Apixaban

💊 What is Apixaban used for?

• •Reducing the risk of stroke and systemic embolism (blood clots that travel to other parts of the body) in people with nonvalvular atrial fibrillation (a type of irregular heartbeat)
• •Preventing deep vein thrombosis (DVT, a blood clot in a deep vein) after hip or knee replacement surgery
• •Treating DVT (blood clots in the veins of the legs) and pulmonary embolism (PE, a blood clot in the lungs)
• •Reducing the risk of DVT and PE coming back after initial treatment

How it works

The label describes apixaban as a factor Xa inhibitor and a blood thinner. The Medication Guide says it lowers the chance of clots forming by helping to prevent them.

How it is usually taken

• •The label describes apixaban as a tablet taken by mouth, usually twice a day. The exact amount and schedule depend on the reason for use and are set by your prescriber. Follow the instructions from your prescriber or pharmacist.

Comes as

• •2.5 mg yellow, round, film-coated tablets
• •5 mg pink, oval, film-coated tablets

⚠️ Apixaban side effects

🛑 Who should not take Apixaban, and who should be careful

The label says not to take it if

• 🚨You currently have certain types of abnormal bleeding (active pathological bleeding).
• 🚨You have had a serious allergic reaction to apixaban (severe hypersensitivity).
• 🚨The label says apixaban is not recommended for people with artificial (prosthetic) heart valves.
• 🚨The label says apixaban is not recommended for people with triple positive antiphospholipid syndrome.

Tell your doctor before taking it if

• •Tell your doctor if you have kidney or liver problems, antiphospholipid syndrome, any other medical condition, or any history of bleeding problems.
• •Tell your doctor if you are pregnant or plan to become pregnant, or if you are breastfeeding or plan to breastfeed.
• •Tell all of your doctors and dentists that you take apixaban. They should talk with your prescriber before any surgery, medical, or dental procedure.
• •Tell your doctor about all medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
• •The label says apixaban is not for patients with artificial heart valves.

🔀 Apixaban with other medicines, food and alcohol

The label says to discuss these with your doctor or pharmacist

• •Aspirin or aspirin-containing products, and other antiplatelet medicines, increase bleeding risk.
• •Long-term (chronic) use of NSAIDs increases bleeding risk.
• •Other anticoagulants, including warfarin and heparin, increase bleeding risk.
• •Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) increase bleeding risk.
• •Thrombolytic agents and other medicines to prevent or treat blood clots increase bleeding risk.
• •The label says inhibitors of CYP3A4 and P-gp (examples given: ketoconazole, itraconazole, ritonavir) increase apixaban levels and bleeding risk. The label says the dose may need to be reduced or the combination avoided.
• •The label says inducers of CYP3A4 and P-gp (examples given: rifampin, carbamazepine, phenytoin, St. John's wort) decrease apixaban levels and may increase stroke risk. The label says to avoid using them together.
• •The label notes that clarithromycin, although a combined P-gp and strong CYP3A4 inhibitor, does not appear to need a dose adjustment with apixaban.

Alcohol and food

The label does not say.

🤰 Apixaban in pregnancy and breastfeeding

Pregnancy

The label says it is not known if apixaban will harm an unborn baby. The available data are limited. The label says treatment may increase the risk of bleeding during pregnancy and delivery. Females who can become pregnant are told to talk with their healthcare provider about pregnancy planning during treatment and about the risk of severe uterine bleeding.

Breastfeeding

The label says it is not known if apixaban passes into breast milk. The label says you and your doctor should decide whether to take apixaban or breastfeed, and that you should not do both.

🗓️ Storage, missed doses and taking too much

Storage

Store at 20°C to 25°C (68°F to 77°F). Short excursions between 15°C and 30°C (59°F to 86°F) are permitted.

If a dose is missed

The label says that if a dose is not taken at the scheduled time, it should be taken as soon as possible on the same day, and the usual twice-daily schedule should then be resumed. The label says the dose should not be doubled to make up for a missed dose.

If too much is taken

The label says an overdose of apixaban increases the risk of bleeding. Activated charcoal may be useful in managing an overdose or accidental ingestion. An agent to reverse the anticoagulant effect of apixaban is available. Get medical help right away if an overdose is suspected.

🗒️ Questions to ask about Apixaban

• What is the right dose and schedule for my condition, and what should I do if I miss a dose?
• How long will I need to take apixaban for my condition?
• When should I stop apixaban before a surgery or dental procedure, and when can I restart it?
• Which of my current medicines, including aspirin, NSAIDs, or supplements, are safe to use with apixaban?
• What bleeding signs should prompt me to call you or get emergency care?
• What should I do if I need a spinal or epidural procedure while taking apixaban?

❓ Apixaban: frequently asked questions