Drug-induced hair loss is a concerning side effect that can significantly affect a person's quality of life and their willingness to continue with prescribed treatments. This article aims to provide a comprehensive overview of medication-related hair loss, focusing on the potential association with Eliquis (apixaban), an anticoagulant medication. We will examine the mechanisms by which drugs can cause hair loss, explore the various drug classes implicated in this adverse effect, and discuss management strategies.
Medications can trigger hair loss through two primary mechanisms: telogen effluvium and anagen effluvium. Each affects the hair growth cycle differently.
Telogen effluvium is the most common type of drug-induced hair loss. This condition typically appears within 2 to 4 months after starting the medication. It causes hair follicles to prematurely enter their resting (telogen) phase and fall out too soon. In normal hair growth, only about 10% of follicles are in the telogen phase. Medications can disrupt this balance, leading to excessive shedding. People experiencing telogen effluvium may shed between 30% to 70% more than the normal 50-100 hairs per day.
Anagen effluvium occurs during the active growth phase of hair and typically develops much more rapidly-within days to weeks after medication exposure. This type of hair loss prevents matrix cells from dividing normally, thereby inhibiting new hair production. Chemotherapy drugs commonly cause anagen effluvium, which can be severe, resulting in loss of most or all scalp hair, eyebrows, eyelashes, and other body hair.
Rarely, some medications such as monoclonal antibodies that target cytokines (e.g., TNF-alpha and interleukin-4 antagonists) can cause a condition called alopecia areata (AA). Another rare form of hair loss from certain medications is scarring alopecia.
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While chemotherapy agents are well-established causes of hair loss, primarily through anagen effluvium, other commonly prescribed medications have also been implicated. These include:
Several psychotropic medications have been associated with hair loss, with valproate derivatives being particularly well-documented culprits. Valproate is notorious for medication-induced hair loss, with alopecia listed among its most common adverse reactions (occurring in >5% of patients). The proposed mechanism for valproate-induced hair loss includes chelation of zinc and selenium, as well as reduced serum biotinidase activity, which decreases the availability of essential micronutrients required for hair growth. Lamotrigine, used to treat epilepsy and bipolar disorder, has also shown evidence of association with alopecia. Certain antidepressants, such as bupropion and imipramine, have also been linked to hair loss. If you are prescribed lamotrigine twice a day, then space out the dosages as much as you can, which means taking one dose first thing in the morning and one dose at night. Contact your healthcare provider or other emergency medical services right away if you develop a skin rash, blistering or peeling of your skin, hives, painful sores in your mouth or around your eyes or other signs of a drug allergy (such as a fever or swelling of your lymph nodes) while taking lamotrigine. This could signal you are having a serious side effect to lamotrigine which may result in hospitalization or cause death.
Both traditional anticoagulants and newer direct oral anticoagulants (DOACs) have been implicated in hair loss. Heparin and warfarin are known to cause alopecia, likely through a telogen effluvium mechanism.
Eliquis (apixaban) is a brand-name oral tablet prescribed for certain blood clots. Eliquis contains the active ingredient apixaban and belongs to the anticoagulant (blood thinner) drug class. Eliquis is approved by the Food and Drug Administration (FDA) for use in adults to:
The World Health Organization's pharmacovigilance database (VigiBase) has received 405 reports of DOAC-associated alopecia: 143 for rivaroxaban, 215 for dabigatran, 47 for apixaban.
Read also: Managing Chemo Hair Loss
A case of a 20-year-old female with recurrent DVTs developed alopecia with multiple anticoagulants, including heparin derivatives and the new oral anticoagulants. This resolved with discontinuation of the agents.
Beta blockers can cause telogen effluvium, though this side effect does not happen often. Medications in this class associated with hair loss include propranolol (Inderal), atenolol (Tenormin), and metoprolol. All ACE inhibitors have also been connected to hair loss as a potential side effect.
Several immunomodulating agents have strong evidence linking them to hair loss. Adalimumab and infliximab, both TNF-alpha inhibitors used to treat autoimmune conditions, have been associated with alopecia in studies with strong levels of evidence.
Hormonal therapies can significantly impact hair growth patterns. Birth control pills, hormone replacement therapy, and thyroid medications are all known to potentially cause hair loss. Many women experience telogen effluvium when starting or discontinuing hormonal contraceptives, as the shift in hormone levels can trigger a synchronized shedding event.
Acne medications containing vitamin A derivatives (retinoids) have been implicated in hair loss. These medications affect cell growth and differentiation throughout the body, including in hair follicles, potentially leading to premature entry into the telogen phase.
Read also: Managing Hair Loss from Chemo
Weight loss medications, such as Wegovy (semaglutide), can contribute to hair loss through multiple mechanisms. Some may directly affect hair follicle cycling, while others might cause nutritional deficiencies that indirectly impact hair growth.
Eliquis (apixaban) is an anticoagulant medication used to prevent blood clots and stroke in people with certain conditions, such as atrial fibrillation (AFib), deep vein thrombosis (DVT), and pulmonary embolism (PE). While Eliquis is generally well-tolerated, it is essential to be aware of its potential side effects, including hair loss.
Although hair loss is not listed as one of the common side effects of Eliquis, some reports suggest a possible association. The World Health Organization's pharmacovigilance database (VigiBase) has received reports of alopecia associated with apixaban, the active ingredient in Eliquis. However, it's important to note that these are just reports, and a causal relationship has not been definitively established.
The exact mechanism by which Eliquis might contribute to hair loss is not fully understood. However, some possible explanations include:
If you are taking Eliquis and experiencing hair loss, it is essential to consult with your healthcare provider. They can help determine whether Eliquis is the likely cause of your hair loss and discuss potential management strategies.
The primary approach to managing medication-induced hair loss is identifying and, when possible, discontinuing the causative agent. For most patients, hair regrowth occurs within several months after stopping the medication. For ongoing treatments like chemotherapy where hair loss is expected, various scalp cooling techniques may help reduce the severity of hair loss. Additionally, topical minoxidil may be prescribed to stimulate hair growth during and after treatment.
One of the best ways to avoid anticoagulant-induced alopecia is to talk with your doctor about the anticoagulant options available before being put on any particular medication. In the case of Warfarin, while telogen effluvium is a temporary form of hair loss, it can become permanent if not treated.
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