Apixaban

ELIQUIS

Open Apixaban in the interactive console ↗

What it isDirect factor Xa inhibitor; stroke prevention in atrial fibrillation and treatment of venous thromboembolism.

Why this oneAmong oral anticoagulants, it combines strong stroke and VTE efficacy with relatively low intracranial and GI bleeding risk.

What limits itBleeding is the tradeoff; premature discontinuation invites thrombosis. Strong dual CYP3A4 and P-gp modulators can make exposure unsafe.

FDA-approved for

stroke prevention in AF/VTE (2012)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING (A) Premature discontinuation increases risk of thrombotic events; (B) spinal/epidural hematoma with neuraxial anesthesia or spinal puncture, may cause permanent paralysis.

FDA dosing	Population	Start	Target	Max
Nonvalvular AF: reduce stroke/systemic embolism	adults	5 mg BID	5 mg BID	5 mg BID
Nonvalvular AF: reduce stroke/systemic embolism	adults with ≥2 of age≥80 y, wt≤60 kg, SCr≥1.5 mg/dL	2.5 mg BID	2.5 mg BID	2.5 mg BID
DVT prophylaxis after hip/knee replacement	adults (hip 35 d, knee 12 d; start 12-24 h post-op)	2.5 mg BID	2.5 mg BID	2.5 mg BID
Treatment of DVT and PE	adults	10 mg BID ×7 days	5 mg BID	10 mg BID
Reduce recurrent DVT/PE after ≥6 mo therapy	adults	2.5 mg BID	2.5 mg BID	2.5 mg BID
VTE treatment / recurrence, after ≥5 d initial anticoagulation	peds birth-<18 y, weight-tiered	weight-based BID (0.3-10 mg BID days 1-7)	weight-based BID (0.15-5 mg BID day 8+)	10 mg BID (≥35 kg)

Renal No dose adjustment for DVT/PE or hip/knee prophylaxis (incl. ESRD on dialysis). AF: use 2.5 mg BID if ≥2 of age≥80 y, wt≤60 kg, SCr≥1.5 mg/dL.

Hepatic Severe hepatic impairment: not recommended.

Instructions

Take with or without food.
For patients unable to swallow whole: may crush and suspend in water, D5W, apple juice, or applesauce and give promptly; or via 12 Fr NG tube.
Missed dose: take same day, resume BID; do not double.
Discontinue ≥48 h before elective surgery with moderate/high bleeding risk, ≥24 h if low risk; restart after hemostasis.
Do not stop prematurely without alternative anticoagulation (increased thrombotic risk).

Contraindications

Active pathological bleeding

Cautions

Serious, potentially fatal bleeding (reversal agent andexanet alfa available); risk increased with antiplatelets, other anticoagulants, NSAIDs, SSRIs/SNRIs
Increased thrombotic risk after premature discontinuation
Spinal/epidural hematoma with neuraxial anesthesia/puncture
Prosthetic heart valves: use not recommended
Triple-positive antiphospholipid syndrome: use not recommended

Adverse reactions

Bleeding (most common in adults)
Pediatrics: headache, vomiting, excessive menstrual bleeding

Pregnancy Limited data; may increase bleeding during pregnancy/delivery; use not recommended.

Lactation Present in animal milk; breastfeeding not recommended.

⚠ BOXED WARNINGS

Premature discontinuation increases thrombotic risk
Spinal or epidural hematoma

Cost, est. cash$500–$750/month

Generic entry2028 (settlement)

Classes and tags

Clinical profile

Therapeutic safety burden3 / 4

Overdose danger3 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryC

Defining liabilityMajor bleeding; risk rises with renal dysfunction and strong CYP3A/P-gp interactions.

Mechanism of action: Apixaban ballicule

Apixaban ballicule: receptor binding, kinetics and half-life diagram

Open Apixaban in the interactive console ↗

Memory aids: mascots and interaction avatars

Apixaban ELIQUIS mascot mnemonic cartoon — **“Eloquent pixie ban”**
Xa-ban mascots wear a BANdana and are “banned” (mnemonically, not literally)

CYP3A4 substrate

P-gp substrate (sensitive)

Open Apixaban in the interactive console ↗