Apixaban

What is apixaban?

Apixaban belongs to a drug class called factor Xa inhibitors. It’s available by prescription only.

The drug has anticoagulant effects and can reduce the risk of blood clots. It works by blocking the action of the enzyme factor Xa.

Apixaban is sold under the brand name Eliquis. The FDA has approved generic versions, but they are not yet available.¹

Eliquis is available as an oral tablet in 2.5mg and 5mg dosages.²

What is apixaban used to treat?

Apixaban is prescribed for the following reasons:³

• To reduce the risk of stroke in people with atrial fibrillation (a heart rhythm disorder).

• To prevent deep vein thrombosis (DVT), a type of blood clot, in people who have recently had a hip or knee replacement. DVT can cause pulmonary embolism (PE), a blood clot in the lungs.

• To treat DVT or PE and to reduce the risk of it recurring.

How do you take apixaban?

Apixaban is usually taken twice per day with or without food.² Crush the tablet and mix it with water, apple juice, or applesauce if you have difficulty swallowing it whole. Do not leave it for later — consume the mixture immediately.⁴

Your doctor will prescribe a dosage depending on why you are taking apixaban and what other medications you are currently taking.

These are the average recommended dosages for apixaban:⁵

• To treat deep vein thrombosis (DVT) and pulmonary embolism (PE): Take a starting dose of 10mg twice daily for seven days. After this, continue taking 5mg twice per day.

• To prevent DVT or PE from recurring: Take 2.5mg twice per day.

• To prevent DVT after knee or hip replacement surgery: After a knee replacement, take a 2.5mg dose twice daily for 12 days. After a hip replacement, take a 2.5mg dose twice daily for 35 days.

• To prevent blood clots and stroke in people with atrial fibrillation: The usual dose is 5mg twice daily. However, the dose will be 2.5mg twice daily if two or more of these factors apply to you:

• You weigh 60kgs (132lb) or less

• Your serum creatinine levels are 1.5mg/dL or higher

• You are 80 years of age and above

Follow your doctor’s instructions carefully. Do not start or stop taking apixaban without medical guidance.

Seeing results

Apixaban will reach its peak concentration within three to four hours of taking it.⁶ Its effects begin to wear off within 24 hours when you stop taking it.

Potential side effects of apixaban

Apixaban causes some side effects. Some are mild and others are severe and require immediate medical attention.

Common side effects

The most common side effects are related to bleeding.⁷ This is because your blood will not clot as easily while taking this drug.

You might experience:⁸

• Bleeding for longer than usual from cuts

• Heavier, longer periods

• Nosebleeds that last for fewer than 10 minutes

• Bruising more easily than usual

• Bruises that take longer to fade than usual

• Bleeding gums when you brush your teeth

If these side effects persist or bother you, speak to your doctor. Otherwise, they should ease on their own.

Other common side effects include:

• Lack of energy and tiredness

• Mild rash

• Dizziness and lightheadedness

• Nausea

Contact your doctor if you are tired, feel like you have no energy, have heart palpitations, have shortness of breath, and you notice your skin is paler than usual. These could be signs of anemia. Anemia is a common side effect of apixaban.⁷

Anemia: Everything You Need To Know

Serious side effects

Apixaban can cause serious bleeding that requires medical attention.

Contact your doctor if you experience:

• Bruising for no reason

• Bruises that are larger than you would expect and keep getting larger

• Blood in your urine or stools

Seek emergency medical attention if you experience symptoms of serious bleeding, including:

• A severe headache

• A nosebleed that lasts longer than 10 minutes, even though you have tried to stop it

• Bleeding from an injury or cut that will not slow or stop

• Blood in your vomit or coughing up blood

Long-term use of apixaban

Taking apixaban over a long period of time is safe,⁹ but you must follow your doctor’s instructions carefully.

Missed doses

If you miss a dose, don’t take two doses of apixaban to catch up. Taking too much apixaban can be dangerous. Instead, if it’s nearly time for your next dose, skip the dose you missed and resume your normal schedule.

Consult your doctor and ask for instructions if you often miss a dose.

Overdoses

Taking an overdose of apixaban can cause the following symptoms:⁴

• Pink, red, or brown urine

• Black or red tarry stools

• Unexplained bleeding or bruising

• Vomiting or coughing up blood (may look like coffee grounds)

If you think you or someone else has taken too much apixaban, seek emergency medical help immediately.

Allergy information

Apixaban is known to cause allergic reactions.

Symptoms of allergic reactions are:

• Chest pain or tightness

• Wheezing or having trouble breathing

• Feeling dizzy

• Swelling of the face, tongue, or throat

Seek emergency medical help if you develop any symptoms of an allergic reaction.

What to discuss with your doctor before taking apixaban

Before taking apixaban, tell your doctor if:³

• You are allergic to apixaban or any other drug.

• You take other medications — your doctor must know about all medications you take, including over-the-counter drugs, prescription drugs, herbal remedies, and supplements.

• You have other medical conditions, including bleeding disorders, liver disease, kidney disease, or antiphospholipid syndrome (APS).

• You have an artificial heart valve.

• You currently have active bleeding (this might be due to a condition, recent surgery, or an injury).

• You have recently had epidural anesthesia or a spinal tap, or you have a history of spinal surgery and spinal taps.

• You currently have a spinal catheter in place or have recently had one removed.

• You have scheduled surgery (including dental surgery).

• You are pregnant or plan to become pregnant.

• You are breastfeeding.

Stopping apixaban

Do not stop taking apixaban without medical guidance. If you stop taking apixaban, you may need to take another blood-thinning medication to prevent blood clots.

Apixaban and pregnancy

Do not take apixaban while pregnant. Doing so could increase your risk of bleeding during your pregnancy or delivery.³

It is not fully understood how apixaban affects nursing infants. The FDA advises mothers to either discontinue apixaban or stop breastfeeding.²

Interactions with other drugs

Apixaban can interact with other medications. Your doctor must be aware of what you are taking before you start apixaban treatment.

Here are some of the medications that can interact with apixaban:¹⁰

Antiplatelet drugs

Taking apixaban together with antiplatelet drugs can increase your risk of bleeding.

Examples of antiplatelet drugs are:

• Clopidogrel (Plavix)

• Aspirin

• Ticagrelor (Brilinta)

Other anticoagulant drugs

Taking other anticoagulant drugs together with apixaban can raise your risk of bleeding.

Other anticoagulant drugs include:

• Dabigatran (Pradaxa)

• Rivaroxaban (Xarelto)

• Edoxaban (Savaysa)

• Dalteparin (Fragmin)

• Fondaparinux (Arixtra)

• Enoxaparin (Lovenox)

• Heparin

• Warfarin (Coumadin or Jantoven)

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Only take NSAIDs with apixaban if your doctor recommends it. Using NSAIDs together with apixaban puts you at an increased risk of bleeding.

NSAIDs that interact with apixaban include:

• Diclofenac (Cambia, Zipsor, or Zorvolex)

• Ibuprofen (Advil, Motrin, Midol, and others)

• Naproxen (Aleve, Anaprox, Naprosyn, and others)

• Celecoxib (Celebrex)

• Meloxicam (Mobic)

Certain antidepressants

Some antidepressants interact with apixaban and increase the risk of bleeding.

Antidepressants that interact with apixaban include:

• Sertraline (Zoloft)

• Citalopram (Celexa)

• Fluoxetine (Prozac)

• Venlafaxine (Effexor XR)

• Desvenlafaxine (Pristiq)

• Duloxetine (Cymbalta)

Antifungal drugs

Some antifungal drugs raise the level of apixaban in your body and increase your risk of serious bleeding.

These drugs include:

• Ketoconazole (Nizoral)

• Itraconazole (Onmel or Sporanox)

Certain HIV drugs

Certain HIV drugs interact with apixaban, which increases the level of apixaban in the body.

HIV drugs that interact with apixaban include:

• Ritonavir (Norvir)

• Cobicistat (Tybost)

• Saquinavir (Invirase)

Certain seizure medications

Certain seizure medications interact with apixaban. The interaction decreases the level of apixaban in the body, rendering apixaban less effective.

Examples of seizure medications that interact with apixaban are:

• Fosphenytoin (Cerebyx)

• Phenobarbital

• Phenytoin (Dilantin and Phenytek)

• Carbamazepine (Carbatrol, Epitol, Tegretol, and Equetro)

• Primidone (Mysoline)

Note that this is not the complete list of medications that interact with apixaban.

Drug approval history

2012: The FDA first approves apixaban tablets to be sold under the brand name Eliquis.

2019: The FDA approves applications for generic apixaban.¹¹ However, these are not currently available and will not enter the market until 2026 at the earliest.¹²

Tips and advice for taking apixaban

The following tips and advice can help you take apixaban safely and effectively:

• Do not drink excessive amounts of alcohol while taking apixaban as this can increase your risk of bleeding.

• Do not drive or do anything that requires high concentration until you know how apixaban affects you. It can cause tiredness, lightheadedness, and dizziness.

• If you have a fall or accident, immediately inform your doctor. You may be checked for a brain bleed.

• If you need surgery, speak to the doctor who prescribes you apixaban. You may need to stop taking it or take a different dosage to lower your risk of bleeding.

• Avoid contact sports while taking apixaban as it increases your risk of bleeding if an injury occurs.