he did so immediately i told him the hospital had found AF, he didn’t wait for any official confirmation :)

I have seen my EP now and he immediately swapped me from rivaroxaban to apixaban (I didn’t even have to ask about it) as he felt it is statistically safer for someone like me who has had GI problems in the past.

Thanks for taking the time to reply xx

There are some very good videos on you tube by Dr Sanjay Gupta on the new NOACs he has videos on most things to do with AF and the heart just Google him he makes it very easy to understand.

JaneFinn in reply to souljacs4

Oh thank you, souljacs- that's really helpful - I'll check them out :)

I have been on Rivaroxaban for months now and take it last thing at night with a slug of milk...just a couple of mouth fulls...no problems

JaneFinn in reply to beryl007

Hey beryl, it's great to hear you're getting on fine with Rivaroxaban and with so little to line your stomach :) My patient info leaflet says to take with a main meal so I don't think I'd dare have only milk - but it seems your stomach is happy :) Thats a thumbs up for Rivaroxaban and your digestion then!

I'm on Rivaroxaban and was told in the hospital it works more effectively when taken with food. I too am on it twice a day until next week and find it hard having to eat something at 9pm every evening. Hope that helps.

I take twice a day 8/8 makes no difference if I eat or not, from time to time I get heartburn (very infrequently) but usually that passes after a few days and I have generally put it down to something I ate? Who knows?

I must say though I am very lucky that I dont suffer many side effects with my medication as I am on quite a few different tablets, the worse one I have is a lack of energy.

Thanks for your reply, Susan. I'm glad to hear you're not really bothered by side effects - with apixaban, or other meds. It seems from the replies here that most people are finding they don't have to eat anything with apixaban to make it easier on the stomach, which sounds promising to me :)

I have been taking 2 Apixaban daily for last 6 weeks and have had no side effects from them.

JaneFinn in reply to Cotters1

Thanks Cotters - that’s great to hear x

I take it in the morning, usually with breakfast and it's fine, and at the same time in the evening about an hour before my evening meal, and it's fine then too.

JaneFinn in reply to UScore

Thanks, UScore x

I have been on apixaban for over a year now I take my morning one at 6 on empty tummy just with water go back to sleep and eat when I get up then night time one take at 6 not with my meal as might not eat till 7 but your answer is I take on empty tummy or if I have tea earl take tab just after but never upset my tummy hope this helps

JaneFinn in reply to Sue5453

Thank you Sue - that’s very helpful :)

BTW, I’m impressed you manage to wake at 6am to take it and go back to sleep- i think i’d be forever wondering if I’d dreamt taking it! :)

I did at first then but not now I take another tablet at the same time and set alarm for 6 then have other 6 at night it works for me but like I say no upset tummy on empty tum hope it work ok for you as there sometimes I don’t eat till 10 if I have had a lay in

I have been on abixaban for 1 year and 3 months and I take it at 6 in morning with just water then go back to sleep and have breakfast any time between 9 and 10 and 6 at night then have my meal anytime after 7 onward and my tummy has been fine no problem at all doing it my way hope this helps I am trying to find out what time to take it when clocks go faward but as in chemist today and she said just take at same time as I do now 6 in morning and 6 at night although the clocks go faward what do you all think

JaneFinn in reply to Sue5453

That’s a very interesting question! I never thought of the clock change issue! There have been several clock changes since I’ve been on my meds. Personally I’d go with what the pharmacist suggests, and keep to the same time according to the clock (even when time has actually shifted an hour forward or back) assuming that time works for me. But I’d be interested to hear if others do otherwise.

Great to hear you have no issues taking apixaban without food. I Can I ask if you’ve been prescribed a stomach ‘protector’ like omeprazole or lansoprazole? I’m assuming you haven’t needed one :)

Thanks! X

Sue5453 in reply to JaneFinn

No don’t take anything for my tummy as dosent give me any problems

JaneFinn in reply to Sue5453

Great, thanks :) x

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