From the Guidelines
The recommended dosing for Eliquis (apixaban) in patients requiring anticoagulation is typically 5 mg taken orally twice daily, with dose adjustments necessary for certain patient populations, as outlined in the most recent guidelines 1. For patients with at least two of the following characteristics - age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL - the recommended dose should be reduced to 2.5 mg twice daily. Key considerations for apixaban dosing include:
- Renal function: For patients with creatinine clearance ≥50 mL/min, no dose adjustment is necessary, but for those with creatinine clearance 15-50 mL/min, a dose reduction to 2.5 mg twice daily may be considered, especially if other risk factors are present 1.
- Drug interactions: Apixaban has significant interactions with strong CYP3A4 and P-glycoprotein inhibitors or inducers, which may necessitate dose adjustments or alternative therapies 1.
- Patient-specific factors: Age, weight, and renal function are critical factors in determining the optimal apixaban dose, as evidenced by the ARISTOTLE trial, which demonstrated the efficacy and safety of apixaban in patients with atrial fibrillation 1. The pharmacokinetic characteristics of apixaban, including its minimal metabolism by CYP3A4 and its 12-hour half-life, support twice-daily dosing, making it a convenient option for patients requiring anticoagulation 1. Overall, the dosing of apixaban should be individualized based on patient-specific factors, renal function, and potential drug interactions, with the goal of minimizing the risk of stroke and systemic embolism while optimizing safety and tolerability, as supported by the latest clinical guidelines and evidence 1.
From the FDA Drug Label
2.1 Recommended Dose Reduction of Risk of Stroke and Systemic Embolism in Patients with Nonvalvular Atrial Fibrillation The recommended dose of apixaban tablets for most patients is 5 mg taken orally twice daily. The recommended dose of apixaban tablets is 2.5 mg twice daily in patients with at least two of the following characteristics: • age greater than or equal to 80 years • body weight less than or equal to 60 kg • serum creatinine greater than or equal to 1.5 mg/dL Prophylaxis of Deep Vein Thrombosis Following Hip or Knee Replacement Surgery The recommended dose of apixaban tablets is 2.5 mg taken orally twice daily. The initial dose should be taken 12 to 24 hours after surgery. • In patients undergoing hip replacement surgery, the recommended duration of treatment is 35 days. • In patients undergoing knee replacement surgery, the recommended duration of treatment is 12 days Treatment of DVT and PE The recommended dose of apixaban tablets is 10 mg taken orally twice daily for the first 7 days of therapy. After 7 days, the recommended dose is 5 mg taken orally twice daily. Reduction in the Risk of Recurrence of DVT and PE The recommended dose of apixaban tablets is 2.5 mg taken orally twice daily after at least 6 months of treatment for DVT or PE
The recommended dosing for Eliquis (apixaban) in patients requiring anticoagulation varies based on the specific indication.
- For patients with nonvalvular atrial fibrillation, the recommended dose is 5 mg twice daily for most patients, and 2.5 mg twice daily for patients with at least two of the following characteristics: age ≥ 80 years, body weight ≤ 60 kg, or serum creatinine ≥ 1.5 mg/dL.
- For prophylaxis of deep vein thrombosis following hip or knee replacement surgery, the recommended dose is 2.5 mg twice daily.
- For treatment of DVT and PE, the recommended dose is 10 mg twice daily for the first 7 days, followed by 5 mg twice daily.
- For reduction in the risk of recurrence of DVT and PE, the recommended dose is 2.5 mg twice daily after at least 6 months of treatment. 2
From the Research
Eliquis (Apixaban) Dosing
The recommended dosing for Eliquis (apixaban) in patients requiring anticoagulation is not explicitly stated in the provided studies. However, the following information can be gathered:
- Apixaban is used for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, as well as for the treatment of deep vein thrombosis and pulmonary embolism 3.
- The studies provided focus on the safety and effectiveness of apixaban compared to warfarin in patients with severe renal impairment or end-stage kidney disease 4, 5, 6.
- The dosing of apixaban is not specified in the provided studies, but it is mentioned that patients with severe renal impairment or end-stage kidney disease require careful assessment and monitoring when using apixaban 4, 5, 6.
Key Findings
- Apixaban appears to be a reasonable alternative to warfarin in patients with severe renal impairment 4.
- No differences in safety or effectiveness were noted between apixaban and warfarin in patients with severe renal impairment or end-stage kidney disease 5, 6.
- Apixaban was associated with a lower risk of bleeding compared to warfarin in patients with end-stage kidney disease on dialysis 6.