What is the equivalent dose of Eliquis (Apixaban) for a patient taking 20 mg of Xarelto (Rivaroxaban) daily?

From the Guidelines

When switching from 20 mg of Xarelto (rivaroxaban) daily to Eliquis (apixaban), the recommended dose is 5 mg of Eliquis twice daily, resulting in a total daily dose of 10 mg. This dosing regimen is based on the most recent and highest quality study available, which compared the efficacy and safety of apixaban with warfarin in patients with atrial fibrillation 1. The study demonstrated that apixaban was significantly better than warfarin, with fewer overall strokes, systemic emboli, and major bleeding events.

Key considerations when making this switch include:

• The first dose of Eliquis should be taken at the time the next dose of Xarelto would have been scheduled
• It's essential not to take both medications simultaneously, as this could increase bleeding risk
• Both medications are direct oral anticoagulants (DOACs) that work by inhibiting Factor Xa in the blood clotting cascade, but they have different dosing schedules and half-lives
• Xarelto is taken once daily, while Eliquis requires twice-daily dosing for better 24-hour coverage
• Some patients may require dose adjustments based on age, weight, kidney function, or concomitant medications, so this switch should always be supervised by a healthcare provider who can evaluate individual factors and provide personalized dosing instructions 1.

In terms of dosing adjustments, the US labeling recommends a dose reduction of apixaban to 2.5 mg twice daily in patients with any two of the following conditions: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL 1. Additionally, for patients with end-stage renal disease requiring hemodialysis, the recommended dose is 5 mg twice daily, with a reduction to 2.5 mg twice daily if age ≥80 years or body weight ≤60 kg 1.

From the Research

Equivalent Dose of Eliquis (Apixaban) for a Patient Taking 20 mg of Xarelto (Rivaroxaban) Daily

There are no direct comparisons of the equivalent doses of Eliquis (Apixaban) and Xarelto (Rivaroxaban) in the provided studies. However, the following information can be gathered:

• Rivaroxaban is administered at a fixed oral dose of 20 mg once daily for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation 2, 3.
• Apixaban is administered at a dose of 5 mg twice daily for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation 4.
• The pharmacological characteristics of rivaroxaban, apixaban, and dabigatran are different, and guidance is needed on optimum doses and dosing intervals 4.
• There is no direct information on the equivalent dose of apixaban for a patient taking 20 mg of rivaroxaban daily.

Key Points to Consider

• The dosing regimens of rivaroxaban and apixaban are different, with rivaroxaban typically administered once daily and apixaban administered twice daily 3, 4.
• The pharmacokinetics and pharmacodynamics of rivaroxaban and apixaban are distinct, and their doses are not directly interchangeable 4.
• In the absence of direct comparative data, the equivalent dose of apixaban for a patient taking 20 mg of rivaroxaban daily cannot be determined with certainty.