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Eliquis
apixaban
Black Box Warnings .
Premature Tx Discontinuation
incr. thrombotic event risk when D/C apixaban for reasons other than pathological bleeding or completion of therapy course; if must D/C apixaban, consider administering another anticoagulant
Epidural/Spinal Hematoma Risk
epidural/spinal hematoma risk after epidural/spinal anesthesia or spinal puncture in anticoagulated patients; hematoma may result in long-term or permanent paralysis; incr. risk if indwelling epidural catheter use, concomitant use of drugs affecting hemostasis including NSAIDs, platelet inhibitors, or other anticoagulants, traumatic or repeated epidural or spinal puncture history, spinal deformity, or spinal surgery history; monitor signs/symptoms of neurologic impairment, treat urgently if needed; consider benefit vs. risk before neuraxial intervention in anticoagulated patients or planned anticoagulation for thromboprophylaxis
Adult Dosing .
Dosage forms: TAB: 2.5 mg, 5 mg; TAB (DVT/PE tx 30-day starter pack): 5 mg x74
thromboembolism/stroke prevention
- [5 mg PO bid]
- Info: for non-valvular atrial fibrillation without moderate-severe mitral stenosis or mechanical heart valve; decr. dose to 2.5 mg PO bid if at least 2 of the following: 80 yo or older, wt <60 kg, Cr >1.5; to convert from warfarin, D/C warfarin, then start apixaban when INR <2; to convert from other anticoagulants, D/C other anticoagulant, then start apixaban at next scheduled anticoagulant dose; depending on bleeding risk, consider holding tx 1-2 days before surgery or invasive procedure if CrCl >25 or 2-5 days if CrCl <25; resume tx >24h postop
DVT prophylaxis
- [hip replacement]
- Dose: 2.5 mg PO bid x35 days; Start: 12-24h postop
- [knee replacement]
- Dose: 2.5 mg PO bid x12 days; Start: 12-24h postop
DVT/PE prophylaxis, recurrent
- [2.5 mg PO bid]
- Info: to convert from warfarin, D/C warfarin, then start apixaban when INR <2; to convert from other anticoagulants, D/C other anticoagulant, then start apixaban at next scheduled anticoagulant dose; depending on bleeding risk, consider holding tx 1-2 days before surgery or invasive procedure if CrCl >25 or 2-5 days if CrCl <25; resume tx >24h postop
DVT/PE tx
- [10 mg PO bid x7 days, then 5 mg PO bid]
- Info: to convert from warfarin, D/C warfarin, then start apixaban when INR <2; to convert from other anticoagulants, D/C other anticoagulant, then start apixaban at next scheduled anticoagulant dose; depending on bleeding risk, consider holding tx 1-2 days before surgery or invasive procedure if CrCl >25 or 2-5 days if CrCl <25; resume tx >24h postop
VTE prophylaxis, cardioversion (off-label)
- [afib/flutter duration <48h]
- Dose: 5 mg PO bid; Start: ASAP before or immediately after cardioversion; Info: for patients with CHA2DS2-VASc score >2; continue tx for at least 4wk after procedure; refer to ACC/AHA/HRS guidelines
- [afib/flutter duration >48h or unknown]
- Dose: 5 mg PO bid; Start: at least 3wk before cardioversion; Info: continue tx for at least 4wk after procedure; refer to ACC/AHA/HRS guidelines
renal dosing
- [thromboembolism/stroke prophylaxis]
- Cr <1.5: 2.5 mg bid if also both wt <60 kg and 80 yo or older; Cr >1.5: 2.5 mg bid if also wt <60 kg and/or 80 yo or older; CrCl <15: not defined
- HD: 2.5 mg bid if also wt <60 kg and/or 80 yo or older; no supplement after dialysis; PD: not defined
- [VTE prophylaxis, cardioversion]
- renal impairment: not defined
- HD/PD: not defined
- [all other indications]
- renal impairment: no adjustment
- HD: no adjustment; no supplement; PD: not defined
hepatic dosing
- [see below]
- Child-Pugh Class A: no adjustment; Child-Pugh Class B: not defined; Child-Pugh Class C: avoid use
Peds Dosing .
- Dosage forms: SPRINKLE CAP: 0.15 mg; DISPERSE TAB: 0.5 mg; TAB: 2.5 mg, 5 mg
VTE tx
- [<18 yo, 2.6-3.9 kg]
- Dose: 0.15 mg PO bid; Start: after at least 5 days standard anticoagulant tx; 0.3 mg PO bid x7 days; Info: to convert from warfarin, D/C warfarin, then start apixaban when INR <2; to convert from other anticoagulants, D/C other anticoagulant, then start apixaban at next scheduled anticoagulant dose; depending on bleeding risk, consider holding tx 24-48h before surgery or invasive procedure; resume tx postop once hemostasis established; use sprinkle capsule form; must open capsule and mix contents in water or formula
- [<18 yo, 4-5.9 kg]
- Dose: 0.5 mg PO bid; Start: after at least 5 days standard anticoagulant tx; 1 mg PO bid x7 days; Info: to convert from warfarin, D/C warfarin, then start apixaban when INR <2; to convert from other anticoagulants, D/C other anticoagulant, then start apixaban at next scheduled anticoagulant dose; depending on bleeding risk, consider holding tx 24-48h before surgery or invasive procedure; resume tx postop once hemostasis established; use disperse tablet form; must mix disperse tablet in food or liquid
- [<18 yo, 6-8.9 kg]
- Dose: 1 mg PO bid; Start: after at least 5 days standard anticoagulant tx; 2 mg PO bid x7 days; Info: to convert from warfarin, D/C warfarin, then start apixaban when INR <2; to convert from other anticoagulants, D/C other anticoagulant, then start apixaban at next scheduled anticoagulant dose; depending on bleeding risk, consider holding tx 24-48h before surgery or invasive procedure; resume tx postop once hemostasis established; use disperse tablet form; must mix disperse tablet in food or liquid
- [<18 yo, 9-11.9 kg]
- Dose: 1.5 mg PO bid; Start: after at least 5 days standard anticoagulant tx; 3 mg PO bid x7 days; Info: to convert from warfarin, D/C warfarin, then start apixaban when INR <2; to convert from other anticoagulants, D/C other anticoagulant, then start apixaban at next scheduled anticoagulant dose; depending on bleeding risk, consider holding tx 24-48h before surgery or invasive procedure; resume tx postop once hemostasis established; use disperse tablet form; must mix disperse tablet in food or liquid
- [<18 yo, 12-17.9 kg]
- Dose: 2 mg PO bid; Start: after at least 5 days standard anticoagulant tx; 4 mg PO bid x7 days; Info: to convert from warfarin, D/C warfarin, then start apixaban when INR <2; to convert from other anticoagulants, D/C other anticoagulant, then start apixaban at next scheduled anticoagulant dose; depending on bleeding risk, consider holding tx 24-48h before surgery or invasive procedure; resume tx postop once hemostasis established; use disperse tablet form; must mix disperse tablet in food or liquid
- [<18 yo, 18-24.9 kg]
- Dose: 3 mg PO bid; Start: after at least 5 days standard anticoagulant tx; 6 mg PO bid x7 days; Info: to convert from warfarin, D/C warfarin, then start apixaban when INR <2; to convert from other anticoagulants, D/C other anticoagulant, then start apixaban at next scheduled anticoagulant dose; depending on bleeding risk, consider holding tx 24-48h before surgery or invasive procedure; resume tx postop once hemostasis established; use disperse tablet form; must mix disperse tablet in food or liquid
- [<18 yo, 25-34.9 kg]
- Dose: 4 mg PO bid; Start: after at least 5 days standard anticoagulant tx; 8 mg PO bid x7 days; Info: to convert from warfarin, D/C warfarin, then start apixaban when INR <2; to convert from other anticoagulants, D/C other anticoagulant, then start apixaban at next scheduled anticoagulant dose; depending on bleeding risk, consider holding tx 24-48h before surgery or invasive procedure; resume tx postop once hemostasis established; use disperse tablet form; must mix disperse tablet in food or liquid
- [<18 yo, >35 kg]
- Dose: 5 mg PO bid; Start: after at least 5 days standard anticoagulant tx; 10 mg PO bid x7 days; Info: to convert from warfarin, D/C warfarin, then start apixaban when INR <2; to convert from other anticoagulants, D/C other anticoagulant, then start apixaban at next scheduled anticoagulant dose; depending on bleeding risk, consider holding tx 24-48h before surgery or invasive procedure; resume tx postop once hemostasis established; use tablet form
VTE prophylaxis, recurrent
- [<18 yo, 2.6-3.9 kg]
- Dose: 0.15 mg PO bid; Start: after at least 5 days standard anticoagulant tx; 0.3 mg PO bid x7 days; Info: to convert from warfarin, D/C warfarin, then start apixaban when INR <2; to convert from other anticoagulants, D/C other anticoagulant, then start apixaban at next scheduled anticoagulant dose; depending on bleeding risk, consider holding tx 24-48h before surgery or invasive procedure; resume tx postop once hemostasis established; use sprinkle capsule form; must open capsule and mix contents in water or formula
- [<18 yo, 4-5.9 kg]
- Dose: 0.5 mg PO bid; Start: after at least 5 days standard anticoagulant tx; 1 mg PO bid x7 days; Info: to convert from warfarin, D/C warfarin, then start apixaban when INR <2; to convert from other anticoagulants, D/C other anticoagulant, then start apixaban at next scheduled anticoagulant dose; depending on bleeding risk, consider holding tx 24-48h before surgery or invasive procedure; resume tx postop once hemostasis established; use disperse tablet form; must mix disperse tablet in food or liquid
- [<18 yo, 6-8.9 kg]
- Dose: 1 mg PO bid; Start: after at least 5 days standard anticoagulant tx; 2 mg PO bid x7 days; Info: to convert from warfarin, D/C warfarin, then start apixaban when INR <2; to convert from other anticoagulants, D/C other anticoagulant, then start apixaban at next scheduled anticoagulant dose; depending on bleeding risk, consider holding tx 24-48h before surgery or invasive procedure; resume tx postop once hemostasis established; use disperse tablet form; must mix disperse tablet in food or liquid
- [<18 yo, 9-11.9 kg]
- Dose: 1.5 mg PO bid; Start: after at least 5 days standard anticoagulant tx; 3 mg PO bid x7 days; Info: to convert from warfarin, D/C warfarin, then start apixaban when INR <2; to convert from other anticoagulants, D/C other anticoagulant, then start apixaban at next scheduled anticoagulant dose; depending on bleeding risk, consider holding tx 24-48h before surgery or invasive procedure; resume tx postop once hemostasis established; use disperse tablet form; must mix disperse tablet in food or liquid
- [<18 yo, 12-17.9 kg]
- Dose: 2 mg PO bid; Start: after at least 5 days standard anticoagulant tx; 4 mg PO bid x7 days; Info: to convert from warfarin, D/C warfarin, then start apixaban when INR <2; to convert from other anticoagulants, D/C other anticoagulant, then start apixaban at next scheduled anticoagulant dose; depending on bleeding risk, consider holding tx 24-48h before surgery or invasive procedure; resume tx postop once hemostasis established; use disperse tablet form; must mix disperse tablet in food or liquid
- [<18 yo, 18-24.9 kg]
- Dose: 3 mg PO bid; Start: after at least 5 days standard anticoagulant tx; 6 mg PO bid x7 days; Info: to convert from warfarin, D/C warfarin, then start apixaban when INR <2; to convert from other anticoagulants, D/C other anticoagulant, then start apixaban at next scheduled anticoagulant dose; depending on bleeding risk, consider holding tx 24-48h before surgery or invasive procedure; resume tx postop once hemostasis established; use disperse tablet form; must mix disperse tablet in food or liquid
- [<18 yo, 25-34.9 kg]
- Dose: 4 mg PO bid; Start: after at least 5 days standard anticoagulant tx; 8 mg PO bid x7 days; Info: to convert from warfarin, D/C warfarin, then start apixaban when INR <2; to convert from other anticoagulants, D/C other anticoagulant, then start apixaban at next scheduled anticoagulant dose; depending on bleeding risk, consider holding tx 24-48h before surgery or invasive procedure; resume tx postop once hemostasis established; use disperse tablet form; must mix disperse tablet in food or liquid
- [<18 yo, >35 kg]
- Dose: 5 mg PO bid; Start: after at least 5 days standard anticoagulant tx; 10 mg PO bid x7 days; Info: to convert from warfarin, D/C warfarin, then start apixaban when INR <2; to convert from other anticoagulants, D/C other anticoagulant, then start apixaban at next scheduled anticoagulant dose; depending on bleeding risk, consider holding tx 24-48h before surgery or invasive procedure; resume tx postop once hemostasis established; use tablet form
renal dosing
- [0-1 wk old]
- eGFR <8: avoid use
- HD/PD: not defined
- [2-8 wk old]
- eGFR <12: avoid use
- HD/PD: not defined
- [9-23 wk old]
- eGFR <22: avoid use
- HD/PD: not defined
- [2 yo and older]
- eGFR <30: avoid use
- HD/PD: not defined
hepatic dosing
- [not defined]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- bleeding, active major
- pregnancy
- breastfeeding
- eGFR <8 (patients 0-1wk old)
- eGFR <12 (patients 2-8wk old)
- eGFR <22 (patients 9-23wk old)
- eGFR <30 (patients 2 yo and older)
- hepatic impairment, Child-Pugh Class C (adult patients)
- acute PE with hemodynamic instability
- acute PE requiring thrombolysis
- acute PE requiring pulmonary embolectomy
- antiphospholipid syndrome
- caution: patients of childbearing potential
- caution: patients 80 yo and older (thromboembolism prevention or stroke prevention use)
- caution: wt <60 kg (thromboembolism prevention or stroke prevention use)
- caution: Cr >1.5 (thromboembolism prevention or stroke prevention use)
- caution: bleeding risk
- caution: spinal puncture
- caution: epidural anesthesia use
- caution: spinal anesthesia use, concurrent
Drug Interactions .
Overview
apixaban
factor Xa inhibitor
Interaction Characteristics:
- CYP3A4 substrate
- P-gp substrate
- anticoagulant
Contraindicated
- defibrotide
- mifepristone
Avoid/Use Alternative
- abrocitinib
- adagrasib
- aficamten
- amiodarone
- anagrelide
- apalutamide
- asciminib
- atazanavir
- azithromycin
- belumosudil
- bisoprolol
- brigatinib
- butalbital
- canagliflozin
- cannabidiol
- caplacizumab
- capmatinib
- captopril
- carbamazepine
- carvedilol
- ceritinib
- chloramphenicol
- cimetidine
- cobicistat
- collagenase clostridium histolyticum
- danicopan
- danshen
- daridorexant
- dicloxacillin
- diosmin
- edoxaban
- elacestrant
- elexacaftor/tezacaftor/ivacaftor
- eliglustat
- enasidenib
- encorafenib
- enoxaparin
- entrectinib
- enzalutamide
- erdafitinib
- felodipine
- flibanserin
- fluvoxamine
- fondaparinux
- fosphenytoin
- fostamatinib
- gepotidacin
- gilteritinib
- ginkgo
- glecaprevir
- ibritumomab tiuxetan
- ibrutinib
- idelalisib
- imlunestrant
- indomethacin
- istradefylline
- itraconazole
- ivacaftor
- ivosidenib
- ketoconazole
- lapatinib
- ledipasvir
- levacetylleucine
- levoketoconazole
- lifileucel
- lomitapide
- lonafarnib
- lopinavir/ritonavir
- lumacaftor/ivacaftor
- maribavir
- mavorixafor
- meropenem
- naproxen
- nefazodone
- nelfinavir
- neratinib
- netupitant
- nifedipine
- quinine
- selpercatinib
- sevabertinib
- sorafenib
- sotagliflozin
- St. John's wort
- stiripentol
- vemurafenib
- venetoclax
- vimseltinib
- voclosporin
- vorapaxar
- voriconazole
- voxilaprevir
- xanomeline
- zonisamide
Monitor/Modify Tx
- acalabrutinib
- ado-trastuzumab emtansine
- afatinib
- anacaulase topical
- antithrombin
- aprepitant
- argatroban
- asparaginase
- aspirin
- avacopan
- avapritinib
- axitinib
- berotralstat
- bevacizumab
- bromelain
- cabazitaxel
- cabozantinib
- calaspargase
- cangrelor
- carfilzomib
- cefaclor
- cefadroxil
- cefdinir
- cefepime
- cefixime
- cefotetan
- cefoxitin
- cefpodoxime
- cefprozil
- ceftazidime
- ceftriaxone
- cefuroxime axetil
- cefuroxime sodium
- celecoxib
- cephalexin
- cilostazol
- ciprofloxacin
- citalopram
- clarithromycin
- clofazimine
- clopidogrel
- conivaptan
- crizotinib
- cyclosporine
- cysteamine
- dabigatran
- dalteparin
- danazol
- darunavir
- dasatinib
- deferasirox
- desvenlafaxine
- deuruxolitinib
- diclofenac
- diclofenac ophthalmic
- diclofenac topical
- diflunisal
- diltiazem
- dimethyl fumarate
- dipyridamole
- diroximel fumarate
- donanemab
- dronedarone
- duloxetine
- duvelisib
- elagolix
- epoprostenol
- eptifibatide
- erlotinib
- erythromycin
- escitalopram
- ethanol (alcoholic beverage)
- etodolac
- evening primrose oil
- fedratinib
- fenoprofen
- fenugreek
- fluconazole
- fluoxetine
- flurbiprofen
- flurbiprofen ophthalmic
- fosamprenavir
- fruquintinib
- garlic
- gefitinib
- gemtuzumab ozogamicin
- grapefruit
- heparin
- hydrocortisone
- ibuprofen
- ibuprofen lysine
- icosapent ethyl
- imatinib
- isavuconazonium
- ketoprofen
- ketorolac
- ketorolac ophthalmic
- lecanemab
- lefamulin
- lenacapavir
- lenvatinib
- letermovir
- levomilnacipran
- magnesium salicylate
- meclofenamate
- mefenamic acid
- meloxicam
- methotrexate
- methyl salicylate topical
- methyltestosterone
- milnacipran
- mitapivat
- monomethyl fumarate
- mycophenolate mofetil
- mycophenolic acid
- nabumetone
- nattokinase
- nepafenac ophthalmic
- niacin (vitamin B3)
- nilotinib
- nintedanib
- nirogacestat
- nusinersen
- obinutuzumab
- omega-3-acid
- oxaliplatin
- oxaprozin
- pacritinib
- pazopanib
- pegaspargase
- penicillin G
- pentosan polysulfate sodium
- pentoxifylline
- piperacillin
- piroxicam
- plasminogen, human
- ponatinib
- porfimer
- pralsetinib
- prasugrel
- pretomanid
- ramucirumab
- ranibizumab
- regorafenib
- resveratrol
- reteplase
- revakinagene taroretcel
- rilzabrutinib
- salsalate
- saw palmetto
- selumetinib
- sepiapterin
- sertraline
- sirolimus albumin-bound
- sotatercept
- sotorasib
- sugammadex
- sulindac
- sunitinib
- tenecteplase
- testosterone
- tirofiban
- tisotumab vedotin
- tivozanib
- tolmetin
- tovorafenib
- trametinib
- treprostinil
- upadacitinib
- vadadustat
- valproic acid
- venlafaxine
- verapamil
- vilazodone
- vinpocetine
- vortioxetine
- warfarin
- willow bark
- zanubrutinib
- ziv-aflibercept
Caution Advised
- bosentan
- cenobamate
- dabrafenib
- efavirenz
- etravirine
- fexinidazole
- lorlatinib
- mavacamten
- modafinil
- nafcillin
- pexidartinib
- repotrectinib
- rifapentine
Adverse Reactions .
Serious Reactions
- epidural hematoma
- spinal hematoma
- bleeding, severe
- thrombocytopenia
- thrombosis if premature D/C
- hypersensitivity reaction
- syncope
Common Reactions
- bleeding
- headache (peds patients)
- vomiting (peds patients)
- anemia
- nausea
Safety/Monitoring .
Monitoring Parameters
eGFR at baseline (peds); Cr at baseline, then q6-12mo if CrCl >50 or q3mo if CrCl <50 (adults); LFTs at baseline, then periodically
Pregnancy/Lactation .
Pregnancy
Clinical Summary
avoid use during pregnancy; inadequate human data available; no known risk of fetal harm, though risk of bleeding in pregnant patients based on animal data at up to 19x MRHD; risk of hemorrhage in pregnant patients during delivery and fetal bleeding based on drug's mechanism of action
Lactation
Clinical Summary
avoid use while breastfeeding; no human data available to assess risk of infant harm, though possible drug excretion into milk based on drug properties; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for apixaban: liver; CYP450: 1A2, 2C8, 2C9, 2C19, 2J2, 3A4 (primary) substrate
Excretion: for apixaban: urine 27%, feces; Half-life: 12h
Subclass: Anticoagulants
Mechanism of Action
for apixaban: selectively blocks active site of factor Xa, inhibiting blood coagulation (factor Xa inhibitor)
Formulary .
No Formulary Selected
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