If I miss my morning dose of Eliquis (apixaban) and it's now 1 PM, should I take the missed dose or skip it and take the evening dose?

From the Guidelines

If you miss your morning dose of Eliquis and it's now 1 PM, you should skip the missed dose and take the evening dose as scheduled, according to the most recent and highest quality study 1. This is because Eliquis has a twice-daily dosing regimen, and the European Heart Rhythm Association practical guide recommends not taking another tablet/capsule if a dose is missed, but rather continuing with the regular dose regimen. The guide suggests that for NOACs with a BID dosing regimen, it is generally advisable to not take another tablet/capsule, but to simply continue with the regular dose regimen, i.e. starting with the next dose at the 12 h interval 1. Some key points to consider when managing missed doses of Eliquis include:

• The medication's half-life, which is around 12 hours, meaning its concentration in the bloodstream decreases relatively quickly 1
• The importance of consistent dosing to maintain effective anticoagulation and prevent blood clots
• The potential risks of taking an extra dose, including increased bleeding risk, although the European Heart Rhythm Association guide does not provide specific recommendations for Eliquis in this scenario, it does suggest that taking an extra dose may be advisable for NOACs with an OD dosing regimen in certain situations 1. However, since Eliquis is a BID dosing regimen, the recommendation is to skip the missed dose and continue with the regular dose regimen. It's also important to note that if you frequently miss doses, you should consider setting alarms or using pill organizers to help maintain your schedule.

From the FDA Drug Label

If a dose of apixaban tablets is not taken at the scheduled time, the dose should be taken as soon as possible on the same day and twice-daily administration should be resumed. The dose should not be doubled to make up for a missed dose. If you miss your morning dose of Eliquis (apixaban) and it's now 1 PM, you should take the missed dose as soon as possible, and then take your evening dose as scheduled. Do not double the dose to make up for the missed dose. Take the missed dose and resume your regular twice-daily administration schedule 2.

From the Research

Missed Dose of Eliquis (Apixaban)

If a dose of Eliquis (apixaban) is missed, it is essential to understand the appropriate course of action to minimize risks.

• The studies provided do not directly address the specific scenario of missing a morning dose of Eliquis and whether to take the missed dose or skip it and take the evening dose 3, 4, 5, 6, 7.
• However, it is known that apixaban is a medication used to prevent blood clots and stroke in patients with non-valvular atrial fibrillation or venous thromboembolism 3.
• The risk of bleeding is a significant concern with anticoagulant therapy, including apixaban 3, 5, 6.
• A study on the history of bleeding and outcomes with apixaban versus warfarin in patients with atrial fibrillation found that apixaban was associated with a lower rate of intracranial hemorrhages and less adverse consequences following extracranial hemorrhage 5.
• Another study compared the risk of major bleeding during anticoagulation therapy between warfarin and NOACs, including apixaban, and found that apixaban was associated with a lower major bleeding risk compared to warfarin or rivaroxaban 6.
• In terms of missed doses, a systematic review of patient information leaflets and summaries of product characteristics found that advice on missed doses is generally inadequate, and pharmaceutical companies and regulatory authorities should produce clear and concise instructions on what patients should do if they miss doses, with supporting evidence where necessary 4.
• Given the lack of specific guidance on missed doses of Eliquis, it is crucial to consult the patient information leaflet or consult with a healthcare professional for advice on how to proceed if a dose is missed.

General Guidance on Missed Doses

• If a dose of Eliquis is missed, patients should not double the dose to make up for the missed dose.
• Patients should take the next scheduled dose as directed by their healthcare provider.
• It is essential to follow the prescribed dosing schedule and consult with a healthcare professional if there are any concerns about missed doses or bleeding risks.