Eliquis

Anticoagulants

APIXABAN is an anticoagulant (blood thinner). It is used to lower the chance of stroke in people with a medical condition called atrial fibrillation. It is also used after knee or hip surgeries to prevent blood clots.

Oral route (Tablet)

Discontinuing apixaban therapy increases the risk of thrombotic events. In clinical trials in patients wit nonvalvular atrial fibrillation, there was an increased rate of stroke was observed after discontinuation of apixaban. If anticoagulation with apixaban is discontinued for a reason other than pathological bleeding, consider an alternative anticoagulant. In patients undergoing spinal epidural anesthesia or spinal puncture, epidural or spinal hematoma risk is increased and could result in long-term or permanent paralysis. Monitor patients for signs and symptoms of neurologic impairment and treat urgently. Consider the benefits and risks of neuraxial intervention in patients who are or need to be anticoagulated


Commonly Used Brand Name(s): Eliquis

Therapeutic Classification: Anticoagulant

Pharmacologic Classification: Factor Xa Inhibitor

Apixaban is used to decrease the risk of stroke and blood clots in patients with a serious heart rhythm problem called nonvalvular atrial fibrillation. It is also used to prevent blood clots (eg, deep vein thrombosis) after hip or knee replacement surgery.

Apixaban is an anticoagulant. It works by preventing harmful clots from forming in the blood vessels.

This medicine is available only with your doctor's prescription.

Take this medicine exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. When your supply of this medicine is running low, contact your doctor or pharmacist ahead of time. Do not allow yourself to run out of this medicine.

This medicine comes with a Medication Guide. It is very important that you read and understand this information. Be sure to ask your doctor if you have any questions.

If you are not able to swallow whole tablets, the tablets may be crushed, mixed in 60 mL of D5W, and then given through a nasogastric tube (NGT).

If you are taking another medicine to thin the blood (eg, heparin, warfarin, Coumadin®, Jantoven®), your doctor will give you very specific instructions about how to switch to apixaban. Carefully follow the instructions and ask your doctor if you have any questions.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For prevention of blood clots after hip replacement surgery:
      • Adults—2.5 milligrams (mg) two times a day, for 35 days. The first dose should be taken 12 to 24 hours after surgery.
      • Children—Use and dose must be determined by your doctor.
    • For prevention of blood clots after knee replacement surgery:
      • Adults—2.5 milligrams (mg) two times a day, for 12 days. The first dose should be taken 12 to 24 hours after surgery.
      • Children—Use and dose must be determined by your doctor.
    • For prevention of strokes and blood clots:
      • Adults—5 milligrams (mg) two times a day.
      • Adults with 2 of the following characteristics: 80 years of age and older, body weight of 60 kilograms (kg) or less, or kidney problems—2.5 mg two times a day.
      • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of apixaban in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of apixaban in the elderly.

Pregnancy

Pregnancy CategoryExplanation
All TrimestersBAnimal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Bleeding, active or
  • Liver disease, severe or
  • Prosthetic (artificial) heart valve—Should not be used in patients with these conditions.

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly and to decide if you should continue to take it. Blood tests may be needed to check for unwanted effects.

This medicine may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash, itching, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.

Make sure any doctor who treats you knows that you are using this medicine. You may need to stop using this medicine for several days before having surgery, including dental procedures.

Do not suddenly stop using this medicine without asking your doctor. You might have a higher risk of stroke after you stop using this medicine.

You may bleed and bruise more easily while you are using this medicine. Be extra careful to avoid injuries. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Gently brush and floss your teeth. Be careful when using sharp objects, including razors and fingernail clippers. Avoid picking your nose. If you need to blow your nose, blow it gently.

Check with your doctor right away if you have any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, headache, dizziness, or weakness, pain, swelling, or discomfort in a joint, pinpoint red spots on your skin, unusual nosebleeds, or unusual vaginal bleeding that is heavier than normal. These may be signs of bleeding problems.

This medicine may increase risk of blood clot in the spine or epidural area, which may lead to long-term or permanent paralysis. This is more likely to occur if you have an epidural catheter placed in your back, are taking NSAID or blood clotting medicine, a history of repeated epidural punctures or problems with your spine, or have had surgery on your spine. Tell your doctor right away if you have tingling, numbness, or muscle weakness, especially in your legs and feet.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

They need to know if you have any of these conditions:

  • bleeding disorders
  • bleeding in the brain
  • blood in your stools (black or tarry stools) or if you have blood in your vomit
  • history of stomach bleeding
  • kidney disease
  • liver disease
  • mechanical heart valve
  • an unusual or allergic reaction to apixaban, other medicines, foods, dyes, or preservatives
  • pregnant or trying to get pregnant
  • breast-feeding

Take this medicine by mouth with a glass of water. Follow the directions on the prescription label. You can take it with or without food. If it upsets your stomach, take it with food. Take your medicine at regular intervals. Do not take it more often than directed. Do not stop taking except on your doctor's advice. Stopping this medicine may increase your risk of a blot clot. Be sure to refill your prescription before you run out of medicine.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

Keep out of the reach of children.

Store at room temperature between 20 and 25 degrees C (68 and 77 degrees F). Throw away any unused medicine after the expiration date.

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