Generic name: apixaban (a PIX a ban)
Brand name: Eliquis, Eliquis Starter Pack for Treatment of DVT and PE
Dosage forms: oral tablet (2.5 mg; 5 mg)
Drug class: Factor Xa inhibitors
Apixaban is used to lower the risk of stroke caused by a blood clot in people with a heart rhythm disorder called atrial fibrillation.
Apixaban is also used after hip or knee replacement surgery to prevent a type of blood clot called deep vein thrombosis (DVT), which can lead to blood clots in the lungs (pulmonary embolism).
Apixaban is also used to treat DVT or pulmonary embolism (PE), and to lower your risk of having a repeat DVT or PE.
Apixaban may also be used for purposes not listed in this medication guide.
Warnings
Apixaban increases your risk of severe or fatal bleeding, especially if you take certain medicines at the same time (including some over-the-counter medicines). It is very important to tell your doctor about all medicines you have recently used.
Call your doctor at once if you have signs of bleeding such as: swelling, pain, feeling very weak or dizzy, bleeding gums, nosebleeds, heavy menstrual periods or abnormal vaginal bleeding, blood in your urine, bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds, or any bleeding that will not stop.
Apixaban can cause a very serious blood clot around your spinal cord if you undergo a spinal tap or receive spinal anesthesia (epidural), especially if you have a genetic spinal defect, if you have a spinal catheter in place, if you have a history of spinal surgery or repeated spinal taps, or if you are also using other drugs that can affect blood clotting. This type of blood clot can lead to long-term or permanent paralysis.
Get emergency medical help if you have symptoms of a spinal cord blood clot such as back pain, numbness or muscle weakness in your lower body, or loss of bladder or bowel control.
Do not stop taking apixaban unless your doctor tells you to. Stopping suddenly can increase your risk of blood clot or stroke.
Before taking this medicine
You should not take apixaban if you are allergic to it, or if you have active bleeding from a surgery, injury, or other cause.
Apixaban may cause you to bleed more easily, especially if you have a bleeding disorder that is inherited or caused by disease.
Tell your doctor if you have an artificial heart valve, or if you have ever had:
- liver or kidney disease;
- if you are older than 80; or
- if you weigh less than 132 pounds (60 kilograms).
Apixaban can cause a very serious blood clot around your spinal cord if you undergo a spinal tap or receive spinal anesthesia (epidural). This type of blood clot could cause long-term paralysis, and may be more likely to occur if:
- you have a spinal catheter in place or if a catheter has been recently removed;
- you have a history of spinal surgery or repeated spinal taps;
- you have recently had a spinal tap or epidural anesthesia;
- you are taking an NSAID (nonsteroidal anti-inflammatory drug)--aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), diclofenac, indomethacin, meloxicam, and others; or
- you are using other medicines to treat or prevent blood clots.
Taking apixaban may increase the risk of bleeding while you are pregnant or during your delivery. Tell your doctor if you are pregnant or plan to become pregnant.
You should not breast-feed while using apixaban.
How should I take apixaban?
Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.
You may take apixaban with or without food.
If you cannot swallow a tablet whole, crush and mix it with water, apple juice, or a spoonful of applesauce. Swallow the mixture right away without chewing. Do not save it for later use.
A crushed tablet mixture may also be given through a nasogastric (NG) feeding tube. Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions.
Apixaban can make it easier for you to bleed, even from a minor injury. Seek medical attention if you have bleeding that will not stop.
If you need surgery or dental work, tell the doctor or dentist ahead of time if you have taken apixaban within the past 24 hours. You may need to stop taking apixaban for a short time.
Do not stop taking apixaban unless your doctor tells you to. Stopping suddenly can increase your risk of blood clot or stroke.
If you stop taking apixaban for any reason, your doctor may prescribe another medication to prevent blood clots until you start taking apixaban again.
Store at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose on the same day you remember it. Take your next dose at the regular time and stay on your twice-daily schedule. Do not take two doses at one time.
Get your prescription refilled before you run out of medicine completely.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid while taking apixaban?
Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth.
Apixaban side effects
Get emergency medical help if you have signs of an allergic reaction: hives; chest pain, wheezing, difficult breathing; feeling light-headed; swelling of your face, lips, tongue, or throat.
Also seek emergency medical attention if you have symptoms of a spinal blood clot: back pain, numbness or muscle weakness in your lower body, or loss of bladder or bowel control.
Call your doctor at once if you have:
- easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), bleeding from wounds or needle injections, any bleeding that will not stop;
- heavy menstrual periods;
- headache, dizziness, weakness, feeling like you might pass out;
- urine that looks red, pink, or brown; or
- black or bloody stools, coughing up blood or vomit that looks like coffee grounds.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What other drugs will affect apixaban?
Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective.
Many other drugs (including some over-the-counter medicines) can increase your risk of bleeding or blood clots, or your risk of developing blood clots around the brain or spinal cord during a spinal tap or epidural. It is very important to tell your doctor about all medicines you have recently used, especially:
- any other medicines to treat or prevent blood clots;
- a blood thinner such as heparin or warfarin (Coumadin, Jantoven);
- an antidepressant; or
- an NSAID (nonsteroidal anti-inflammatory drug) used long term.
This list is not complete and many other drugs may affect apixaban. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.