Names and pronunciation
(a-pix′-a-ban) Eliquis
Source page 97
Loading InternPractice…
Individual generic drug information
Extracted information for apixaban only.
(a-pix′-a-ban) Eliquis
Source page 97
Func. class.: Anticoagulant
Source page 97
Chem. class.: Factor Xa inhibitor
Source page 97
ACTION: Inhibits factor Xa and thereby decreases thrombin and clot formation
Source page 97
USES: Deep venous thrombosis (DVT) after hip or knee replacement, to prevent stroke and embolism in atrial fibrillation (nonvalvular)
Source page 97
Extracted information for apixaban only.
CONTRAINDICATIONS: Hyper- sensitivity, active bleeding Precautions: Breastfeeding, dialysis, hepatic/renal disease, labor, pregnancy, surgery, prosthetic heart valves
Source page 97
Black Box Warning: Abrupt discontinu- ation, epidural, spinal anesthesia, lumbar puncture Black Box Warning: Neurologic status: monitor for impairment, including numb- ness, paresthesia, weakness, confusion, back pain, bowel/bladder impairment; notify prescriber immediately Black Box Warning: Abrupt discon- tinuation: do not discontinue abruptly; if bleeding occurs, consider using another anticoagulant to prevent thromboembolic events Black Box Warning: Epidural, spinal anes- thesia, lumbar puncture: avoid use in these conditions, risk of hematoma and permanent paralysis, may be increased with use of other anticoagulants, thrombolytics, antiplatelets • Hypersensitivity: rash, itching, chills, fever; report to prescriber • Beers: avoid in older adults; may cause increased risk of bleeding, de- creased creatinine clearance Black Box Warning: Not to discontinue without prescriber approval; stroke, clots may occur • Bleeding: to report bleeding, bruising, confusion, weakness, numbness of limbs • To avoid OTC products, supplements, herbs unless approved by prescriber; serious product interactions may occur • To carry emergency ID with product taken; to inform all health providers of product use • To report hypersensitivity reactions: rash, chills, fever, itching • Pregnancy/breastfeeding: To avoid breastfeeding; it is not known if the product appears in breast milk; to notify prescriber if pregnancy is planned or suspected
Source pages 98, 99
SIDE EFFECTS CNS: Syncope, intracranial bleeding CV: Hypotension HEMA: Severe bleeding INTEG: Rash MISC: Hypersensitivity
Source page 98
INTERACTIONS Increase: bleeding risk—antiplatelets, other anticoagulants, salicylates, NSAIDs, SNRIs, SSRIs, thrombolytics; avoid con- current use Increase: apixaban effect—CYP3A4 inhib- itors, P-gp; give 2.5 mg apixaban Decrease: apixaban effect—strong induc- ers of CYP3A4 and also P-glycoprotein (carBAMazepine, ketoconazole, itracon- azole, phenytoin, rifAMPin); use lower dose Drug/Herb Decrease: apixaban effect—St. John’s wort; avoid concurrent use Drug/Lab Test Increase: PT, PTT, INR, coagulation studies
Source page 98
Extracted information for apixaban only.
DOSAGE AND ROUTES DVT or pulmonary embolism (PE) • Adult: PO 10 mg bid × 7 days, then 5 mg bid ≥6 mo, to reduce recurrence >6 mo 2.5 mg bid Stroke prophylaxis and systemic embolism prophylaxis • Adult: PO 5 mg bid; in those with any 2 of the following—age ≥80 yr, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL—reduce the dose to 2.5 mg bid. Also decrease the dose to 2.5 mg bid (strong inhibitor of both CYP3A4 and P- glycoprotein) Reduction in risk of recurrent DVT and/or PE after completion of treatment for acute DVT or PE • Adult: 2.5 mg bid daily after at least 6 mo of treatment for DVT or PE DVT prophylaxis and PE prophylaxis in patients undergoing knee or hip replacement surgery • Adult: 2.5 mg bid × 12 days after knee replacement surgery or for 35 days after hip replacement surgery. Give initial dose 12-24 hr after surgery Renal dose: • No dosage adjustment needed when used for treatment/prevention of venous thromboembolism • Adult: PO serum CCr ≥1.5 mg/dL, ≤60 kg, and/or ≥80 yr; if 2 of these 3 charac- teristics are present, then decrease dose to 2.5 mg bid Hemodialysis end-stage renal disease maintained on hemodialysis • Adult: PO 5 mg bid; reduce to 2.5 mg bid if patient is ≥80 yr or ≤60 kg
Source page 98
Available forms: Tablets 2.5, 5 mg
Source page 98
Administer: • May be taken without regard to food • If unable to swallow whole, may crush and suspend the tablet in 60 mL 5% dex- trose solution; give immediately via NG • If a dose is missed, it should be taken as soon as possible on the same day. Twice-daily dosing should be resumed. Do not double the dose to make up for a missed dose.
Source page 98
Extracted information for apixaban only.
Assess: • Bleeding: bleeding may occur from any body system; may be fatal if severe
Source page 98
Evaluate: Therapeutic response: prevention/treat- ment of DVT, adequate anticoagulation
Source page 99
CLINICAL CONSIDERATIONS
Source page 98
Patient and caregiver information:
Source page 99
Extracted information for apixaban only.
PHARMACOKINETICS Peak 3-4 hr, half-life 12 hr
Source page 98
Filter the extracted dose blocks for this individual drug.
DVT or pulmonary embolism (PE)
• Adult: PO 10 mg bid × 7 days, then 5 mg bid ≥6 mo, to reduce recurrence >6 mo 2.5 mg bid Stroke prophylaxis and systemic embolism prophylaxis
Candidate age grouping · source page 98
DVT or pulmonary embolism (PE)
• Adult: PO 5 mg bid; in those with any 2 of the following—age ≥80 yr, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL—reduce the dose to 2.5 mg bid. Also decrease the dose to 2.5 mg bid (strong inhibitor of both CYP3A4 and P- glycoprotein) Reduction in risk of recurrent DVT and/or PE after completion of treatment for acute DVT or PE
Candidate age grouping · source page 98
DVT or pulmonary embolism (PE)
• Adult: 2.5 mg bid daily after at least 6 mo of treatment for DVT or PE DVT prophylaxis and PE prophylaxis in patients undergoing knee or hip replacement surgery
Candidate age grouping · source page 98
DVT or pulmonary embolism (PE)
• Adult: 2.5 mg bid × 12 days after knee replacement surgery or for 35 days after hip replacement surgery. Give initial dose 12-24 hr after surgery Renal dose:
Candidate age grouping · source page 98
DVT or pulmonary embolism (PE)
• No dosage adjustment needed when used for treatment/prevention of venous thromboembolism
Candidate age grouping · source page 98
DVT or pulmonary embolism (PE)
• Adult: PO serum CCr ≥1.5 mg/dL, ≤60 kg, and/or ≥80 yr; if 2 of these 3 charac- teristics are present, then decrease dose to 2.5 mg bid Hemodialysis end-stage renal disease maintained on hemodialysis
Candidate age grouping · source page 98
DVT or pulmonary embolism (PE)
• Adult: PO 5 mg bid; reduce to 2.5 mg bid if patient is ≥80 yr or ≤60 kg
Candidate age grouping · source page 98