Generic Name and Formulations:
Apixaban 2.5mg, 5mg; tabs.
Bristol-Myers Squibb and Pfizer
To reduce risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (AF). Prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE) in patients who have undergone hip or knee replacement surgery. Treatment of DVT or PE. To reduce risk of recurrent DVT and PE following initial therapy.
Nonvalvular AF: 5mg twice daily. If any two of the following: age ≥80yrs; body weight ≤60kg, serum creatinine ≥1.5mg/dL: 2.5mg twice daily. Prophylaxis of DVT: 2.5mg twice daily; give initial dose at 12–24hrs after surgery. Hip: treat for 35 days. Knee: treat for 12 days. Treatment of DVT, PE: 10mg twice daily for 7 days, then 5mg twice daily. Reduction in risk of recurrence of DVT, PE: 2.5mg twice daily after at least 6 months of DVT or PE treatment. Unable to swallow whole tabs: may crush tabs and suspend in water, D5W, apple juice, or mix with applesauce; alternatively, may crush tabs and suspend in 60mL of water or D5W, then immediately deliver through NG tube. Concomitant strong dual inhibitors of CYP3A4 and P-gp (eg, ketoconazole, itraconazole, ritonavir, clarithromycin): reduce dose by 50%; if already on 2.5mg twice daily, coadministration should be avoided. Switching from warfarin: discontinue warfarin, start Eliquis when INR is <2. Switching from Eliquis to warfarin: discontinue Eliquis and begin both parenteral anticoagulant and warfarin at the time the next dose of Eliquis would have been taken, discontinue parenteral anticoagulant when INR reaches acceptable range. Switching between Eliquis and anticoagulants other than warfarin: discontinue one being taken and begin the other at usual time of next dose. Discontinue at least 48hrs prior to surgery with moderate-to-high risk of bleeding or 24hrs for procedures with low risk of bleeding. Moderate hepatic impairment: dosing recommendation cannot be provided. Severe hepatic impairment: not recommended.
Active pathological bleeding.
Premature discontinuation increases risk of thrombotic events; if discontinued for reason other than bleeding or therapy completion, consider alternative anticoagulant. Risk of spinal/epidural hematoma in anticoagulated patients receiving neuraxial anesthesia or undergoing spinal/epidural puncture (esp. post-op use of indwelling epidural/intrathecal catheters or concomitant drugs affecting hemostasis); monitor for signs/symptoms of neurological impairment. Increased risk of bleeding; evaluate any signs/symptoms of blood loss; discontinue if active pathological hemorrhage occurs. Not recommended as alternative to unfractionated heparin for initial treatment of PE in hemodynamically unstable patients or who require thrombolysis or pulmonary embolectomy. Patients with prosthetic heart valves: not recommended. Labor & delivery. Pregnancy (Cat.B). Nursing mothers: not recommended.
See Adult dose. Potentiated by dual inhibitors of CYP3A4 and P-gp. Antagonized by concomitant strong dual inducers of CYP3A4 and P-gp (eg, rifampin, carbamazepine, phenytoin, St. John’s wort); avoid. Increased risk of bleeding with concomitant aspirin, antiplatelet agents, fibrinolytics, other anticoagulants, heparin, thrombolytic agents, SSRIs, SNRIs, NSAIDs.
Factor Xa inhibitor.
Bleeding (may be serious or fatal), nausea, anemia.
Hepatic (CYP3A4; 1A2, 2C8, 2C9, 2C19, 2J2 [minor]); 87% protein bound.
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