What advice should be given to a 64-year-old female patient with hypertension and atrial fibrillation, currently taking Eliquis (apixaban) 5 mg twice daily and metoprolol (metoprolol succinate) extended release 25 mg daily?

From the Guidelines

For a 64-year-old female patient with hypertension and atrial fibrillation on Eliquis (apixaban) 5 mg twice daily and metoprolol succinate extended release 25 mg daily, I recommend continuing both medications as prescribed while monitoring for side effects. The patient should take Eliquis consistently at 12-hour intervals with or without food and never skip doses, as this medication prevents stroke by reducing blood clot formation 1. Blood pressure should be checked regularly, ideally at the same time each day, with a goal of maintaining it below 130/80 mmHg, as recommended for patients with hypertension and diabetes 1. The patient should report any unusual bleeding, bruising, dizziness, or shortness of breath immediately. Lifestyle modifications are also important, including:

• Reducing sodium intake to less than 2,300 mg daily
• Engaging in moderate exercise for 30 minutes most days
• Maintaining a healthy weight
• Limiting alcohol consumption
• Avoiding tobacco The patient should inform all healthcare providers about these medications before any procedures and carry a medical alert card. These recommendations help manage both conditions effectively while minimizing risks, as apixaban prevents strokes associated with atrial fibrillation and metoprolol controls heart rate and blood pressure 1. It is also important to note that metoprolol succinate is a recommended medication for patients with heart failure and hypertension, and has been shown to improve outcomes in these patients 1. Overall, the patient's current medication regimen and lifestyle modifications should be continued, with regular monitoring and adjustments as needed to ensure optimal management of her hypertension and atrial fibrillation.

From the FDA Drug Label

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

The patient is a 64-year-old female with hypertension and atrial fibrillation, taking Eliquis (apixaban) 5 mg twice daily. No dose adjustment is necessary based on the provided information, as the patient's characteristics do not meet the criteria for a dose reduction.

• The patient's age is less than 80 years.
• There is no information provided about the patient's body weight or serum creatinine level. Continue the current dose of 5 mg twice daily. 2

From the Research

Patient Advice

To advise the 64-year-old female patient with hypertension and atrial fibrillation, currently taking Eliquis (apixaban) 5 mg twice daily and metoprolol (metoprolol succinate) extended release 25 mg daily, consider the following points:

• The patient's current medication regimen includes apixaban, which has been shown to be effective in reducing the risk of stroke or systemic embolism in patients with atrial fibrillation 3.
• The use of metoprolol, a beta-blocker, is common in patients with atrial fibrillation and hypertension, and its efficacy in managing these conditions is well-established 4.
• However, it is essential to monitor the patient's response to the current medication regimen and adjust as necessary to minimize the risk of adverse effects, such as bleeding 5.
• The patient's age and medical history should be taken into account when considering any changes to the medication regimen, and regular follow-up appointments should be scheduled to assess the patient's condition and adjust the treatment plan as needed.

Medication Considerations

Some key points to consider regarding the patient's medications:

• Apixaban has been shown to be effective in reducing the risk of stroke or systemic embolism in patients with atrial fibrillation, but it may increase the risk of major bleeding 3, 5.
• Metoprolol is commonly used to manage hypertension and atrial fibrillation, and its efficacy in reducing blood pressure and heart rate is well-established 4.
• The patient's current dose of metoprolol is 25 mg daily, which is a relatively low dose, and the medication is administered in an extended-release formulation, which can help to minimize peak-to-trough fluctuations in blood levels 6.

Monitoring and Follow-up

To ensure the patient's safety and optimize the effectiveness of the medication regimen:

• Regular monitoring of the patient's blood pressure, heart rate, and international normalized ratio (INR) levels (if applicable) is essential to assess the patient's response to the medication regimen and adjust as necessary.
• The patient should be educated on the signs and symptoms of bleeding and instructed to seek medical attention immediately if any concerns arise.
• Follow-up appointments should be scheduled regularly to assess the patient's condition, adjust the medication regimen as needed, and monitor for any potential adverse effects.