apixaban (Oral route)

a-PIX-a-ban

Oral route(Tablet)

Discontinuing apixaban therapy increases the risk of thrombotic events. In clinical trials in patients wit nonvalvular atrial fibrillation, there was an increased rate of stroke was observed after discontinuation of apixaban. If anticoagulation with apixaban is discontinued for a reason other than pathological bleeding, consider an alternative anticoagulant. In patients undergoing spinal epidural anesthesia or spinal puncture, epidural or spinal hematoma risk is increased and could result in long-term or permanent paralysis. Monitor patients for signs and symptoms of neurologic impairment and treat urgently. Consider the benefits and risks of neuraxial intervention in patients who are or need to be anticoagulated

Commonly used brand name(s)

In the U.S.

  • Eliquis

Available Dosage Forms:

  • Tablet

Therapeutic Class: Anticoagulant

Pharmacologic Class: Factor Xa Inhibitor

Uses For apixaban

Apixaban is used to decrease the risk of stroke and blood clots in patients with a serious heart rhythm problem called nonvalvular atrial fibrillation. It is also used to prevent blood clots (eg, deep vein thrombosis) after hip or knee replacement surgery.

Slideshow: Atrial Fibrillation - Stroke Prevention Guidelines & Treatment Options

Apixaban is an anticoagulant. It works by preventing harmful clots from forming in the blood vessels.

apixaban is available only with your doctor's prescription.

Before Using apixaban

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For apixaban, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to apixaban or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of apixaban in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of apixaban in the elderly.

Pregnancy

Pregnancy Category Explanation
All Trimesters B Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking apixaban, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using apixaban with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Abciximab
  • Aceclofenac
  • Acemetacin
  • Acenocoumarol
  • Alipogene Tiparvovec
  • Alteplase, Recombinant
  • Amtolmetin Guacil
  • Anagrelide Hydrochloride
  • Anistreplase
  • Argatroban
  • Aspirin
  • Bivalirudin
  • Bromfenac
  • Bufexamac
  • Carbamazepine
  • Celecoxib
  • Ceritinib
  • Choline Salicylate
  • Cilostazol
  • Citalopram
  • Clarithromycin
  • Clonixin
  • Clopidogrel
  • Cobicistat
  • Collagenase, Clostridium histolyticum
  • Conivaptan
  • Crizotinib
  • Dabigatran Etexilate
  • Dabrafenib
  • Dalteparin
  • Danaparoid
  • Desirudin
  • Desvenlafaxine
  • Dexibuprofen
  • Dexketoprofen
  • Diclofenac
  • Diflunisal
  • Dipyridamole
  • Dipyrone
  • Drotrecogin Alfa
  • Duloxetine
  • Enoxaparin
  • Eptifibatide
  • Escitalopram
  • Eslicarbazepine Acetate
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Felbinac
  • Fenofibrate
  • Fenoprofen
  • Fepradinol
  • Feprazone
  • Floctafenine
  • Fluconazole
  • Flufenamic Acid
  • Fluoxetine
  • Flurbiprofen
  • Fluvoxamine
  • Fondaparinux
  • Fosphenytoin
  • Heparin
  • Ibuprofen
  • Ibuprofen Lysine
  • Indomethacin
  • Itraconazole
  • Ketoconazole
  • Ketoprofen
  • Ketorolac
  • Lepirudin
  • Levomilnacipran
  • Lomitapide
  • Lopinavir
  • Lornoxicam
  • Loxoprofen
  • Lumiracoxib
  • Meclofenamate
  • Mefenamic Acid
  • Meloxicam
  • Milnacipran
  • Mitotane
  • Morniflumate
  • Nabumetone
  • Naproxen
  • Nefazodone
  • Nepafenac
  • Niflumic Acid
  • Nimesulide
  • Oxaprozin
  • Oxyphenbutazone
  • Parecoxib
  • Paroxetine
  • Pentosan Polysulfate Sodium
  • Phenindione
  • Phenprocoumon
  • Phenylbutazone
  • Phenytoin
  • Piketoprofen
  • Piperaquine
  • Piroxicam
  • Pranoprofen
  • Prasugrel
  • Primidone
  • Proglumetacin
  • Propyphenazone
  • Proquazone
  • Protein C, Human
  • Reteplase, Recombinant
  • Rifampin
  • Ritonavir
  • Rivaroxaban
  • Rofecoxib
  • Salicylic Acid
  • Salsalate
  • Sertraline
  • Sibutramine
  • Siltuximab
  • Simeprevir
  • Sodium Salicylate
  • St John's Wort
  • Streptokinase
  • Sulfinpyrazone
  • Sulindac
  • Telaprevir
  • Tenecteplase
  • Tenoxicam
  • Tiaprofenic Acid
  • Ticagrelor
  • Ticlopidine
  • Tinzaparin
  • Tirofiban
  • Tocophersolan
  • Tolfenamic Acid
  • Tolmetin
  • Treprostinil Sodium
  • Urokinase
  • Valdecoxib
  • Venlafaxine
  • Vorapaxar
  • Vortioxetine
  • Warfarin

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of apixaban. Make sure you tell your doctor if you have any other medical problems, especially:

  • Bleeding, active or
  • Liver disease, severe or
  • Prosthetic (artificial) heart valve—Should not be used in patients with these conditions.
  • Bleeding problems, history of—May have an increased risk of bleeding.
  • Kidney disease, severe—Use with caution.

Proper Use of apixaban

Take apixaban exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. When your supply of apixaban is running low, contact your doctor or pharmacist ahead of time. Do not allow yourself to run out of apixaban.

apixaban comes with a Medication Guide. It is very important that you read and understand this information. Be sure to ask your doctor if you have any questions.

If you are not able to swallow whole tablets, the tablets may be crushed, mixed in 60 mL of D5W, and then given through a nasogastric tube (NGT).

If you are taking another medicine to thin the blood (eg, heparin, warfarin, Coumadin®, Jantoven®), your doctor will give you very specific instructions about how to switch to apixaban. Carefully follow the instructions and ask your doctor if you have any questions.

Dosing

The dose of apixaban will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of apixaban. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For prevention of blood clots after hip replacement surgery:
      • Adults—2.5 milligrams (mg) two times a day, for 35 days. The first dose should be taken 12 to 24 hours after surgery.
      • Children—Use and dose must be determined by your doctor.
    • For prevention of blood clots after knee replacement surgery:
      • Adults—2.5 milligrams (mg) two times a day, for 12 days. The first dose should be taken 12 to 24 hours after surgery.
      • Children—Use and dose must be determined by your doctor.
    • For prevention of strokes and blood clots:
      • Adults—5 milligrams (mg) two times a day.
      • Adults with 2 of the following characteristics: 80 years of age and older, body weight of 60 kilograms (kg) or less, or kidney problems—2.5 mg two times a day.
      • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of apixaban, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using apixaban

It is very important that your doctor check your progress at regular visits to make sure that apixaban is working properly and to decide if you should continue to take it. Blood tests may be needed to check for unwanted effects.

apixaban may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash, itching, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are using apixaban.

Make sure any doctor who treats you knows that you are using apixaban. You may need to stop using apixaban for several days before having surgery, including dental procedures.

Do not suddenly stop using apixaban without asking your doctor. You might have a higher risk of stroke after you stop using apixaban.

You may bleed and bruise more easily while you are using apixaban. Be extra careful to avoid injuries. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Gently brush and floss your teeth. Be careful when using sharp objects, including razors and fingernail clippers. Avoid picking your nose. If you need to blow your nose, blow it gently.

Check with your doctor right away if you have any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, headache, dizziness, or weakness, pain, swelling, or discomfort in a joint, pinpoint red spots on your skin, unusual nosebleeds, or unusual vaginal bleeding that is heavier than normal. These may be signs of bleeding problems.

apixaban may increase risk of blood clot in the spine or epidural area, which may lead to long-term or permanent paralysis. This is more likely to occur if you have an epidural catheter placed in your back, are taking NSAID or blood clotting medicine, a history of repeated epidural punctures or problems with your spine, or have had surgery on your spine. Tell your doctor right away if you have tingling, numbness, or muscle weakness, especially in your legs and feet.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

apixaban Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Rare
  • Blood in the eyes
  • blood in the urine
  • bloody or black, tarry stools
  • bruising or purple areas on the skin
  • confusion
  • constipation
  • coughing up blood
  • decreased alertness
  • difficulty swallowing
  • dizziness
  • fainting
  • fast heartbeat
  • headache
  • hives
  • itching
  • joint pain or swelling
  • nausea and vomiting
  • nosebleeds
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • redness of the eye
  • severe stomach pain
  • shortness of breath
  • skin rash
  • tightness in the chest
  • unusual tiredness or weakness
  • vomiting of blood or material that looks like coffee grounds

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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