From the Guidelines
The initial dose of Eliquis (apixaban) for atrial fibrillation is 5 mg taken orally twice daily, with a reduced dose of 2.5 mg twice daily recommended for patients who meet at least two of the following criteria: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥133 μmol/L. This recommendation is based on the most recent and highest quality study, the 2024 ESC guidelines for the management of atrial fibrillation 1. The guidelines provide a clear and evidence-based approach to the use of direct oral anticoagulants, including apixaban, for the prevention of stroke and systemic embolism in patients with atrial fibrillation.
Some key points to consider when initiating apixaban therapy include:
- The standard initial dose of 5 mg twice daily is recommended for most patients with atrial fibrillation
- A reduced dose of 2.5 mg twice daily is recommended for patients who meet at least two of the following criteria: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥133 μmol/L
- Apixaban should be taken consistently at the same times each day, with or without food
- Patients should not stop taking apixaban without consulting their healthcare provider due to increased risk of thrombotic events
It's also important to note that the dosing recommendations for apixaban may vary depending on the specific clinical context and patient population. For example, the 2020 ACC expert consensus decision pathway for anticoagulant and antiplatelet therapy in patients with atrial fibrillation or venous thromboembolism undergoing percutaneous coronary intervention or with atherosclerotic cardiovascular disease provides additional guidance on dosing adjustments for patients with end-stage kidney disease or those undergoing percutaneous coronary intervention 1. However, the 2024 ESC guidelines provide the most up-to-date and comprehensive recommendations for the use of apixaban in patients with atrial fibrillation.
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.
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.
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.
The initial dose for Eliquis (apixaban) varies depending on the indication:
- For nonvalvular atrial fibrillation, the initial dose is 5 mg twice daily.
- For prophylaxis of deep vein thrombosis following hip or knee replacement surgery, the initial dose is 2.5 mg twice daily, taken 12 to 24 hours after surgery.
- For treatment of DVT and PE, the initial dose is 10 mg twice daily for the first 7 days of therapy 2.
From the Research
Initial Dose for Eliquis (Apixaban)
The initial dose for Eliquis (apixaban) is not explicitly stated in the provided studies. However, the following information is available:
- Apixaban is approved for venous thromboembolism (VTE) prophylaxis in total hip replacement and total knee replacement, and has been pre-approved in several countries 3.
- The treatment dose of apixaban is 5 mg twice daily, and the thromboprophylactic dose is 2.5 mg twice daily 4.
- Apixaban has been evaluated in several clinical trials, including those for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) 5, 6.
- In patients with acute DVT, apixaban showed efficacy and safety similar to low-molecular-weight heparin followed by vitamin K antagonist (LMWH/VKA) 7.
Key Points
- Apixaban is an oral, direct factor Xa inhibitor with a rapid onset of action and predictable pharmacokinetics.
- The treatment dose of apixaban is 5 mg twice daily, and the thromboprophylactic dose is 2.5 mg twice daily.
- Apixaban has been evaluated in several clinical trials for the treatment of VTE, DVT, and PE.
- The initial dose for Eliquis (apixaban) is not explicitly stated in the provided studies, but the treatment dose is 5 mg twice daily.