Administration of Apixaban (Eliquis) via gastric tube

From the Guidelines

Eliquis (apixaban) can be administered through a gastric tube by crushing the tablets and suspending them in 60 mL of water or D5W, followed by immediate delivery through the tube. This method is supported by the latest guidelines from the National Comprehensive Cancer Network 1, which provide recommendations for the administration of direct oral anticoagulants (DOACs) via enteral feeding tubes.

Key Considerations

• The crushed tablets are stable in water and D5W for up to 4 hours 1.
• Bioavailability is reduced if administered distal to the stomach 1.
• The standard dosing for Eliquis remains the same as oral administration, typically 5 mg twice daily for most patients.

Administration Instructions

• Crush the Eliquis tablet into a fine powder.
• Mix the powder with 60 mL of water or D5W.
• Draw the mixture into a syringe and administer it through the gastric tube.
• Flush the tube with water after administration to ensure complete delivery of the dose. It is essential to follow these guidelines to maintain the efficacy and safety of Eliquis in preventing thrombotic events, particularly in patients with cancer-associated venous thromboembolic disease 1.

From the FDA Drug Label

2.6 Administration Options For patients who are unable to swallow whole tablets, 5 mg and 2. 5 mg apixaban tablets may be crushed and suspended in water, 5% dextrose in water (D5W), or apple juice, or mixed with applesauce and promptly administered orally [see Clinical Pharmacology (12.3)]. Alternatively, apixaban tablets may be crushed and suspended in 60 mL of water or D5W and promptly delivered through a nasogastric tube [see Clinical Pharmacology (12. 3)]. Eliquis (apixaban) can be administered via a gastric tube by crushing the tablets and suspending them in water or 5% dextrose in water (D5W) 2.

From the Research

Administration of Eliquis via Gastric Tube

• There is limited information available on the administration of Eliquis (apixaban) via a gastric tube.
• However, studies have shown that liquid medications, particularly elixirs and suspensions, are preferred for enteral administration 3.
• It is essential to consider the properties of the medication, such as hypertonicity or sorbitol content, which can increase the potential for adverse effects 3, 4.
• When administering medications through a feeding tube, it is crucial to determine if the medications are suitable for manipulation, such as crushing a tablet or opening a capsule, and to properly flush the tube with water before and after each medication administration 3.
• The use of liquid form medications may reduce the risk of tube occlusions, but it is also important to consider the sorbitol content of some liquid medications, which can cause diarrhea 4.
• There is no specific information available on the administration of Eliquis via a gastric tube, but it is recommended to follow the general guidelines for enteral medication administration and to consult with a healthcare professional for specific guidance.

Considerations for Enteral Medication Administration

• Enteral medication administration requires careful consideration of the tube size and placement, as well as the selection and administration of drug dosage forms 3.
• Nurses play a crucial role in administering medications through enteral tubes and should be aware of the potential complications and take precautions to prevent them 4.
• The use of 30 mL of water for irrigation when administering medications or flushing small-diameter nasoenteral tubes may reduce the number of tube occlusions 4.
• It is essential to monitor patients for potential complications, such as tube occlusion, diarrhea, and aspiration pneumonia, and to take immediate action if any issues arise 4.

Apixaban Administration and Efficacy

• Apixaban has been shown to be effective in preventing recurrent venous thromboembolism in patients with active cancer, with a reduced dose being noninferior to a full dose 5.
• The efficacy of apixaban is not affected by a history of bleeding, and it has been shown to have a lower risk of major bleeding compared to warfarin 6.
• However, there have been reports of apixaban failure in post-bariatric surgery patients due to altered pharmacokinetics, highlighting the need for careful consideration of anticoagulation therapy in this population 7.