Eliquis Dosing Guide

Front 1

Eliquis

Back 1

Apixaban

Front 2

Dose

Back 2

5 mg orally twice daily (bid) recommended for most patients

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Purpose?

Back 3

To reduce the risk of stroke in patients with nonvalvular atrial fibrillation

Front 4

Who receives a dose adjustment of 2.5 mg orally twice daily?

Back 4

Recommended for patients with 2 of the following:

Age-80 years and older
Body weight-60 kg or less
serum Creatinine-1.5 or greater

ABC

Or for patients taking drugs that are strong dual inhibitors of cytochrome P450 3A4 (CYP3A4) and P-glycoprotein (P-gp) (eg, ketoconazole, itraconazole, ritonavir, clarithromycin)

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Additional dosing considerations

Back 5

Does not require routine monitoring using INR or other tests of coagulation

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Additional dosing considerations

Back 6

No known dietary restrictions

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Additional dosing considerations

Back 7

Can be taken with or without food

Front 8

Missed dose

Back 8

If a dose of Eliquis is not taken at the scheduled time, the dose should be taken as soon as possible on the same day and twice daily administration should be resumed. The dose should not be doubled to make up for a missed dose.

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Warning

Back 9

Discontinuing Eliquis in patients without adequate continuous anticoagulation increases risk of stroke

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Contraindications

Back 10

Active physiological bleeding
Severe hypersensitivity reaction to Eliquis (anaphylactic reactions)

Front 11

Patients with renal impairment

Back 11

No dose adjustment required in patients with mild, moderate, or severe renal impairment alone

EXCEPT for those patients who meet the criteria for 2.5 mg twice daily

No data inform use in patients with creatinine clearance less than 15 or on dialysis

Renal excretion accounts for about 27% of total clearance

Front 12

Patients with hepatic impairment

Back 12

No dose adjustment required in patients with mild hepatic impairment alone

There is limited clinical experience with Eliquis in patients with moderate hepatic impairment, dosing recommendation cannot be provided

Eliquis is not recommended in patients with severe hepatic impairment

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Bleeding risk

Back 13

Eliquis increases the risk of bleeding and can cause serious, potentially fatal bleeding.

Front 14

Bleeding risk

Back 14

Concomitant use of drugs affecting hemostasis increases the risk of bleeding including aspirin and other anti-platelet agents, other anti-coagulants, heparin, thrombolytic agents, SSRIs, SNRIs, and NSAIDs.`

Front 15

Bleeding risk

Back 15

Patients should be made aware of signs or symptoms of blood loss and instructed to immediately report to an ER. D/c Eliquis in patients with active pathological hemorrhage.

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Surgery and interventions with MODERATE or HIGH risk of unacceptable or clinically significant bleeding

Back 16

Discontinue Eliquis at least 48 hours prior

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Surgery and interventions with LOW risk of bleeding or bleeding in noncritical site and easily controlled

Back 17

Discontinue Eliquis at least 24 hours prior

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Warnings and precautions

Back 18

There is no established way to reverse the anticoagulant effect of apixaban, which can be expected to persist for about 24 hours after the last dose (about 2 half-lives).

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Warnings and precautions

Back 19

A specific antidote for Eliquis is not available.

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Warnings and precautions

Back 20

Because of high plasma protein binding, Eliquis is not expected to be dialyzable

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Warnings and precautions

Back 21

Use of procoagulant reversal agents such as prothrombin complex concentrate, activated prothrombin complex concentrate, or recombinant factor VIIa may be considered but has not been evaluated in clinical studies.

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Warnings and precautions

Back 22

Activated charcoal reduces absorption of apixaban thereby lowering apixaban plasma concentrations.

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Warnings and precautions

Back 23

Prosthetic Heart Valves: The safety and efficacy of Eliquis has not been studied in patients with prosthetic heart valves and is not recommended in these patients.

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Adverse effects

Back 24

The most common and most serious adverse reactions reported with Eliquis were related to bleeding.

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Switching to Eliquis from Warfarin

Back 25

Discontinue warfarin and start Eliquis when the INR is below 2.0

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Switching from Eliquis to warfarin

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D/c Eliquis and begin both parenteral anticoagulant and warfarin at the time the next dose would have been taken. D/c the parenteral anticoagulant when INR reaches an acceptable range.

Front 27

Switching from Eliquis to warfarin

Back 27

Eliquis affects INR, so that INR measurements during coadministration with warfarin may not be useful for determining the appropriate dose of warfarin.

Front 28

Switching between Eliquis and anticoagulants other than warfarin

Back 28

D/c the anticoagulant being taken and begin the other at the next scheduled dose.

Front 29

Drug interactions

Back 29

Inhibitors of CYP3A4 and P-gp increase exposure to apixaban and increase the risk of bleeding.

Front 30

Drug interactions

Back 30

Inducers of CYP3A4 and P-gp decrease exposure to apixaban and increase the risk of stroke.

Front 31

Warnings and precautions

Back 31

Protamine sulfate and vitamin K would not be expected to affect the anticoagulant activity of Eliquis

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Warnings and precautions

Back 32

There is no experience with antifibrinolytic agents (transexamic acid, aminocaproic acid) in individuals receiving Eliquis

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Warnings and precautions

Back 33

There is neither scientific rationale for reversal nor experience with systemic hemostatics (desmopressin and aprotinin) in individuals receiving Eliquis