ā/piks’ ə/ban

Brand Name: Eliquis®

• Generic Available

Common Dosage Forms:

  • Tablets: 2.5 mg and 5 mg

FDA Indications/Dosages:

  • For the reduction of risk of stroke and systemic embolism in nonvalvular atrial fibrillation: 5 mg twice daily. Use 2.5 mg twice daily in patients with 2 of the following; age ≥80 years, weight ≤60kg, or serum creatinine ≥1.5 mg/dL.
  • For prophylaxis of DVT following hip or knee replacement surgery: 2.5 mg twice daily.
  • For the treatment of DVT and PE: 10 mg twice daily for 7 days followed by 5 mg twice daily.
  • Reduction in the risk of recurrent DVT and PE following initial therapy: 2.5 mg twice daily.

Pharmacology/Pharmacokinetics:

Apixaban is a selective inhibitor of Factor Xa (FXa). Through inhibition of FXa, apixaban decreases thrombin and thrombus formation. Oral bioavailability is approximately 50% with no affect from food. Cmax occurs about 3 to 4 hours post oral dose and with an apparent half- life of 12 hours. Metabolism occurs in the liver primarily via CYP3A4. Renal elimination accounts for about 27% of the total clearance.

Drug Interactions:

Apixaban exposure is increased by strong dual inhibitors of CYP3A4 and P-gp such as keto- conazole, itraconazole, ritonavir, or clar- ithromycin. Exposure is decreased by CYP3A4 inducers such as rifampin, carbamazepine, phenytoin, and St. John’s wort. Coadministration with anticoagulants and antiplatelets increases the risk of bleeding adverse effects.

Contraindications/Precautions:

Contraindicated in patients with active pathological bleeding. PREMATURE DISCONTINUATION OF THERAPY INCREASES THE RISK OF THROMBOTIC EVENTS. USE CAUTION IN PATIENTS UNDERGOING SPINAL/EPIDURAL  ANESTHESIA,  ESPECIALLY THOSE WITH INDWELLING EPIDURAL CATHETERS. Not recommended for use in patients with prosthetic heart valves. Pregnancy Category B.

Adverse Effects:

Adverse effects are uncommon and are primarily composed of bleeding events such as contusion, hemorrhage, hematoma, and gingival bleeding.

Patient Consultation:

  • May be taken without regard to food.
  • Do not discontinue use without consulting your physician.
  • Inform your physician of any upcoming surgical procedures.
  • Do not take aspirin, NSAIDs, or other drugs that increase your risk of bleeding.
  • Contact your physician if you experience any signs or symptoms of unusual bleeding such as nose bleeds, bleeding gums, pink or brown urine, red or black stools, coughing or vomiting blood, or headaches or dizziness.
  • If you miss a dose, take it as soon as possible. If is about time for your next dose, skip the missed dose and return to your normal dosing schedule. Do not double doses.