Eliquis (Apixaban)

Eliquis (Apixaban)

How is Eliquis Used?

Eliquis is available in tablet form taken orally twice per day. There should be a period of 12 hours between each dose. It may be taken with or without food, and it is acceptable for patients to crush the tablet for easier consumption. However, patients that need to crush an Eliquis tablet to take it should mix the crushed medication with applesauce, apple juice, or water and be sure to consume it all at once.

Depending on the condition for which it has been prescribed, Eliquis may be used alongside additional medications or just by itself.

Storage

Eliquis tablets should be stored at room temperature and be kept away from moisture and light. This medication should not be stored in one’s bathroom.

Keep this medication out of the reach of children at all times.

When disposal of Eliquis tablets is required due to expiration or no longer needing them, these tablets should not be put down the sink, flushed down the toilet, or tossed into one’s household trash. Please contact your prescribing physician or pharmacist for instructions regarding the safe and proper disposal of this medication.

Uses

Eliquis is prescribed for the prevention or treatment of blood clots associated with the following conditions:

• deep vein thrombosis (DVT)
• pulmonary embolism (PE)

It may also be prescribed for:

• the prevention of blood clots after hip replacement surgery
• the prevention of blood clots after knee replacement surgery
• the prevention of blood clots associated with atrial fibrillation
• the prevention of stroke associated with atrial fibrillation

How Does Eliquis Work?

Eliquis is an anticoagulant medication that functions by inhibiting an enzyme within the body that contributes to blood clotting. As a factor Xa (FXa) inhibitor, it prevents FXa from performing its function, and this reduces the production of the substances within a patient’s body that results in blood being able to clot. By doing this, the patient’s blood becomes thinner, and their risk of blood clots and stroke is lowered.

Dosage

Eliquis is available in tablet form and in the following strengths:

• 5 mg
• 5 mg

Patients that are using Eliquis after having hip replacement surgery or knee replacement surgery will typically be prescribed a dose of 2.5 mg to be taken two times per day and 12 hours apart. Most physicians require that their post-op patients take the first dose of Eliquis about 12 to 24 hours after they have had either of these surgeries. Patients who are taking Eliquis after knee replacement surgery will typically remain using Eliquis to prevent blood clots for about two weeks. Those who have been prescribed Eliquis after hip replacement surgery will often need to continue using the medication for about 38 days after their procedure.

For the treatment of pulmonary embolism or deep vein thrombosis, the most commonly prescribed dose of Eliquis is 10 mg twice daily for the duration of a week. After seven days, this will likely be reduced to just 5 mg of Eliquis twice daily for about six months. After any present clots in the patient have been successfully treated, they will usually remain on a lowered dose of 2.5 mg twice per day to continue managing their condition and to prevent additional blood clots from developing.

Patients that have atrial fibrillation may be prescribed the 5 mg strength of Eliquis to be taken twice daily, 12 hours apart, to reduce the likelihood of experiencing blood clots or a stroke. However, due to age and any additional health conditions an individual may have, some of these patients may be prescribed the lower dose of 2.5 mg for treatment.

Overdose

Individuals that consume more than the recommended dose of Eliquis are at a significantly higher risk of bleeding. This risk level may be dangerously high depending on the amount of Eliquis that was consumed, and it may even be fatal in some circumstances.

If you or someone else has overdosed on Eliquis or taken a much higher dose than prescribed, medical attention should be sought immediately.

Side Effects

Eliquis is associated with a number of common side effects, as well as some that may require medical attention, as they are signs that indicate a patient’s blood clotting proteins have been affected too strongly by the medication.

The most common side effects of taking Eliquis are as follows:

• anemia
• bruising
• fainting
• minor bleeding
• nausea
• skin rash

Some of the following more significant side effects may also occur, and these should be reported to your doctor immediately:

• black/tarry/bloody stools
• changes in menstrual flow (heavier than usual or lasting longer)
• coughing up blood
• dark-colored or pink urine
• difficulty swallowing
• dizziness
• excessive bleeding from one’s gums
• fainting
• frequent or persistent nosebleeds
• joint pain
• muscle weakness
• prolonged bleeding from any cuts
• severe headache
• unusual bruising
• unusual discomfort/pain
• unusual fatigue
• unusual swelling
• vomit that looks like coffee grounds
• vomiting blood

Please seek emergency medical attention immediately if you experience any of the following additional side effects:

• changes in vision
• confusion
• difficulty speaking
• weakness on one side of your body

Although very rare, allergic reactions may occur in some individuals when taking Eliquis. Seek emergency medical assistance if you experience any of the following symptoms of an allergic reaction:

• difficulty breathing
• extreme dizziness
• itching
• rash
• swelling of the throat, tongue, or face

Warnings & Precautions

Patients should be sure to discuss their medical history with their doctor before beginning treatment with Eliquis. This includes important information such as all current medications they may be taking as well as any preexisting health conditions to ensure that Eliquis is not contraindicated with any other aspects of your current health and treatment plans.

Certain Medical Conditions

If you have any of the following medical conditions, exercise caution when taking Eliquis and discuss your medical history with your doctor before beginning this medication, as many of these will significantly increase your risk of bleeding and serious side effects:

• any recent major injuries
• any recent major surgeries
• bleeding issues (in the brain or intestines/stomach)
• blood disorders (i.e., thrombocytopenia, hemophilia, anemia)
• clotting disorder (antiphospholipid syndrome)
• kidney disease
• liver disease
• prone to falling or becoming injured
• stroke

Alcohol Use

Due to Eliquis causing patients to be at an increased risk of experiencing stomach bleeding, it is strongly recommended that their intake of alcoholic beverages be limited while using the medication. Patients that consume alcohol on a regular basis should discuss this intake with their prescribing physician before beginning treatment with Eliquis.

Bleeding Risk

Eliquis is a blood thinner, and its use causes patients to have a significantly increased risk of bleeding. Patients that are using this medication should exercise extreme caution when engaging in any activities that involve sharp objects (e.g., shaving, using scissors, etc.), and they should also be cautious if engaging in contact sports. A mild head injury during such a sport requires immediate medical attention if the individual is taking anticoagulant medications. Eliquis will cause much easier bruising in those taking it, along with the increased risk of bleeding.

Epidural and Spinal Catheters

Eliquis is not safe for use in any patients who have an epidural or spinal catheter in place or for those who have had such a catheter placed and removed within the past five hours. If a patient is receiving any type of pain medication through their catheter, Eliquis should not be used alongside those medications until five hours after the epidural or spinal catheter has been removed.

Pregnancy and Breastfeeding

Eliquis poses bleeding risks for a pregnant patient, the unborn baby, and also the newborn after it has been birthed. The patient’s doctor will determine whether the benefits of using Eliquis during pregnancy are worth the risks that also occur when using this medication. Based on the patient’s condition, an alternative medication may be more suited for use during pregnancy.

Additionally, it is not known whether Eliquis is passed into breast milk. Due to the lack of study regarding this potential risk, patients are not advised to use Eliquis while breastfeeding.

Surgery

Any patients taking Eliquis should be sure to inform their physicians or other health care professionals about using this medication before having surgery or having any dental work performed, as the use of Eliquis may contribute to heavy and potentially serious bleeding during these procedures.

Drug Interactions

Speak to your doctor about any medications or herbal supplements you are currently taking before beginning treatment with Eliquis. Discuss any concerns you may have with your doctor or a trusted pharmacist.

Drugs That Are Known to Interact with Eliquis

The following medications are known to interact with Eliquis and may increase your chances of experiencing adverse side effects:

• acetylsalicylic acid (ASA)
• aminosalicylic acid
• amlodipine
• antidepressants
• antiplatelet medications
• aprepitant
• blood thinners
• bosentan
• calcium channel blockers
• carbamazepine
• citalopram
• clarithromycin
• clopidogrel
• conjugated estrogen
• crizotinib
• cyclosporine
• dabigatran
• dabrafenib
• dalteparin
• dasatinib
• deferasirox
• delavirdine
• desipramine
• dexamethasone
• desvenlafaxine
• dienogest
• diltiazem

• dipyridamole
• dronedarone
• duloxetine
• edoxaban
• efavirenz
• enoxaparin
• enzalutamide
• erythromycin
• estrogen
• estradiol
• ethinyl estradiol
• etravirine
• fluoxetine
• heparin
• HIV non-nucleoside reverse transcriptase inhibitors
• imatinib
• levonorgestrel
• lomitapide
• low-molecular-weight heparins
• lumacaftor
• macrolide antibiotics
• medroxyprogesterone
• mifepristone
• mitotane
• modafinil
• nefazodone

• nevirapine
• nifedipine
• NNRTIs
• norethindrone
• norfloxacin
• obinutuzumab
• omega-3 fatty acids
• oxcarbazepine
• paroxetine
• phenobarbital
• prasugrel
• primidone
• progestins
• rivaroxaban
• sertraline
• siltuximab
• SNRIs
• SSRIs
• tetracycline
• ticagrelor
• ticlopidine
• tinzaparin
• tocilizumab
• tyrosine kinase inhibitors
• venlafaxine
• verapamil
• vitamin E
• warfarin

Drugs That Inhibit the Removal of Eliquis from the Body

The following medications may inhibit the removal of Eliquis from a patient’s body and impact the overall safety and efficacy of Eliquis:

• azole antifungals
• carbamazepine
• conivaptan
• HIV protease inhibitors
• itraconazole
• ketoconazole
• lopinavir
• phenytoin
• posaconazole
• rifabutin
• rifampin
• rifapatine
• ritonavir
• saquinavir
• seizure medications
• John’s wort
• voriconazole

Drugs That Increase the Bleeding Risk When Taking Eliquis

These medications may further increase a patient’s bleeding risk when taken in conjunction with Eliquis. Patients should be sure to check all medication labels carefully due to the common presence of the following:

• aspirin
• diclofenac
• ibuprofen
• naproxen
• NSAIDs

Patients that have been prescribed a low-dose aspirin regimen for the prevention of stroke or heart attack should be sure to discuss this with their prescribing physician and not stop their current aspirin regimen unless otherwise instructed to do so by their doctor.

There are also many herbal supplements that may increase bleeding and should either not be taken with Eliquis or be used with caution. Please discuss the use of any of the following supplements with your physician before beginning treatment with Eliquis:

• cat’s claw
• chamomile
• dong quai
• garlic
• ginger
• ginseng
• John’s wort

Other Substances That May Interact with Eliquis

The following additional substances are also indicated to interact with Eliquis:

• grapefruit juice

Alternative Medications

For patients who are unable to take Eliquis or experiencing significant adverse side effects, alternative medications may be used to treat some of the associated conditions for which this medication is commonly prescribed:

• dabigatran (Pradaxa)
• edoxaban (Savaysa)
• heparin
• rivaroxaban (Xarelto)
• warfarin (Coumadin, Jantoven)