Is it ok to cut Eliquis (apixaban) in half for a patient with impaired renal function (creatinine 1.4) and advanced age (almost 90)?

From the Guidelines

It is not recommended to cut Eliquis (apixaban) tablets in half for a patient with impaired renal function and advanced age. Eliquis tablets should be taken whole as prescribed. For patients with renal impairment (creatinine 1.4) and advanced age (almost 90), dose adjustment may be necessary, but this should be determined by a healthcare provider rather than by physically splitting the tablets.

Key Considerations

• The standard dose of Eliquis for atrial fibrillation is 5 mg twice daily, but for patients who meet at least two of the following criteria—age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL—the recommended dose is reduced to 2.5 mg twice daily, as indicated in the study by 1.
• Cutting Eliquis tablets can affect the drug's release pattern and potentially alter its effectiveness in preventing blood clots.
• Additionally, the tablet coating helps protect the active ingredient from degradation.
• If dose adjustment is needed, the patient should be prescribed the appropriate strength tablet (2.5 mg) rather than cutting a higher-strength tablet.

Dosing Guidelines

• According to the study by 1, for patients with CrCl 30–59 ml/min, the recommended dose of apixaban is 5.0 or 2.5 mg BID, with the lower dose used if any 2 patient characteristics are present: Cr >1.5 mg/dl, >80 years of age, or body weight <60 kg.
• The study by 1 also provides guidance on dosing for patients with renal impairment, recommending a reduced dose of apixaban for patients with certain characteristics, such as age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL.

Conclusion Not Applicable - Direct Answer Only

The patient's healthcare provider should determine the appropriate dose of Eliquis based on their individual characteristics and medical history, rather than cutting the tablets in half, as supported by the studies 1, 1, and 1.

From the FDA Drug Label

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 has a creatinine level of 1.4, which is less than 1.5 mg/dL, but is almost 90 years old. No direct information is provided in the label about cutting the tablet in half. However, based on the dosing recommendations, a dose reduction may be considered for patients with certain characteristics, such as advanced age.

• The label does recommend a dose of 2.5 mg twice daily for patients with at least two of the specified characteristics, but it does not explicitly state that the tablet can be cut in half.
• It is not explicitly stated that cutting the tablet in half is acceptable, and the label does not provide guidance on this specific situation.
• Given the patient's advanced age and renal function, a conservative approach would be to consult with the physician or pharmacist to determine the best course of action, as the label does not provide clear guidance on cutting the tablet in half 2.

From the Research

Apixaban Dosing Considerations

• The standard dose of apixaban is 5 mg twice daily, but dose reduction to 2.5 mg twice daily is recommended for patients with at least two of the following criteria: age 80 years or older, weight 60 kg or less, and serum creatinine level 1.5 mg/dL or higher 3.
• For patients with impaired renal function, such as a creatinine level of 1.4, the dosing criteria may not be clearly defined, and the decision to reduce the dose should be made on a case-by-case basis 4, 5.
• Advanced age, in this case almost 90, is a consideration for dose reduction, but the presence of only one dose-reduction criterion may not necessitate a reduced dose 3, 6.

Clinical Practice and Dosing

• Studies have shown that apixaban dosing in clinical practice is often inconsistent with labeling, and factors such as age, weight, and serum creatinine level are associated with inappropriate dose reduction 6.
• The use of apixaban-calibrated anti-Xa assays may be useful in certain circumstances, such as in patients with renal insufficiency or advanced age, to guide therapeutic decision making 7.

Specific Considerations for Cutting Eliquis in Half

• There is no clear evidence to support cutting Eliquis in half for a patient with a creatinine level of 1.4 and advanced age, as the dosing criteria are based on specific thresholds and combinations of factors 4, 5, 3.
• The decision to cut Eliquis in half should be made on a case-by-case basis, taking into account the individual patient's characteristics and medical history, and in consultation with a healthcare professional 6, 7.