Dosage and administration

Nonvalvular atrial fibrillation

  • Recommended dose is 5 mg orally twice daily.
  • In patients with at least 2 of the following: age ≥80 yrs, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL, recommended dose is 2.5 mg PO BID.

Prophylaxis of DVT following hip or knee replacement surgery

  • Recommended dose is 2.5 mg PO BID.

Treatment of DVT and PE

  • Recommended dose is 10 mg PO BID for 7 days, then 5 mg PO BID.

Reduction in the risk of recurrent DVT and PE following initial therapy

  • Recommended dose is 2.5 mg PO BID.

Dosage forms and strengths

  • Tablets
    • 2.5 mg
    • 5 mg

Contraindications

  • Active pathological bleeding
  • Severe hypersensitivity to apixaban

Warnings and precautions

  • Bleeding: serious and potentially fatal bleeding. Promptly evaluate signs and symptoms of blood loss.
  • Prosthetic heart valves: Use is not recommended.

Adverse reactions

  • Most common adverse reactions (>1%) are related to bleeding

Drug interactions

  • For patients receiving apixaban at doses greater than 2.5 mg BID, the dose should be reduced 50% when it is coadministered with strong dual inhibitors of CYP3A4 and P-gp (e.g. ketoconazole, itraconazole, ritonavir, and clarithromycin). For patients on apixaban 2.5 mg BID avoid coadministration with these drugs.
  • Simultaneous use of strong dual inducers of CYP3A4 and P-gp (e.g. rifampin, carbamazepine, phenytoin, and St. John's wort) reduces blood levels of apixaban: avoid concomitant use.
  • Simultaneous use with other anti-platelet or anti-coagulant drugs increases risk of bleeding.

Use in specific populations

  • Pregnancy: Not recommended.
  • Nursing mothers: Discontinue drug or discontinue nursing.
  • Moderate or severe hepatic impairment: Not recommended.
  • End stage renal disease on hemodialysis: No change in dosing recommendations, but use caution, as this specific patient population was not included in clinical trials.