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Apixaban Patient Tips

Medically reviewed on Nov 17, 2017 by C. Fookes, BPharm.

How it works

  • Apixaban is a selective inhibitor of factor Xa (FXa), an enzyme that plays a key role in the formation of substances that cause blood clotting. Through its action on FXa, apixaban makes blood less likely to clot.
  • Apixaban belongs to the class of drugs known as factor Xa inhibitors. It may also be called an anticoagulant.

Upsides

  • Used to reduce the risk of stroke and blood clot formation in people with nonvalvular Atrial Fibrillation (AF).
  • Also used to protect against the development of deep vein thrombosis (DVT) (blood clots in the deep veins) following hip or knee replacement surgery.
  • Apixaban is also used in the treatment of DVT and pulmonary embolism (PE) (where blood clots lodge in the lungs), and to lower the risk of recurrent DVT and PE.
  • Does not require regular blood tests.
  • Apixaban is available as an oral tablet in two strengths (2.5mg and 5mg).
  • Is less likely than warfarin to interact with other drugs or foods; however, it does interact with some medicines.

Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Minor bleeding, nausea, anemia, and hemorrhage are the most common side effects. Gastrointestinal side effects such as constipation, vomiting, diarrhea, or abdominal pain may also occur.
  • Severe bleeding is uncommon; however, the risk is increased in people with kidney disease or taking other medications that also reduce the ability of the blood to clot.
  • Consider coverage with another anticoagulant if apixaban needs to be stopped for any reason other than significant bleeding or completion of the course of therapy because premature discontinuation has been associated with thrombotic events (the formation of a blood clot within a blood vessel).
  • There is an increased risk of spinal or epidural hematomas resulting in long-term or permanent paralysis forming in people taking apixaban who are also undergoing spinal puncture or epidural or spinal anesthesia. The risk is greater in those taking other medications that affect blood clotting (such as NSAIDs, aspirin), with a history of traumatic or repeated spinal procedures or a history of spinal deformity or surgery.
  • May not be suitable for some people including those with artificial heart valves, undergoing epidural or spinal anesthesia or spinal puncture, or with active bleeding.
  • May be difficult to confirm if the "one dosage fits all" regimen suits everybody, because there is not a commercial blood test available to check the actual effect apixaban is having on each individual taking it.
  • Guidelines suggest avoiding the use of apixaban in people who are obese (BMI >40kg/m2 or weight of 120kg or more) because there is a lack of research investigating use of the drug in this population.
  • No antidote is available, although a potential antidote, andexanet alfa, has been developed but is yet to be FDA approved. The lack of an antidote may be of concern in the event of a major bleed or in patients requiring unexpected, immediate surgery. However, the actual risk of major bleeding is low; in case of major bleeding, supportive measures and use of fresh frozen plasma (FFP) for volume replacement may be considered.
  • May interact with a number of other drugs including other anticoagulants and NSAIDs, drugs metabolized through CYP 3A4, hormonal agents, St John's Wort, and omega 3 fatty acids.
  • There is currently no generic version of apixaban, only the brand, Eliquis, which is expensive.

Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.

Bottom Line

Apixaban reduces the clotting ability of the blood and is used in the treatment and prevention of a number of medical conditions associated with blood clots. It does not require monitoring; however, there is currently no antidote if severe bleeding occurs, although supportive measures (such as fresh frozen plasma) may help restore blood volume.

Tips

  • May be taken with or without food.
  • Tablets may be crushed and mixed with water or apple juice/sauce to make swallowing easier. Swallow mixture straight away and do not save for later use.
  • Apixaban is usually dosed twice daily. Check with your doctor what dosage is recommended for you. Take exactly as directed.
  • Tell all healthcare providers that you are taking Apixaban. Apixaban may need to be temporarily discontinued at least 48 hours prior to surgery that carries a moderate-to-high risk of unacceptable or clinically significant bleeding; 24 hours before surgery with a low risk of bleeding or if bleeding likely to be noncritical. Bridging therapy is not usually required and apixaban should be re-started once the risk of bleeding post-surgery has returned to normal.
  • Apixaban may also increase your risk of bleeding from a minor fall or bump on the head. Contact your doctor if you experience an injury or have bleeding that will not stop. Call 911 if you experience severe or unstoppable bleeding, pink or brown urine, red or black tar-like stools, coughing or vomiting up blood or blood clots (may look like coffee grounds). Also seek urgent medical help with any symptoms of a stroke (such as sudden dizziness, headache or loss of vision; difficulty with speech or slurring of your words, one-sided facial drooping) or signs of a blood clot (sudden, severe shortness of breath; pain, heat or swelling in a limb).
  • Your doctor may require you to undertake extra monitoring when switching to or from apixaban.
  • Do not stop taking apixaban suddenly. Your doctor will advise you on how to discontinue apixaban when or if you no longer require it.
  • Talk to your doctor or pharmacist before taking any other medication with apixaban, including that bought over-the-counter to check that it is compatible.

Response and Effectiveness

  • Peak concentrations of apixaban appear within 3 to 4 hours of an oral dose. Absorption is not affected by food or by crushing the tablets but the rate of absorption is reduced at higher dosages.
  • Effect on blood clotting factors happens within a few hours of taking a single dose of apixaban. When apixaban is stopped, its effect on clotting begins to wear off within 24 hours.

References

  • Apixaban. Drugs.com https://www.drugs.com/ppa/apixaban.html
  • Cabral KP, Ansell JE. The role of factor Xa inhibitors in venous thromboembolism treatment. Vascular Health and Risk Management. 2015;11:117-123. doi:10.2147/VHRM.S39726.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use apixaban only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that this information is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This drug information does not endorse drugs, diagnose patients or recommend therapy. It is an informational resource designed as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of this information. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2017 Drugs.com. Revision Date: 2017-11-17 01:02:45

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