Apixaban, Oral Tablet

Other warnings

• Bleeding risk warning: This drug increases your risk of bleeding. This can be serious or even fatal. This is because this medication is a blood-thinning drug that lowers the risk of blood clots forming in your body. Call your doctor or go to the emergency room right away if you have symptoms of serious bleeding. If needed, a healthcare provider can administer a treatment to reverse the blood-thinning effects of apixaban.
• Symptoms of bleeding to watch for include:
  • unexpected bleeding or bleeding that lasts a long time, such as frequent nosebleeds, unusual bleeding from your gums, menstrual bleeding that’s heavier than normal, or other vaginal bleeding
  • bleeding that’s severe or that you can’t control
  • red-, pink-, or brown-colored urine
  • bright red- or black-colored stools that look like tar
  • coughing up blood or blood clots
  • vomiting blood or vomit that looks like coffee grounds
  • headaches, dizziness, or weakness
  • pain, swelling, or new drainage at wound sites
• Artificial heart valve warning: Don’t use this drug if you have an artificial heart valve. It isn’t known if this drug will work for you.
• Medical or dental procedure risk warning: You may need to temporarily stop taking this drug before a surgery or medical or dental procedure. Your doctor will tell you how to stop taking it and when you can start taking it again. While the drug is stopped, your doctor may prescribe another drug to help keep blood clots from forming.
• Antiphospholipid syndrome (APS) warning: If you have triple-positive APS, this drug will increase your risk of developing blood clots. If you have APS, you shouldn’t use this drug.

Apixaban is a prescription drug. It comes as an oral tablet.

Apixaban is available as the brand-name drug Eliquis. It’s not available as a generic drug.

Why it’s used

Apixaban is used to:

• lower your risk of blood clots and stroke if you have atrial fibrillation without an artificial heart valve
• prevent deep vein thrombosis (blood clot in your legs) or pulmonary embolism (blood clot in your lungs) after hip or knee replacement surgery
• prevent another occurrence of deep vein thrombosis (DVT) or pulmonary embolism (PE) in people with a history or DVT or PE
• treat DVT or PE

How it works

Apixaban belongs to a class of drugs called anticoagulants, specifically factor Xa blockers. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Apixaban is a blood thinner and helps to prevent blood clots from forming in your body. It does this by blocking the substance factor Xa, which in turn decreases the amount of the enzyme thrombin in your blood. Thrombin is a substance that causes platelets in your blood to stick to one another, causing clots to form. When thrombin is decreased, this prevents a clot (thrombus) from forming in your body.

Apixaban oral tablet doesn’t cause drowsiness, but it can cause other side effects.

More common side effects

The more common side effects that can occur with apixaban include:

• Bleeding. Symptoms may include:
  • nosebleeds
  • bruising more easily
  • heavy menstrual bleeding
  • bleeding of your gums when you brush your teeth

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Serious bleeding. This can be deadly, symptoms can include:
  • unexpected bleeding or bleeding that lasts a long time (including unusual bleeding from your gums, nosebleeds that happen often, or heavy menstrual bleeding)
  • bleeding that is severe or uncontrollable
  • red-, pink-, or brown-colored urine
  • red- or black-colored, tarry stools
  • coughing up blood or blood clots
  • vomiting blood or vomit that looks like coffee grounds
  • unexpected pain or swelling
  • headaches, dizziness, or weakness
• Spinal or epidural blood clots. If you take apixaban and have another drug injected into your spine, or if you have a spinal puncture, you may be at risk of a spinal or epidural blood clot. This can lead to permanent paralysis. Symptoms can include:
  • tingling, numbness, or muscle weakness, especially in your legs and feet
  • loss of control of your bladder or bowels

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Apixaban oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with apixaban are listed below.

Anticoagulant or antiplatelet drugs

Using apixaban with other drugs from the same class increases your risk of bleeding. Examples of these other drugs include:

• warfarin
• heparin
• aspirin
• clopidogrel
• nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen

Drugs that inhibit CYP3A4 and P-glycoprotein

Apixaban is processed by certain enzymes in your liver (known as CYP3A4) and transporters in the gut (known as P-gp). Medications that block these enzymes and transporters increase the amount of apixaban in your body. This puts you at greater risk of bleeding. If you need to take apixaban with one of these drugs, your doctor may lower your dosage of apixaban or prescribe a different drug.

Examples of these drugs include:

• ketoconazole
• itraconazole
• ritonavir

Drugs that induce CYP3A4 and P-glycoprotein

Apixaban is processed by certain enzymes in your liver (known as CYP3A4) and transporters in the gut (known as P-gp). Medications that increase the activity of these liver enzymes and gut transporters decrease the amount of apixaban in your body. This puts you at greater risk of stroke or other blood-clotting events. You shouldn’t take apixaban with these medications.

Examples of these drugs include:

• rifampin
• carbamazepine
• phenytoin
• St. John’s wort

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you’re taking.

This drug comes with several warnings.

Allergy warning

This drug can cause a severe allergic reaction. Symptoms can include:

• chest pain or tightness
• swelling of your face or tongue
• trouble breathing or wheezing
• feeling dizzy or faint

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Warnings for people with certain health conditions

For people with liver problems: If you have severe liver problems, you shouldn’t take this drug. This drug is processed by your liver. If your liver isn’t working well, more of the drug may stay in your body. This puts you at risk of more side effects.

For people with kidney problems: If you have severe kidney problems, you may need a lower dosage of this drug. If your kidneys aren’t working well, more of the drug may stay in your body. This puts you at risk of more side effects.

For people with antiphospholipid syndrome (APS): If you have APS, you shouldn’t take this drug. It may increase your risk of developing blood clots. Your risk may be higher if you have triple-positive APS.

For people with active bleeding: If you’re bleeding or losing blood, you shouldn’t take this drug. It may increase your risk of serious or fatal bleeding.

Warnings for other groups

For pregnant women: This drug is a pregnancy category B drug. That means two things:

1. Studies of the drug in pregnant animals have not shown risk to the fetus.
2. There aren’t enough studies done in pregnant women to show the drug poses a risk to the fetus.

Tell your doctor if you’re pregnant or plan to become pregnant. This drug should be used during pregnancy only if the potential benefit justifies the potential risk.

For women who are breastfeeding: It is unknown if this drug passes through breast milk. If it does, it may cause serious effects in a child who is breastfed. You and your doctor may need to decide if you’ll take this drug or breastfeed.

For seniors: As you age, your body may not process drugs as well as it once did. This can increase your risk of side effects from this medication.

For children: This drug has not been established as safe and effective for use in children under the age of 18 years.

For people who will be having surgery: If you plan to have surgery or a medical or a dental procedure, tell your doctor or dentist that you’re taking apixaban. Your doctor may stop your treatment with apixaban for a time. While the drug is stopped, they may prescribe another medication to help keep blood clots from forming.

• If you’re having any surgery or a procedure that has a moderate or high risk of significant bleeding, your doctor will have you stop taking apixaban at least 48 hours before the procedure. Your doctor will tell you when it’s okay to start taking the drug again.
• If you’re having any surgery or procedure that has a low risk of bleeding or where bleeding could be controlled, your doctor will have you stop taking apixaban at least 24 hours before the procedure. Your doctor will tell you when it’s okay to start taking the drug again.

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

• your age
• the condition being treated
• the severity of your condition
• other medical conditions you have
• how you react to the first dose

Drug form and strengths

Brand: Eliquis

• Form: oral tablet
• Strengths: 2.5 mg and 5 mg

Dosage to reduce the risk of stroke and blood clots in people with atrial fibrillation

Adult dosage (ages 18–79 years)

The typical dosage is 5 mg taken two times per day.

Child dosage (ages 0–17 years)

A safe and effective dosage hasn’t been established for this age group.

Senior dosage (ages 80 years and older)

If you have severe kidney problems or weigh less than or equal to 132 pounds (60 kg), your doctor may lower your dosage. If your kidneys aren’t working well, more of the drug may stay in your body. This puts you at higher risk of side effects.

Special dosage considerations

For people with kidney problems: If your kidneys aren’t working well, more of the drug may stay in your body. This puts you at higher risk of side effects.

• If you have severe kidney problems and are on dialysis, your dosage should be 5 mg taken two times per day.
• If you’re age 80 years or older or if you weigh less than 132 pounds (60 kg), your dosage should be 2.5 mg taken twice per day.

For people with low body weight: If you weigh less than or equal to 132 pounds (60 kg), and have kidney problems or are age 80 years or older, the recommended dosage is 2.5 mg taken two times per day.

Dosage to reduce the risk of blood clots in people who have just had hip or knee replacement surgery

Adult dosage (18 years and older)

• The typical dosage is 2.5 mg taken two times per day.
• You should take your first dose 12 to 24 hours after surgery.
• For hip surgery, your treatment with apixaban will last 35 days.
• For knee surgery, your treatment with apixaban will last 12 days.

Child dosage (ages 0 to 17 years)

A safe and effective dosage hasn’t been established for this age group.

Dosage for deep vein thrombosis and pulmonary embolism

Adult dosage (18 years and older)

The typical dosage is 10 mg taken two times per day for 7 days. After that, it’s 5 mg taken two times per day for at least 6 months.

Child dosage (ages 0 to 17 years)

A safe and effective dosage hasn’t been established for this age group.

Dosage to reduce the risk of deep vein thrombosis and pulmonary embolism

Adult dosage (18 years and older)

The typical dosage is 2.5 mg taken two times per day. You should take this drug after at least six months of treatment for DVT or PE.

Child dosage (ages 0 to 17 years)

A safe and effective dosage hasn’t been established for this age group.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Apixaban oral tablet may be used for short-term or long-term treatment. Your doctor will decide how long you should take this drug. Don’t stop taking it without talking with your doctor first.

Apixaban comes with serious risks if you don’t take it as prescribed.

If you miss a dose: If you miss a dose, take it as soon as you remember on the same day. Then go back to your normal schedule. Don’t take more than one dose of this drug at a time to try to make up for a missed dose.

If you stop taking it: Stopping this drug may increase your risk of a stroke or blood clots. Be sure to refill your prescription before you run out. If you plan to have surgery or a medical or dental procedure, tell your doctor or dentist that you’re taking this drug. You may need to temporarily stop taking it.

If you take too much: If you take more than your prescribed dose of this drug, you have a greater risk of bleeding. This can be serious and even fatal. If you think that you’ve taken too much of this drug, call your doctor or go to the emergency room right away.

How to tell the drug is working: When using the drug to reduce the risk of blood clots, you may not be able to tell if the drug is working. The medication was designed so you wouldn’t have to get routine tests to see if it’s working. Your doctor may do tests to check blood levels of this drug, but this isn’t very common.

For treating DVT and PE, you may be able to tell it’s working if your symptoms improve.

Keep these considerations in mind if your doctor prescribes apixaban for you.

General

• You can take this drug with or without food.
• If you cannot swallow whole tablets:
  • Apixaban tablets may be crushed and mixed with water, apple juice, or applesauce. You can then consume them by mouth. Be sure to take the drug within four hours of crushing the tablets.
  • If you have a nasogastric tube, your doctor may crush this drug, mix it in a dextrose water solution, and give you the drug through the tube.

Storage

• Store at room temperature: 68–77°F (20–25°C).
• Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

• Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
• Don’t worry about airport X-ray machines. They can’t harm your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
• Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

Your doctor may check the following during your treatment:

• Kidney function. Your doctor may do blood tests to check how well your kidneys are working. If you have kidney problems, your body won’t be able to clear out the drug as well. This could cause more of this drug to stay in your body, which will increase your risk of side effects.
• Liver function. Your doctor may do blood tests to check how well your liver is working. If your liver isn’t working well, more of the drug may stay in your body. This puts you at risk of more side effects.

Availability

Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.

Prior authorization

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.