Indications
Apixaban is a blood thinner (anticoagulant). It is used to:
- Lower the risk of stroke and blood clots in people with atrial fibrillation (an irregular heartbeat) that is not caused by a heart valve problem.
- Treat blood clots in the deep veins of the legs (deep vein thrombosis) and in the lungs (pulmonary embolism), and prevent them from coming back.
- Prevent blood clots after hip or knee replacement surgery.
How It Works
Apixaban blocks factor Xa, a protein the blood needs to form clots. This makes clots less likely to form or grow. It does not dissolve clots that are already there, but it lets the body break them down over time.
Dosage and Administration
Take exactly as prescribed; the dose depends on the reason for treatment, age, weight and kidney function.
- Atrial fibrillation: usually 5 mg twice a day. Some people, such as older or lighter people or those with reduced kidney function, are prescribed 2.5 mg twice a day.
- Treating a clot in the leg or lung: usually a higher starting dose for the first week, then a lower dose twice a day, as prescribed.
- After hip or knee replacement: usually 2.5 mg twice a day for a set number of weeks, as prescribed.
Take about 12 hours apart, with or without food. Tablets can be crushed and mixed with water or apple puree if swallowing is hard. If a dose is missed, take it as soon as remembered on the same day and continue twice daily; do not take a double dose. Do not stop without talking to the doctor, as stopping early raises the risk of stroke or clots.
Interactions
The risk of bleeding goes up with other blood thinners (such as Warfarin, Heparin, Rivaroxaban, Clopidogrel), Aspirin and painkillers such as Ibuprofen, Naproxen and Diclofenac, and with some antidepressants (SSRIs and SNRIs). Ketoconazole, Itraconazole, Ritonavir and Clarithromycin can raise apixaban levels. Rifampicin, Carbamazepine, Phenytoin, Phenobarbital and St John’s wort can lower its effect. Check with a pharmacist before taking any new medicine.
Contraindications
- Allergy to apixaban.
- Active, serious bleeding, or a condition with a high risk of major bleeding (such as a recent brain bleed or a bleeding stomach ulcer).
- Liver disease that affects blood clotting.
- Taking another blood thinner at the same time, except when switching under medical supervision.
- Artificial (mechanical) heart valve.
Side Effects
Common: bruising, nosebleeds, bleeding gums, heavier periods, blood in urine, nausea and anaemia. Less common: skin rash, itching and raised liver tests.
Get urgent medical help for: vomiting blood or material like coffee grounds; black, tarry or bloody stools; bleeding that will not stop; coughing up blood; a severe headache, sudden weakness, confusion, problems with speech or sight (possible bleeding in the brain); a fall or a blow to the head; or signs of a serious allergic reaction.
Pregnancy and Lactation
Not recommended in pregnancy. Women who could become pregnant should use contraception and tell the doctor at once if pregnancy is planned or happens. Not recommended while breastfeeding; the doctor will advise on a suitable alternative.
Precautions and Warnings
- Tell any doctor, dentist or surgeon that you take apixaban before a procedure; it may need to be stopped for a short time.
- Use with care in kidney problems, older age, low body weight, or a history of stomach ulcers or bleeding.
- People with antiphospholipid syndrome should discuss whether it is suitable.
- Spinal or epidural injections while on apixaban can rarely cause bleeding around the spine, leading to paralysis.
- Carry a card or note saying you take a blood thinner.
Overdose
An overdose raises the risk of serious bleeding. Seek urgent medical help, even if there are no symptoms. Activated charcoal may be given if the overdose was recent, and a specific reversal treatment exists in some hospitals.
Therapeutic Class
Anticoagulant (direct factor Xa inhibitor).
Storage
Store below 30°C in a dry place, away from light and out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.