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Apixaban Uses, Dosage, Side Effects & Interactions Overview
Key Points About Apixaban
Apixaban is a prescription blood thinner used to prevent blood clots and lower the risk of stroke in patients with certain heart conditions. It is commonly prescribed for atrial fibrillation, deep vein thrombosis (DVT), and pulmonary embolism (PE). Apixaban works by inhibiting specific proteins in the blood that are involved in clotting. Always consult your healthcare provider before starting or adjusting your dose. Our telemedicine providers are available to assist you with any questions or concerns.
Apixaban Medication Names
US Brand Name: Eliquis (Apixaban)
The generic name refers to the active ingredient, while the brand name is the marketed version. The generic name is listed in parentheses.
Pharmacologic Category of Apixaban
Factor Xa Inhibitors
Anticoagulants
Apixaban Dosage and Uses
Apixaban is prescribed to treat and prevent conditions related to blood clots. The dosage may vary depending on the condition being treated. Always follow your healthcare provider’s instructions and consult them before making any changes to your dose. You can also schedule a telemedicine appointment with one of our providers for further guidance.
Apixaban for Atrial Fibrillation (AFib)
Indication: To reduce the risk of stroke and blood clots in patients with nonvalvular atrial fibrillation.
Dosage: 5 mg orally twice daily.
Duration: Long-term treatment.
Special Considerations: For patients over 80 years old, weighing less than 60 kg, or with kidney problems, the dose may be reduced to 2.5 mg twice daily.
Apixaban for Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)
Indication: Treatment of DVT and PE, and to reduce the risk of recurrence.
Dosage: 10 mg orally twice daily for the first 7 days, followed by 5 mg twice daily.
Duration: Typically 6 months, but may vary based on individual risk factors.
Apixaban for Stroke Prevention
Indication: To reduce the risk of stroke in patients with atrial fibrillation.
Dosage: 5 mg orally twice daily.
Duration: Long-term treatment.
Apixaban for Myocardial Infarction (Heart Attack) and Thrombosis
Indication: To reduce the risk of blood clots in patients with a history of heart attack or thrombosis.
Dosage: 2.5 mg orally twice daily.
Duration: Long-term treatment.
Apixaban for Venous Thromboembolism (VTE)
Indication: Prevention of VTE in patients undergoing surgery or at risk for blood clots.
Dosage: 2.5 mg orally twice daily.
Duration: Typically 12 days for knee replacement surgery or 35 days for hip replacement surgery.
Apixaban for Coronary Artery Disease (CAD) and Peripheral Artery Disease (PAD)
Indication: To reduce the risk of major cardiovascular events in patients with CAD or PAD.
Dosage: 2.5 mg orally twice daily, in combination with aspirin.
Duration: Long-term treatment.
Heart Valve Replacement and Apixaban
Indication: Apixaban is not typically recommended for patients with mechanical heart valves. Consult your healthcare provider for alternative treatments.
Apixaban Dosage Forms and Strengths
Tablets: 2.5 mg, 5 mg
How to Take Apixaban: Administration Instructions
Take Apixaban exactly as prescribed by your healthcare provider. It can be taken with or without food. If you miss a dose, take it as soon as you remember, but do not take two doses at once. Swallow the tablet whole with water. Do not crush, chew, or break the tablet. If you have difficulty swallowing pills, speak with your healthcare provider about alternative options.
Apixaban Contraindications
A contraindication is a specific situation where a treatment or medication should not be used because it may cause harm. Below is a list of common contraindications for Apixaban and why it is not recommended in these cases:
- Active bleeding: Apixaban is a blood thinner, so taking it during active bleeding (such as from an injury or internal bleeding) can worsen the condition.
- Severe liver disease: Apixaban is processed by the liver. If your liver is not functioning properly, the medication may not be broken down correctly, increasing the risk of bleeding or other complications.
- Allergy to Apixaban: If you have had an allergic reaction to Apixaban or any of its ingredients, you should not take it again, as this could lead to serious allergic reactions, such as difficulty breathing or swelling.
- Artificial heart valves: Apixaban is not recommended for patients with artificial heart valves because it has not been shown to be effective in preventing blood clots in these patients, and other anticoagulants may be more appropriate.
- Pregnancy: Apixaban is not typically recommended during pregnancy due to potential risks to the fetus (see more details below).
Apixaban Drug Interactions
Apixaban can interact with other medications, which may increase the risk of bleeding or affect how well the medication works. If you are taking any of the following medications, inform your healthcare provider:
- Rifampin (Rifadin): This antibiotic can reduce the effectiveness of Apixaban by increasing the breakdown of the drug in your body.
- Ketoconazole (Nizoral): This antifungal medication can increase the levels of Apixaban in your blood, raising the risk of bleeding.
- Carbamazepine (Tegretol): This seizure medication can reduce the effectiveness of Apixaban by speeding up its metabolism.
- Phenytoin (Dilantin): Another seizure medication that can decrease the effectiveness of Apixaban by increasing its breakdown.
- St. John’s Wort: This herbal supplement can reduce the effectiveness of Apixaban by increasing its breakdown in the liver.
- Clarithromycin (Biaxin): This antibiotic can increase the levels of Apixaban in your blood, raising the risk of bleeding.
Apixaban in Pregnancy
Is it safe to take Apixaban when pregnant?
Apixaban, a commonly prescribed anticoagulant, is generally not recommended during pregnancy. While research on its safety in pregnant women is limited, animal studies suggest potential risks to the developing fetus. If you are pregnant or planning to become pregnant, it is crucial to discuss alternative treatments with your healthcare provider. In some cases, other anticoagulants, such as heparin, may be safer options during pregnancy.
Apixaban while Breastfeeding
Is it safe to take Apixaban while breastfeeding?
There is limited information on whether Apixaban passes into breast milk. Due to the potential for serious side effects in nursing infants, it is generally advised to avoid breastfeeding while taking Apixaban. If you are breastfeeding and require anticoagulation therapy, consult your healthcare provider to explore safer alternatives for both you and your baby.
Estimated Cost of Apixaban Medication
The cost of a 30-day supply of Apixaban (Eliquis) without insurance can vary. However, with a GoodRx coupon, the price typically ranges from $500 to $600 for a standard dose. Prices may fluctuate depending on your location and pharmacy, so it’s advisable to check for the most up-to-date pricing before purchasing your Apixaban prescription.
Possible Alternatives to Apixaban
If Apixaban is unsuitable due to contraindications, side effects, or other reasons, alternative treatments and lifestyle changes may help manage your condition. Always consult your healthcare provider before making any changes to your treatment plan. You can also schedule a telemedicine appointment with one of our providers to discuss these options in more detail.
Alternatives for Atrial Fibrillation
For atrial fibrillation, alternatives to Apixaban include other anticoagulants like warfarin (Coumadin) or dabigatran (Pradaxa). Additionally, lifestyle changes such as reducing alcohol intake, managing high blood pressure, and maintaining a healthy weight can help manage atrial fibrillation.
Alternatives for Deep Vein Thrombosis (DVT)
For deep vein thrombosis (DVT), alternatives to Apixaban include anticoagulants like rivaroxaban (Xarelto) or enoxaparin (Lovenox). Compression stockings and regular exercise can also help prevent DVT.
Alternatives for Pulmonary Embolism (PE)
For pulmonary embolism (PE), alternatives include anticoagulants such as heparin or warfarin. Staying active and avoiding long periods of immobility can also help reduce the risk of PE.
Alternatives for Stroke Prevention
For stroke prevention, alternatives to Apixaban include aspirin or clopidogrel (Plavix). Managing risk factors such as high blood pressure, diabetes, and high cholesterol is also essential for reducing stroke risk.
Alternatives for Myocardial Infarction (Heart Attack)
For those at risk of myocardial infarction (heart attack), alternatives include medications like aspirin, beta-blockers, and statins. Lifestyle changes such as quitting smoking, eating a heart-healthy diet, and exercising regularly can also reduce the risk of heart attacks.
Alternatives for Thrombosis
For thrombosis, alternatives to Apixaban include anticoagulants like warfarin or low-molecular-weight heparin. Staying active and maintaining a healthy weight can help reduce the risk of thrombosis.
Alternatives for Venous Thromboembolism (VTE)
For venous thromboembolism (VTE), alternatives include anticoagulants like rivaroxaban or warfarin. Regular physical activity and avoiding long periods of sitting can help prevent VTE.
Alternatives for Coronary Artery Disease (CAD)
For coronary artery disease (CAD), alternatives to Apixaban include medications like aspirin, statins, and beta-blockers. Lifestyle changes such as quitting smoking, eating a healthy diet, and exercising regularly are crucial for managing CAD.
Alternatives for Peripheral Artery Disease (PAD)
For peripheral artery disease (PAD), alternatives include medications like cilostazol (Pletal) or aspirin. Regular exercise, particularly walking, and quitting smoking can also help manage PAD.
Alternatives for Heart Valve Replacement
For patients with mechanical heart valves, warfarin is typically preferred over Apixaban. It is essential to discuss with your healthcare provider which anticoagulant is best for your specific situation.
Recent Updates on Apixaban Research
Recent studies continue to explore the safety and efficacy of Apixaban in various patient populations. One ongoing area of research is the use of Apixaban in patients with cancer-associated thrombosis, where it may offer a more convenient alternative to traditional anticoagulants like low-molecular-weight heparin. Additionally, studies are investigating the use of Apixaban in patients with chronic kidney disease, as this population is at higher risk for both clotting and bleeding complications. As always, it’s important to stay informed about the latest research and discuss any new findings with your healthcare provider.
