💊 Apixaban (Eliquis)

🏷️ Brand names & manufacturers

Apixaban🏭 Indoco Remedies LimitedDailyMed

💊

Apixaban🏭 Amneal Pharmaceuticals of New York LLC

✅ What it is used for

• Reduce the risk of stroke and systemic embolism in adults with nonvalvular atrial fibrillation
• Prevent deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE), in adults after hip or knee replacement surgery
• Treat DVT and PE in adults
• Reduce the risk of recurrent DVT and PE in adults after initial therapy
• Treat venous thromboembolism (VTE) and reduce the risk of recurrent VTE in pediatric patients from birth and older after at least 5 days of initial anticoagulant treatment

🧪 Active ingredient

The active substance is apixaban, a selective factor Xa inhibitor that decreases thrombin generation and blood clot development.

🌿 Benefits

• Reduces stroke risk in nonvalvular atrial fibrillation
• Helps prevent venous clots after joint replacement surgery
• Treats venous clots and pulmonary embolism and lowers the risk of recurrence

📝 How to use

• Taken by mouth, in most cases twice daily, as prescribed by your doctor
• The dose and duration are set by your doctor or pharmacist and should not be changed without advice
• Do not stop the medicine suddenly without your doctor's approval, as this increases the risk of blood clots
• Children's doses are based on body weight and are set by the doctor

💊 Dosage forms

• Tablets 2.5 mg and 5 mg
• Tablets for oral suspension 0.5 mg (pediatric)
• Powder for oral suspension 0.15 mg in a capsule (pediatric)

🔄 Drug interactions

• Combined P-gp and strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, ritonavir) raise apixaban levels; the dose is reduced or co-use avoided depending on the dose
• Combined P-gp and strong CYP3A4 inducers (e.g., rifampin, carbamazepine, phenytoin, St. John's wort) lower apixaban levels and should be avoided
• Aspirin, other antiplatelets, other anticoagulants, heparin, thrombolytics, SSRIs, SNRIs, and NSAIDs increase bleeding risk
• Clarithromycin: no dose adjustment needed per pharmacokinetic data
• Tell your doctor or pharmacist about all medicines and herbal products you take

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👨‍⚕️ For healthcare professionals

Mechanism of action

Selective factor Xa inhibitor that does not require antithrombin III; inhibits free and clot-bound FXa and prothrombinase activity, decreasing thrombin generation and thrombus development. No direct effect on platelet aggregation.

Labeled dosing

Nonvalvular AF: 5 mg twice daily; 2.5 mg twice daily if at least two of: age ≥80 years, weight ≤60 kg, serum creatinine ≥1.5 mg/dL. Post hip/knee replacement prophylaxis: 2.5 mg twice daily starting 12–24 hours after surgery, for 35 days (hip) or 12 days (knee). DVT/PE treatment: 10 mg twice daily for 7 days, then 5 mg twice daily. Reduction of recurrent DVT/PE: 2.5 mg twice daily after at least 6 months of treatment. Pediatric dosing is weight-based. Dose is determined by the prescriber.

• Boxed warning: premature discontinuation increases thrombotic events; spinal/epidural hematoma
• PT, INR, and aPTT are not useful for monitoring the anticoagulant effect
• With combined P-gp and strong CYP3A4 inhibitors: reduce dose by 50% in patients on 5 or 10 mg twice daily; avoid with 2.5 mg twice daily
• Avoid combined P-gp and strong CYP3A4 inducers
• Use not recommended with prosthetic heart valves, triple positive antiphospholipid syndrome, or severe hepatic impairment

🎓 Key points for students

• Apixaban is a direct factor Xa inhibitor and does not require antithrombin III
• Main adverse effect is bleeding; andexanet alfa is the reversal agent for adults
• Premature discontinuation without alternative anticoagulation raises thrombotic and stroke risk
• Boxed warning: spinal/epidural hematoma with neuraxial anesthesia
• Key interactions: strong P-gp/CYP3A4 inhibitors and inducers, antiplatelets, NSAIDs
• AF dose is reduced to 2.5 mg twice daily when two of three criteria (age, weight, creatinine) are met