How does this medication work? What will it do for me?
Apixaban belongs to the group of medications called anticoagulants. Anticoagulants prevent harmful blood clots from forming in the blood vessels. They do this by reducing the ability of the blood to clot.
Apixaban is used to prevent blood clots for people who have had total hip replacement or knee replacement surgery. It may also be used to prevent stroke or blood clots in people with atrial fibrillation (a type of abnormal heart rhythm).
Apixaban is also used to treat and prevent clots from forming in the legs (deep vein thrombosis [DVT]) or in the lungs (pulmonary embolism).
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What form(s) does this medication come in?
Each yellow, round tablet, with "893" marked on one side and "2 ½" on the other side, contains 2.5 mg of apixaban. Nonmedicinal ingredients: tablet core: anhydrous lactose, croscarmellose sodium, magnesium stearate, microcrystalline cellulose, and sodium lauryl sulfate; film coating: hypromellose, lactose monohydrate, titanium dioxide, triacetin, and yellow iron oxide.
Each pink, oval tablet, with "894" marked on one side and "5" on the other side, contains 5 mg of apixaban. Nonmedicinal ingredients: tablet core: anhydrous lactose, croscarmellose sodium, magnesium stearate, microcrystalline cellulose, and sodium lauryl sulfate; film coating: hypromellose, lactose monohydrate, titanium dioxide, triacetin, and red iron oxide.
How should I use this medication?
After knee replacement surgery or hip replacement surgery, the usual dose of apixaban is 2.5 mg twice daily (once in the morning and once in the evening, about 12 hours apart). The first dose is usually taken 12 to 24 hours after surgery. After hip surgery, treatment will usually continue for up to 38 days. After knee surgery, treatment will usually continue for up to 14 days.
For stroke and clot prevention in people with atrial fibrillation, the usual dose is 5 mg twice daily (once in the morning and once in the evening, about 12 hours apart). If you are older than 80 years of age, weigh less than 60 kg, or have kidney problems, your doctor may prescribe a lower dose.
To treat DVT or pulmonary embolism, the recommended dose is 10 mg taken twice a day for 7 days. The dose is then reduced to 5 mg taken twice a day. Treatment is continued for at least 6 months.
After treating the blood clot, the recommended dose to continue to prevent DVT or pulmonary embolism is 2.5 mg taken twice a day. For a maximum effect from this medication, apixaban should be taken regularly, approximately 12 hours separating each dose.
Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
Apixaban may be taken with food or on an empty stomach. If you cannot swallow whole tablets, you may crush this medication to a fine powder and mix it in water or applesauce. After it has been prepared in this manner, the dose of apixaban should be taken immediately.
It is important to take this medication exactly as prescribed by your doctor. Do not stop taking this medication without checking with your doctor first.
If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take this medication?
Do not take this medication if you:
- are allergic to apixaban or any ingredients of the medication
- are bleeding actively (e.g., bleeding stomach ulcer) or have a medical condition that increases your risk of bleeding
- are taking certain medications such as ketoconazole, itraconazole, voriconazole, posaconazole, or ritonavir
- are taking other anticoagulants such as enoxaparin, dalteparin, fondaparinux, warfarin, dabigatran, or heparin (unless your doctor has decided to switch you to apixaban)
- have a body lesion at risk of bleeding, including bleeding in the brain within the last 6 months
- have liver disease associated with an increased risk of bleeding
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- bruising or swelling
Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- bleeding or oozing from the surgical wound
- blood in urine
- signs of bleeding (e.g., bloody nose, blood in urine, coughing blood, cuts that don't stop bleeding, bleeding in the rectum or from hemorrhoids, bleeding gums, black stools)
- symptoms of anemia (e.g., decreased energy, shortness of breath, tiredness, paleness)
- symptoms of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools, itching)
- symptoms of unidentified bleeding (e.g., weakness, paleness, dizziness, headache, unexplained swelling or bruising)
- symptoms of low blood pressure (e.g., fast heartbeat, dizziness, fainting)
Stop taking the medication and seek immediate medical attention if any of the following occur:
- allergic reaction (rash; hives; swelling of the face, lips, tongue, or throat; difficulty breathing)
- signs of bleeding in the stomach (e.g., bloody, black, or tarry stools; spitting up of blood; vomiting blood or material that looks like coffee grounds)
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Increased bleeding risk: If you have any medical conditions that may cause an increased risk of bleeding, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. These conditions include uncontrolled very high blood pressure; a problem with the blood vessels in the back of the eye called retinopathy; current or past ulcer of the stomach or intestines; recent stroke; or recent surgery of the brain, spinal column, or eye.
If you are taking medications to prevent blood clots (blood thinners; warfarin, ticlopidine) or other medications that reduce blood clotting such as non-steroidal anti-inflammatories (NSAIDs; e.g., diclofenac, naproxen) or acetylsalicylic acid, discuss with your doctor whether any special monitoring is needed.
Heart valves: The safety and effectiveness of apixaban have not been established for people with prosthetic heart valves or severe rheumatic heart disease. Apixaban is not recommended for use by people with these conditions.
Kidney disease: This medication is not recommended for people with severely reduced kidney function or those who are receiving dialysis. If you have kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Liver disease: If you have liver disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Apixaban is not recommended for people with severe liver problems.
Spinal or epidural catheters: This medication should not be taken by people who have spinal or epidural catheters in place or for 5 hours after their removal. It should not be taken by people receiving pain medications through an epidural catheter.
Surgery: Inform all health care professionals involved in your care that you are taking apixaban. Apixaban may need to be stopped temporarily before dental or surgical procedures to reduce your risk of bleeding heavily during or after the procedure.
Pregnancy: The safety and effectiveness of apixaban have not been established for pregnant women. Apixaban is not recommended during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: It is not known if apixaban passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children and adolescents: The safety and effectiveness of apixaban have not been established for children and adolescents less than 18 years of age. Apixaban is not recommended in this age group.
Seniors: People over the age of 75 are at an increased risk of bleeding. Report any unusual bruising or bleeding to your doctor immediately.
What other drugs could interact with this medication?
There may be an interaction between apixaban and any of the following:
- acetylsalicylic acid (ASA)
- aminosalicylic acid
- "azole" antifungals (e.g., itraconazole, ketoconazole, voriconazole)
- calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
- estrogens (e.g., conjugated estrogen, estradiol, ethinyl estradiol)
- grapefruit juice
- herbal products that can increase bleeding (e.g., cat's claw, chamomile, dong quai, garlic, ginger, ginseng)
- HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delavirdine, efavirenz, etravirine, nevirapine)
- HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
- low-molecular-weight heparins (e.g., dalteparin, enoxaparin, tinzaparin)
- macrolide antibiotics (e.g., clarithromycin, erythromycin)
- nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., naproxen, ibuprofen, diclofenac)
- omega-3 fatty acids
- progestins (e.g., dienogest, levonorgestrel, medroxyprogesterone, norethindrone)
- St. John's wort
- selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
- serotonin-norepinephrine reuptake inhibitors (SNRIs; desvenlafaxine, duloxetine, venlafaxine)
- tyrosine kinase inhibitors (e.g., crizotinib, dabrafenib, dasatinib, imatinib)
- vitamin E
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.
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