apixaban (Rx)

Brand and Other Names:Eliquis
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 2.5mg
  • 5mg

Stroke Prophylaxis with Atrial Fibrillation

To prevent stroke and systemic embolism in nonvalvular atrial fibrillation

5 mg PO BID

Renal impairment (nonvalvular atrial fibrillation)

  • Mild-to-moderate: No dosage adjustment required
  • Serum creatinine ≥1.5 mg/dL: Decrease dose to 2.5 mg BID if patient has 1 additional characteristic of age ≥80 years or weight ≤60 kg
  • ESRD maintained on hemodialysis: 5 mg BID; decrease dose to 2.5 mg BID if 1 additional characteristic of age ≥80 years or weight ≤60 kg is present

Postoperative Prophylaxis of DVT/PE

Indicated following hip or knee replacement surgery

Initial: Give 2.5 mg PO 12-24 hr after surgery

Duration of therapy (hip replacement): 2.5 mg PO BID for 35 days

Duration of therapy (knee replacement): 2.5 mg PO BID for 12 days

Renal impairment, including with ESRD on dialysis

  • Deep Vein Thrombosis: No dose adjustment recommended; not studied in ESRD on dialysis or patients with a CrCl <15 mL/min; dosing recommendations based on pharmacokinetic and pharmacodynamic (anti-FXa activity) data in study subjects with ESRD maintained on dialysis

DVT or PE Treatment

Indicated for treatment of deep venous thrombosis (DVT) and pulmonary embolism (PE)

10 mg PO BID x 7 days, then 5 mg BID

Reduce risk for recurrent DVT or PE

  • Indicated to reduce the risk of recurrent DVT and PE following initial 6 months treatment for DVT and/or PE
  • 2.5 mg PO BID

Renal impairment, including with ESRD

  • Deep Vein Thrombosis: No dose adjustment recommended; not studied in ESRD on dialysis or patients with a CrCl <15 mL/min; dosing recommendations based on pharmacokinetic and pharmacodynamic (anti-FXa activity) data in study subjects with ESRD maintained on dialysis

Dosage Modifications

Coadministration with dual inhibitors of CYP3A4 and P-gp

  • If taking >2.5 PO BID, decrease dose by 50%
  • If taking 2.5 mg BID, avoid coadministration with strong dual inhibitors

Nonvalvular atrial fibrillation

  • Decrease dose to 2.5 mg PO BID in patients with any 2 of the following characteristics:
  • Age ≥80 years
  • Weight ≤60 kg
  • Serum creatinine ≥1.5 mg/dL

Hepatic impairment

  • Mild: No dosage adjustment required
  • Moderate: Patients may have intrinsic coagulation abnormalities; data are limited and no recommendations are available
  • Severe: Not recommended

Dosing Considerations

Switching between apixaban and anticoagulants other than warfarin: Discontinue one being taken, and begin the other at the next scheduled dose

Switching from warfarin to apixaban: Discontinue warfarin and initiate apixaban when INR <2.0

Switching from apixaban to warfarin

  • Apixaban affects INR, so measurements during coadministration with warfarin may not determine appropriate warfarin dose
  • If continuous anticoagulation is necessary, discontinue apixaban and begin both a parenteral anticoagulant and warfarin at the time the next dose of apixaban would have been taken
  • Discontinue parenteral anticoagulant when INR reaches an acceptable level

Surgery/procedures

  • Discontinue at least 48 hr before elective surgery or invasive procedures with a moderate or high risk of unacceptable or clinically significant bleeding
  • Discontinue at least 24 hr before elective surgery or invasive procedures with low risk of unacceptable bleeding or where bleeding would be noncritical in location and easily controlled

Safety and efficacy not established

Next:

Interactions

Interaction Checker

and apixaban

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      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (15)

            • betrixaban

              apixaban, betrixaban. Either increases levels of the other by anticoagulation. Contraindicated. Therapeutic duplication; may use temporarily when switching anticoagulants.

            • carbamazepine

              carbamazepine will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Reduces anticoagulant effect by decreasing apixaban systemic exposure

            • defibrotide

              defibrotide increases effects of apixaban by pharmacodynamic synergism. Contraindicated. Coadministration of defibrotide is contraindicated with antithrombotic/fibrinolytic drugs. This does not include use for routine maintenance or reopening of central venous lines.

            • dexamethasone

              dexamethasone will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Reduces anticoagulant effect by decreasing apixaban systemic exposure

            • fondaparinux

              fondaparinux and apixaban both increase anticoagulation. Contraindicated. Avoid concurrent use of rivaroxaban with other anticoagulants due to increased bleeding risk other than during therapeutic transition periods where patients should be observed closely. Monitor for signs/symptoms of blood loss.

            • fosphenytoin

              fosphenytoin will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Reduces anticoagulant effect by decreasing apixaban systemic exposure

            • mifepristone

              mifepristone increases toxicity of apixaban by anticoagulation. Contraindicated.

            • omacetaxine

              omacetaxine increases toxicity of apixaban by anticoagulation. Contraindicated.

            • phenytoin

              phenytoin will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Reduces anticoagulant effect by decreasing apixaban systemic exposure

            • prothrombin complex concentrate, human

              apixaban, prothrombin complex concentrate, human. pharmacodynamic antagonism. Contraindicated.

            • rifabutin

              rifabutin will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Reduces anticoagulant effect by decreasing apixaban systemic exposure

            • secobarbital

              secobarbital will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • St John's Wort

              St John's Wort will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Reduces anticoagulant effect by decreasing apixaban systemic exposure

            • vorapaxar

              vorapaxar increases toxicity of apixaban by anticoagulation. Contraindicated.

            • warfarin

              warfarin and apixaban both increase anticoagulation. Contraindicated.

            Serious - Use Alternative (71)

            • abametapir

              abametapir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

            • abciximab

              abciximab and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • alteplase

              alteplase and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • anagrelide

              anagrelide and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • antithrombin alfa

              antithrombin alfa and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • apalutamide

              apalutamide will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

            • argatroban

              argatroban and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • atazanavir

              atazanavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • bivalirudin

              bivalirudin and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • celecoxib

              celecoxib and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • cilostazol

              cilostazol and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • clopidogrel

              clopidogrel and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • conivaptan

              conivaptan will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • dabigatran

              dabigatran and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • dalteparin

              dalteparin and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • darunavir

              darunavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If taking apixaban dose >2.5 mg BID, decrease dose by 50% if coadministered with strong dual inhibitors of CYP3A4 and P-gp; if currently taking apixaban 2.5 mg PO BID, avoid coadministration with strong dual inhibitors of CYP3A4 and P-gp

            • desirudin

              desirudin and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • desvenlafaxine

              desvenlafaxine and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • diclofenac

              diclofenac and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • dipyridamole

              dipyridamole and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • duloxetine

              duloxetine and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • edoxaban

              edoxaban, apixaban. Either increases toxicity of the other by anticoagulation. Avoid or Use Alternate Drug. Both drugs have the potential to cause bleeding, monitor closely. Promptly evaluate any signs or symptoms of blood loss. Long-term concomitant treatment with edoxaban and other anticoagulants is not recommended. Short-term coadministration may be needed for patients transitioning to or from edoxaban.

            • enoxaparin

              enoxaparin and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • enzalutamide

              enzalutamide will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • eptifibatide

              eptifibatide and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • etodolac

              etodolac and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • Factor X, human

              apixaban will decrease the level or effect of Factor X, human by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Based on the mechanism of action, Factor X is likely to be counteracted by direct and indirect Factor Xa inhibitors.

            • fenoprofen

              fenoprofen and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • fexinidazole

              fexinidazole will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

            • flurbiprofen

              flurbiprofen and apixaban both decrease anticoagulation. Avoid or Use Alternate Drug.

            • heparin

              heparin and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • ibuprofen

              ibuprofen and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • ibuprofen IV

              ibuprofen IV and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • idelalisib

              idelalisib will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

            • indomethacin

              indomethacin and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • ivosidenib

              ivosidenib will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

            • ketoconazole

              ketoconazole will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If taking apixaban dose >2.5 mg BID, decrease dose by 50% if coadministered with strong dual inhibitors of CYP3A4 and P-gp; if currently taking apixaban 2.5 mg PO BID, avoid coadministration with strong dual inhibitors of CYP3A4 and P-gp

            • ketoprofen

              ketoprofen and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • ketorolac

              ketorolac and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • lasmiditan

              lasmiditan increases effects of apixaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

            • levomilnacipran

              levomilnacipran, apixaban. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. SNRIs may further impair platelet activity in patients taking antiplatelet or anticoagulant drugs.

            • lonafarnib

              lonafarnib will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.

            • meclofenamate

              meclofenamate and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • mefenamic acid

              mefenamic acid and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • meloxicam

              meloxicam and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • milnacipran

              milnacipran and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • nabumetone

              nabumetone and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • naproxen

              naproxen and apixaban both decrease anticoagulation. Avoid or Use Alternate Drug.

            • nelfinavir

              nelfinavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If taking apixaban dose >2.5 mg BID, decrease dose by 50% if coadministered with strong dual inhibitors of CYP3A4 and P-gp; if currently taking apixaban 2.5 mg PO BID, avoid coadministration with strong dual inhibitors of CYP3A4 and P-gp

            • oxaprozin

              oxaprozin and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • phenobarbital

              phenobarbital will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • piroxicam

              piroxicam and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • posaconazole

              posaconazole will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If taking apixaban dose >2.5 mg BID, decrease dose by 50% if coadministered with strong dual inhibitors of CYP3A4 and P-gp; if currently taking apixaban 2.5 mg PO BID, avoid coadministration with strong dual inhibitors of CYP3A4 and P-gp

            • prasugrel

              prasugrel and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • primidone

              primidone will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            • protein C concentrate

              protein C concentrate and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • quinidine

              quinidine will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If taking apixaban dose >2.5 mg BID, decrease dose by 50% if coadministered with strong dual inhibitors of CYP3A4 and P-gp; if currently taking apixaban 2.5 mg PO BID, avoid coadministration with strong dual inhibitors of CYP3A4 and P-gp

            • reteplase

              reteplase and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • rifampin

              rifampin will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Rifampin, a combined P-gp and strong CYP3A4 inducer, may decrease exposure to apixaban.

            • ritonavir

              ritonavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If taking apixaban dose >2.5 mg BID, decrease dose by 50% if coadministered with strong dual inhibitors of CYP3A4 and P-gp; if currently taking apixaban 2.5 mg PO BID, avoid coadministration with strong dual inhibitors of CYP3A4 and P-gp

            • rivaroxaban

              rivaroxaban and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • saquinavir

              saquinavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If taking apixaban dose >2.5 mg BID, decrease dose by 50% if coadministered with strong dual inhibitors of CYP3A4 and P-gp; if currently taking apixaban 2.5 mg PO BID, avoid coadministration with strong dual inhibitors of CYP3A4 and P-gp

            • sotorasib

              sotorasib will decrease the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.

            • sulindac

              sulindac and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • tenecteplase

              tenecteplase and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • tepotinib

              tepotinib will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling.

            • ticlopidine

              ticlopidine and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • tirofiban

              tirofiban and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • tolmetin

              tolmetin and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • venlafaxine

              venlafaxine and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • voxelotor

              voxelotor will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

            Monitor Closely (51)

            • acalabrutinib

              acalabrutinib increases effects of apixaban by anticoagulation. Use Caution/Monitor. Coadministration of acalabrutinib with antiplatelets or anticoagulants may further increase risk of hemorrhage. Monitor for signs of bleeding and consider the benefit-risk of withholding acalabrutinib for 3-7 days presurgery and postsurgery depending upon the type of surgery and the risk of bleeding.

            • aspirin

              aspirin and apixaban both increase anticoagulation. Modify Therapy/Monitor Closely. Both drugs have the potential to cause bleeding. The need for simultaneous use of low-dose aspirin (<100 mg/day) with anticoagulants are common for patients with cardiovascular disease, but may result in increased bleeding; monitor closely. Promptly evaluate any signs or symptoms of blood loss if treated concomitantly with low-dose aspiriin. Avoid coadministration with chronic use of higher dose aspirin. In 1 trial (APPRAISE-2), therapy was terminated because of significantly increased bleeding when apixaban was administered with dual antiplatelet therapy (eg, aspirin plus clopidogrel) compared with single antiplatelet treatment

            • belzutifan

              belzutifan will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.

            • berotralstat

              berotralstat will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor or titrate P-gp substrate dose if coadministered.

            • caplacizumab

              caplacizumab, apixaban. Either increases effects of the other by anticoagulation. Use Caution/Monitor.

            • cenobamate

              cenobamate will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

            • citalopram

              citalopram increases effects of apixaban by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

            • cobicistat

              cobicistat will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

            • crofelemer

              crofelemer increases levels of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

            • dabrafenib

              dabrafenib will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

            • diltiazem

              diltiazem increases levels of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Patients with renal impairment receiving apixaban with drugs that are combined P-gp and weak or moderate CYP3A4 inhibitors may have significant increases in exposure compared with patients with normal renal function and no inhibitor use, since both pathways of apixaban elimination are affected. Since these increases may increase bleeding risk, use apixaban in this situation only if the potential benefit justifies the potential risk.

            • dronedarone

              dronedarone will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dronedarone also inhibits P-gp activity, which can further increase rivaroxaban serum levels; since both pathways of rivaroxaban elimination are affected, patients with renal impairment receiving rivaroxaban with drugs that are combined P-gp and moderate CYP3A4 inhibitors may have significant increases in exposure compared to patients with normal renal function; since the drug combination may increase bleeding risk, monitor closely.

            • efavirenz

              efavirenz will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • elagolix

              elagolix will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              elagolix will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

            • eliglustat

              eliglustat increases levels of apixaban by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.

            • encorafenib

              encorafenib, apixaban. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

            • escitalopram

              escitalopram increases effects of apixaban by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

            • fedratinib

              fedratinib will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

            • fish oil triglycerides

              fish oil triglycerides will increase the level or effect of apixaban by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

            • fluoxetine

              fluoxetine increases effects of apixaban by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

            • fluvoxamine

              fluvoxamine increases effects of apixaban by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

            • glecaprevir/pibrentasvir

              glecaprevir/pibrentasvir will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely.

            • ibrutinib

              ibrutinib will increase the level or effect of apixaban by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.

            • iloperidone

              iloperidone increases levels of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

            • imatinib

              imatinib, apixaban. Either increases toxicity of the other by Other (see comment). Modify Therapy/Monitor Closely. Comment: Imatinib may cause thrombocytopenia; bleeding risk increased when imatinib is coadministered with anticoagulants, NSAIDs, platelet inhibitors, and thrombolytic agents; patients requiring anticoagulation while on imatinib should receive LMWH or unfractionated heparin instead of warfarin because of multiple interaction mechanisms of imatinib with warfarin.

            • indinavir

              indinavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • istradefylline

              istradefylline will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

              istradefylline will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.

            • itraconazole

              itraconazole will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Apixaban is a both CYP3A4 and P-gp substrate. For patients receiving apixaban 5 or 10 mg BID, decrease apixaban dose by 50% when coadministered with drugs that are both P-gp and strong CYP3A4 inhibitors. For patients receiving apixaban 5 mg BID, avoid coadministration with combined P-gp and strong CYP3A4 inhibitors.

            • lonafarnib

              lonafarnib will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Lonafarnib is a weak P-gp inhibitor. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. Reduce P-gp substrate dose if needed.

            • lopinavir

              lopinavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • lorlatinib

              lorlatinib will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • melatonin

              melatonin increases effects of apixaban by anticoagulation. Use Caution/Monitor. Melatonin may decrease prothrombin time.

            • mifepristone

              mifepristone will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce apixaban dose by 50% when mifepristone used for treatment of Cushing's disease or other hormonal conditions; if patients are already receiving 2.5 mg twice daily, avoid coadministration

            • mitotane

              mitotane decreases levels of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

            • nefazodone

              nefazodone will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • nintedanib

              nintedanib increases effects of apixaban by anticoagulation. Use Caution/Monitor. Nintedanib is a VEGFR inhibitor, and may increase the risk of bleeding; monitor patients on full anticoagulation therapy; monitor closely for bleeding and adjust therapy as needed .

            • paroxetine

              paroxetine increases effects of apixaban by anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

            • ribociclib

              ribociclib will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rucaparib

              rucaparib will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

            • sarecycline

              sarecycline will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.

            • saw palmetto

              saw palmetto increases toxicity of apixaban by unspecified interaction mechanism. Use Caution/Monitor. May increase risk of bleeding.

            • sertraline

              sertraline and apixaban both increase anticoagulation. Use Caution/Monitor. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants.

            • stiripentol

              stiripentol, apixaban. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.

              stiripentol will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

            • tazemetostat

              tazemetostat will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tecovirimat

              tecovirimat will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

            • tipranavir

              tipranavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tucatinib

              tucatinib will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.

            • verapamil

              verapamil will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Verapamil also inhibits P-gp activity, which can further increase apixaban serum levels; since both pathways of apixaban elimination are affected, patients with renal impairment receiving apixaban with drugs that are combined P-gp and moderate CYP3A4 inhibitors may increase exposure compared to patients with normal renal function; monitor for bleeding.

            • voriconazole

              voriconazole will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • vortioxetine

              vortioxetine and apixaban both increase anticoagulation. Use Caution/Monitor.

            • zanubrutinib

              apixaban, zanubrutinib. Either increases effects of the other by anticoagulation. Modify Therapy/Monitor Closely. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.

            Minor (1)

            • clarithromycin

              clarithromycin will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. Although clarithromycin is a combined P-gp and strong CYP3A4 inhibitor, the manufacturer has stated that pharmacokinetic data suggest that no dose adjustment is necessary with concomitant administration

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            Adverse Effects

            Bleeding (Aristotle Study)

            Major (2.13%, warfarin 3.09%; P <0.0001)

            GI (0.83%, warfarin 0.93%)

            Intracranial (0.33%, warfarin 0.82%)

            Intraocular (0.06%, warfarin 0.14%)

            Fatal (0.06%, warfarin 0.24%)

            Clinically relevant nonmajor bleeding (2.08%, warfarin 3.0%; P <0.0001)

            Bleeding (Averroes Study)

            Major (1.41%, aspirin 0.92%; P = 0.07)

            Fatal (0.16%, aspirin 0.16%)

            Intracranial (0.34%, aspirin 0.35%)

            <1%

            Hypersensitivity reactions (including skin rash and anaphylactic reactions such as allergic edema)

            Syncope

            Postmarketing Reports

            Blood and lymphatic system disorders: Thrombocytopenia (including platelet count decreases)

            Vascular disorders: Hypotension (including procedural hypotension)

            Respiratory, thoracic, and mediastinal disorders: Epistaxis

            Gastrointestinal disorders: Gastrointestinal hemorrhage (including hematemesis and melena), hematochezia

            Hepatobiliary disorders: Liver function test abnormal, blood alkaline phosphatase increased, blood bilirubin increased

            Renal and urinary disorders: Hematuria (including respective laboratory parameters)

            Injury, poisoning, and procedural complications: Wound secretion, incision-site hemorrhage (including incision-site hematoma), operative hemorrhage

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            Warnings

            Black Box Warnings

            Discontinuing in patients with nonvalvular atrial fibrillation

            • Premature discontinuation of any oral anticoagulant, including, apixaban, increases risk of thrombotic events; consider using another anticoagulant if anticoagulation with apixaban is discontinued for a reason other than pathological bleeding or completion of a course of therapy
            • An increased rate of stroke was observed following discontinuation of apixaban in clinical trials in patients with nonvalvular atrial fibrillation
            • If anticoagulation with apixaban must be discontinued for a reason other than pathological bleeding, coverage with another anticoagulant should be strongly considered (see Dosing Considerations)

            Spinal/epidural hematoma

            • Increased risk of epidural or spinal hematoma when used with neuraxial anesthesia (epidural/spinal anesthesia) or spinal puncture (can result in long-term or permanent paralysis)
            • Risk increased with indwelling epidural catheters for administration of analgesia or by the concomitant use of drugs affecting hemostasis (eg, NSAIDs, platelet aggregation inhibitors, other anticoagulants)
            • Risk also increased by traumatic or repeated epidural or spinal puncture; if this occurs, delay apixaban administration for 48 hr
            • Monitor patients for signs and symptoms of neurologic impairment; if neurologic compromise is noted, urgent treatment is necessary
            • Indwelling epidural or intrathecal catheters should not be removed earlier than 24 hr after the last administration of apixaban; the next apixaban dose should not be administered earlier than 5 hr after the removal of the catheter
            • Consider the potential benefit versus risk before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis

            Contraindications

            Severe hypersensitivity (ie, anaphylactic reactions)

            Active pathological bleeding

            Cautions

            Discontinuing apixaban in the absence of adequate alternative anticoagulation increases the risk of thrombotic events (see Black Box Warnings)

            Risk of epidural or spinal hematoma when used with neuraxial anesthesia (see Black Box Warnings)

            Safety and efficacy has not been studied in patients with prosthetic heart valves; therefore, use of is not recommended in these patients

            Not recommended as an alternative to unfractionated heparin for the initial treatment of PE in patients who present with hemodynamic instability or who may receive thrombolysis or pulmonary embolectomy

            Coadministration with strong dual inhibitors of CYP3A4 and P-gp (see Dosage Modifications)

            Avoid coadministration with strong dual inducers of CYP3A4 and P-gp; such drugs decrease apixaban’s systemic exposure

            Increases the risk of bleeding and can cause serious, potentially fatal, bleeding; advise patients of signs and symptoms of blood loss and to report them immediately or go to an emergency room; discontinue therapy in patients with active pathological hemorrhage

            Coadministration with other drugs that affect hemostasis increases bleeding risk (eg, aspirin and other antiplatelet agents, other anticoagulants, heparin, thrombolytic agents, SSRIs, SNRIs, NSAIDs)

            Prolongs PT and aPTT; however, changes are small and highly variable and are not useful for monitoring anticoagulation effect of apixaban

            Direct-acting oral anticoagulants (DOACs), are not recommended for use in patients with triple-positive antiphospholipid syndrome (APS); for patients with APS (especially those who are triple positive [positive for lupus anticoagulant, anticardiolipin, and anti–beta 2- glycoprotein I antibodies]), treatment with DOACs has been associated with increased rates of recurrent thrombotic events compared with vitamin K antagonist therapy

            Reversing apixaban effect

            • Anticoagulant effect is expected to persist for about 24 hr after the last dose (~2 half-lives)
            • Coagulation factor Xa recombinant, inactivated-zhzo is commercially available for reversal of the anticoagulant effect of apixaban when reversal of anticoagulation is needed because of life-threatening or uncontrolled bleeding
            • Because of high plasma protein binding, apixaban is not expected to be dialyzable
            • Protamine sulfate and vitamin K would not be expected to affect the anticoagulant activity of apixaban
            • There is no experience with antifibrinolytic agents (tranexamic acid, aminocaproic acid) in individuals receiving apixaban
            • There is neither scientific rationale for reversal nor experience with systemic hemostatics (desmopressin and aprotinin) in individuals receiving apixaban
            • Use of procoagulant reversal agents (eg, prothrombin complex concentrate, activated prothrombin complex concentrate, or recombinant factor VIIa) may be considered but has not been evaluated in clinical studies
            • Activated oral charcoal reduces absorption of apixaban, thereby lowering plasma concentration
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            Pregnancy & Lactation

            Pregnancy

            There are no adequate and well-controlled studies in pregnant women

            Treatment is likely to increase the risk of hemorrhage during pregnancy and delivery

            Use of anticoagulants, during pregnancy, may increase risk of bleeding in fetus and neonate

            Pregnancy confers an increased risk of thromboembolism that is higher for women with underlying thromboembolic disease and certain high-risk pregnancy conditions

            Published data describe that women with a previous history of venous thrombosis are at high risk for recurrence during pregnancy

            Therapy should be administered during pregnancy only if the potential benefit outweighs the potential risk to the mother and fetus

            Animal studies

            • Treatment of pregnant rats, rabbits, and mice after implantation until the end of gestation resulted in fetal exposure to apixaban, but was not associated with increased risk for fetal malformations or toxicity

            Labor and delivery

            • All patients receiving anticoagulants, including pregnant women, are at risk for bleeding; use during labor or delivery in women who are receiving neuraxial anesthesia may result in epidural or spinal hematomas; consider use of a shorter acting anticoagulant as delivery approaches
            • Consider the risks of bleeding and of stroke in this setting

            Females of reproductive potential

            • Females of reproductive potential requiring anticoagulation should discuss pregnancy planning with their physician
            • The risk of clinically significant uterine bleeding, potentially requiring gynecological surgical interventions, identified with oral anticoagulants should be assessed in females of reproductive potential and those with abnormal uterine bleeding

            Lactation

            There are no data on presence of drug metabolites in human milk, effects on breastfed child, or the effects on milk production; the drug and/or its metabolites were present in milk of rats

            Rats excrete apixaban in milk (12% of the maternal dose)

            Because human exposure through milk is unknown, instruct women to either discontinue breastfeeding or to discontinue apixaban therapy, taking into account the importance of the drug to the mother

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Factor Xa inhibitor that inhibits platelet activation by selectively and reversibly blocking the active site of factor Xa without requiring a cofactor (eg, antithrombin III) for activity

            Inhibits free and clot-bound factor Xa, and prothrombinase activity; no direct effect on platelet aggregation, but indirectly inhibits platelet aggregation induced by thrombin

            Blood coagulation cascade is dependent on the activation of factor X to factor Xa via the intrinsic and extrinsic pathways, which play a central role in the blood coagulation cascade

            Absorption

            Bioavailability: Displays prolonged absorption Peak Plasma Concentration: 3-4 hr

            Distribution

            Protein Bound: 87%

            Vdss: 21 L

            Metabolism

            Metabolized mainly by CYP3A4

            Metabolized with minor contributions from CYP1A2, 2C8, 2C9, 2C19 and 2J2

            Major sites of biotransformation: O-demethylation and hydroxylation at the 3-oxopirperidinyl moiety

            Metabolites: No active circulating metabolites Substrate of P-gp and BCRP

            Elimination

            Half-life: 5-6 hr (dominant); 12 hr (apparent half-life with repeated dosing)

            Dialyzable: No

            Renal clearance: 27%

            Excretion: 25% in urine and feces as metabolites; renal excretion accounts for 27% of total clearance; biliary and direct intestinal excretion contributes to elimination in feces

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            Administration

            Oral Administration

            May take with or without food

            Missed dose

            • If not taken at the scheduled time, the dose should be taken as soon as possible on the same day and twice daily administration should be resumed
            • Do not double the dose to make up for a missed dose

            Unable to swallow whole tablets

            • 5 mg and 2.5 mg tablets may be crushed and suspended in water, 5% dextrose in water (D5W), or apple juice, or mixed with applesauce and promptly administered orally
            • Alternatively, tablets may be crushed and suspended in 60 mL of water or D5W and promptly delivered through a nasogastric tube
            • Crushed tablets are stable in water, D5W, apple juice, and applesauce for up to 4 hr
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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Eliquis oral
            -
            5 mg tablet
            Eliquis oral
            -
            2.5 mg tablet
            Eliquis DVT-PE Treatment 30-Day Starter oral
            -
            5 mg (74 tabs) tablet

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            apixaban oral

            APIXABAN - ORAL

            (a-PIX-a-ban)

            COMMON BRAND NAME(S): Eliquis

            WARNING: Do not stop taking apixaban unless directed by your doctor. If you stop taking this medication early, you have a higher risk of forming a serious blood clot (such as a stroke, blood clot in the legs/lungs). Your doctor may direct you to take a different "blood thinning" or antiplatelet medication to reduce your risk. Get medical help right away if you have weakness on one side of the body, trouble speaking, sudden vision changes, confusion, chest pain, trouble breathing, pain/warmth/swelling in the legs.People taking this medication may bleed near the spinal cord after certain spinal procedures. Bleeding in this area can cause paralysis that lasts a long time or could become permanent. Ask your doctor about the benefits and risks before any spinal procedure. The risk of bleeding may be higher if you have a deformed spine, or have had spinal procedures/surgery before (such as epidural catheter placement, difficult epidural/spinal puncture), or are taking other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, "blood thinners" such as warfarin/enoxaparin, nonsteroidal anti-inflammatory drugs-NSAIDs such as ibuprofen). Tell your doctor right away if you notice symptoms such as back pain, leg numbness/tingling/weakness, loss of control of the bowels or bladder (incontinence).

            USES: Apixaban is used to prevent serious blood clots from forming due to a certain irregular heartbeat (atrial fibrillation) or after hip/knee replacement surgery. With atrial fibrillation, part of the heart does not beat the way it should. This can lead to blood clots forming, which can travel to other parts of your body (such as the lungs or legs) or increase your risk for stroke. In the United States, apixaban is also approved to treat certain types of blood clots (deep vein thrombosis-DVT, pulmonary embolus-PE) and to prevent them from forming again.Apixaban is an anticoagulant that works by blocking certain clotting proteins in your blood.

            HOW TO USE: See also Warning section.Read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start taking apixaban and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth with or without food as directed by your doctor, usually twice daily (every 12 hours). If you cannot swallow the tablet whole, you may crush the tablet and mix with water, apple juice, or applesauce and take it right away.The dosage is based on your medical condition, age, weight, kidney function, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). If you are taking apixaban to prevent blood clots from forming after surgery, the length of treatment is based on the type of surgery that you had.Do not stop taking this medication without consulting your doctor. Some conditions may become worse when this drug is suddenly stopped. Do not run out of this medication. Order your refills early to avoid running out of pills.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.

            SIDE EFFECTS: See also Warning section.Nausea, easy bruising, or minor bleeding (such as nosebleed, bleeding from cuts) may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication can cause serious bleeding if it affects your blood clotting proteins too much. Tell your doctor right away if you have any signs of serious bleeding, including: unusual pain/swelling/discomfort, unusual bruising, prolonged bleeding from cuts or gums, persistent/frequent nosebleeds, unusually heavy/prolonged menstrual flow, pink/dark urine, coughing up blood, vomit that is bloody or looks like coffee grounds, severe headache, dizziness/fainting, unusual or persistent tiredness/weakness, bloody/black/tarry stools, difficulty swallowing.Get medical help right away if you have any signs of very serious bleeding, including: vision changes, confusion, trouble speaking, weakness on one side of the body.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before taking apixaban, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, kidney disease, bleeding problems (such as bleeding of the stomach/intestines, bleeding in the brain), blood disorders (such as anemia, hemophilia, thrombocytopenia), recent major injury/surgery, stroke, a certain clotting disorder (antiphospholipid syndrome), frequent falls/injuries.Before having surgery or any medical/dental procedures (especially spinal puncture or spinal/epidural anesthesia), tell your doctor or dentist that you are taking this medication and about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). Your doctor or dentist may tell you to stop taking apixaban before your surgery. Ask for specific instructions about stopping or starting this medication.This medication may cause stomach bleeding. Daily use of alcohol while using this medicine will increase your risk for stomach bleeding. Limit alcoholic beverages. Ask your doctor or pharmacist about how much alcohol you may safely drink.This medication can cause bleeding. To lower the chance of getting cut, bruised, or injured, use great caution with sharp objects like safety razors and nail cutters. Use an electric razor when shaving and a soft toothbrush when brushing your teeth. Avoid activities such as contact sports. If you fall or injure yourself, especially if you hit your head, contact your doctor right away. Your doctor may need to check you for hidden bleeding that could be serious.During pregnancy, this medication should be used only when clearly needed. Apixaban may increase the risk of bleeding in the pregnant woman, the unborn baby, and the newborn baby. Discuss the risks and benefits with your doctor. Your doctor may switch the type of medication you use during pregnancy.It is unknown if this medication passes into breast milk. Because of the possible risk to the infant, breast-feeding while using this drug is not recommended. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: mifepristone, other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, "blood thinners" such as warfarin, enoxaparin), certain antidepressants (including SSRIs such as fluoxetine, SNRIs such as desvenlafaxine/venlafaxine).Other medications can affect the removal of apixaban from your body, which may affect how apixaban works. Examples include certain azole antifungals (such as itraconazole, ketoconazole, posaconazole), conivaptan, HIV protease inhibitors (such as lopinavir, ritonavir), rifamycins (such as rifabutin), St. John's wort, drugs used to treat seizures (such as carbamazepine, phenytoin), among others.Check all prescription and nonprescription medicine labels carefully since many medications contain pain relievers/fever reducers (aspirin, NSAIDs such as ibuprofen, naproxen) that may increase your risk for bleeding if taken together with this medication. However, if your doctor has directed you to take low-dose aspirin to prevent heart attack or stroke (usually 81-162 milligrams a day), you should continue taking the aspirin unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: bloody/black/tarry stools, pink/dark urine, unusual/prolonged bleeding.

            NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as hematocrit/hemoglobin, red blood cell count) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

            MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. If you are crushing the tablet and mixing it as directed in water, apple juice, or applesauce, use the mixture within 4 hours of preparing it. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

            Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.