Apixaban - Uses, Dosage, Side Effects, Drug Warnings, and Precautions

Overview:

Apixaban is a generic medicine and is sold under the brand name Eliquis. It is an anticoagulant drug and helps reduce the risk of stroke in individuals with heart rhythm disorders. It also prevents the occurrence and/or recurrence of serious blood clot-related life-threatening conditions like deep vein thrombosis and pulmonary embolism in people who underwent lower limbs or hip surgeries.

Once you are prescribed Apixaban for any medical condition, do not stop it without a doctor’s advice. Sudden Apixaban withdrawal can increase the risk of developing blood clots in circulation and stroke.

Drug Group:

Apixaban belongs to the group of drugs called oral anticoagulants or antithrombotics. It is a potent, reversible, direct inhibitor of factor Xa, meaning it blocks the activity of factor Xa. Factor Xa is a coagulation factor. It is a protein that our body produces to aid in the coagulation pathway. All drugs belonging to this group work to reduce the blood-clot forming tendencies and prevent the formation of serious blood clots. They help the blood flow easier within the blood vessels. Other drugs belonging to factor Xa inhibitor groups similar to Apixaban include Edoxaban, Rivaroxaban, and Fondaparinux.

What Is Apixaban Used For?

1. Reduce Stroke Risk in Non-Valvular Atrial Fibrillation - Apixaban is chiefly used to reduce the risk of stroke in people with atrial fibrillation. Non-valvular atrial fibrillation is a heart rhythm disorder where the heart beats in an abnormal rhythm due to underlying conditions such as high blood pressure, overactive thyroid, lung problems, etc. In such cases, it increases the risk of blood clot formation while the blood is within the heart chambers. This clot could detach and move to the brain and lead to stroke. Hence to prevent such risk, Apixaban is used in such people prophylactically.

2. Deep Vein Thrombosis and Pulmonary Embolism - It is also indicated in individuals with deep vein thrombosis (DVT) and pulmonary embolism (PE) to prevent its recurrence. In deep vein thrombosis, clots form in the leg’s deep veins, which, when detached, can obstruct the lung vessels, which can be life-threatening.

3. After Hip or Knee Replacement Surgery - In people who have undergone surgeries of the hips or knees and remain under bed rest without enough movements to their legs, the chances of deep vein thrombosis and pulmonary embolism due to DVT increase. Hence to prevent such risk, Apixaban is prescribed.

4. Post COVID-19: Currently, Apixaban is being prescribed to people affected and recovering from the COVID pandemic to prevent any life-threatening thrombotic events which are being observed in COVID infection.

NOTE: If you are prescribed Apixaban or any blood thinners for any of the above conditions or conditions not specified above, continue the medicine as advised by your doctor. Do not stop it on your own. If you feel unwell and think of stopping it, talk to your treating physician. Suddenly withdrawing the drug could cost your life.

How Does Apixaban Work?

In our body, certain clotting factors are synthesized by the liver. One of which is the tenth factor or factor X. It is also known as the Stuart-Prower factor. Factor Xa is the activated form of factor X. These are proteins that aid in the clotting process. Apixaban, being a potent, selective, reversible inhibitor of factor Xa, blocks its activity, thereby preventing blood clot formation.

Onset of Action:

Following oral administration, nearly 50% of Apixaban reaches circulation. Peak effects of Apixaban are observed 3 to 4 hours after oral administration. And its effects are found to last for about 24 hours. About 56% of oral Apixaban is excreted through feces, and 24% to 29% is excreted via urine.

Habit-Forming:

No habit-forming tendencies of Apixaban were reported among people taking it.

Expiry Date:

Do not take Apixaban or any other medicine beyond its expiration date or best before date. You can find one printed on the back of the pack, strip, or in the leaflet.

What Is the Dosage of Apixaban?

Apixaban is available in oral tablet forms to be taken by mouth. It is available in 2.5 mg and 5 mg dosage forms, respectively.

In people with any two of the following characteristics, the recommended dose of Apixaban is adjusted to 2.5 mg twice daily.

• Age ≥80 years.

• Body Weight ≤60 kg.

• Serum Creatinine ≥1.5 mg/dL.

Consult your doctor and inform if you have any of such conditions that need dose adjustments.

How to Use Apixaban?

Apixaban is available in the oral tablet form and has to be taken by mouth. It can be taken with or without food as advised by your physician. Do not take in excess or reduced quantities than recommended. Take it at the same time every day and twice daily. Continue taking the drug even if you feel well and good. Talk to your doctor regarding your drug dosage and duration.

Missed Dose:

If you happen to forget to take a dose of Apixaban, take it as soon as you remember. And make sure two doses for the day are resumed. If it is already time for your next dose, then skip the missed dose and take the next one. Do not double up the consecutive dose to compensate for the missed one.

What Are the Drug Warnings and Precautions?

1. If you are under Apixaban and are about to get any surgical procedure, inform your treating physician in advance, as anticoagulants like Apixaban can cause significant bleeding. Based on the procedure, your physician might ask you to discontinue it one or two days before the procedure.

2. Hepatic Impairment: Apixaban is not recommended in people with hepatic impairment. Inform your doctor in advance.

3. Kidney Impairment: If you have any mild to moderate kidney disorders, your dose will be adjusted based on your kidney function.

4. Thrombotic Events: Discontinuing Apixaban suddenly can increase the risk of stroke.

5. Prosthetic Heart Valves: Apixaban is not recommended in people with prosthetic heart valves.

6. Pregnancy and Breastfeeding: Apixaban is not recommended in pregnant women and breastfeeding mothers unless the benefits outweigh the risks.

7. Pediatric Population: The efficacy and safety of Apixaban are not studied in children effectively. Hence it is contraindicated in children.

8. Drug Switching: If you are taking Apixaban and are suggested to shift to another anticoagulant drug like Warfarin or vice versa, you will be ordered a blood test called INR (international normalized ratio) that measures your blood clotting time. Based on the value, your drug will be switched.

9. Bleeding: Using antiplatelets, Aspirin, NSAIDs (nonsteroidal anti-inflammatory drugs), etc., along with Apixaban, can increase the risk of profuse bleeding even with mild injury. Internal bleeding, heavy or long-lasting periods, nose bleeds, and bleeding gums can also take place.

If you experience serious bleeding such as blood in vomit, cough, stools, severe nosebleeds, etc., immediately contact your emergency medical helpline and seek medical management.

What Are the Side Effects of Apixaban?

Some common side effects of Apixaban are:

• Bruises.

• Heavy periods.

• Nose bleeds.

• Bleeding gums.

• Shortness of breath.

• Pale skin.

• Nausea.

• Rash.

• Dizziness.

• Tiredness.

These mild side effects can fade away with Apixaban use.

Some serious side effects include,

• Allergic reactions.

• Chest pain.

• Bleeding in the brain.

• Headache.

• Seizures.

• Vision problems.

• Sick feeling.

• Numbness or tingling sensation of the limbs.

If you experience any of the above serious side effects or any unlisted adverse effect and feel unwell, it is an emergency condition. Contact your doctor immediately to prevent further complications.

What Are the Interactions of Apixaban?

As with every drug, Apixaban also interacts with several other drugs and disease conditions resulting in undesirable effects. Common interactions of Apixaban include;

• With Medicines:

• NSAIDs.

• Carbamazepine.

• Phenytoin.

• Phenobarbital.

• Quinidine.

• Verapamil.

• Erythromycin.

• Rifampin.

• Ketoconazole.

• Ciprofloxacin.

• Clarithromycin.

• Escitalopram.

• With Diseases:

• Bleeding Disorders: In people with existing bleeding disorders like hemophilia, Apixaban can further induce bleeding.

• With Supplements:

• Using herbal supplements like St.John’s Wort can increase the risk of side effects.

What Are the Common Brands or Trade Names of Apixaban?

1. Tablet Eliquis.

2. Tablet Apixabid.

3. Tablet Apigat.

4. Tablet Apivas.