How to order Eliquis (apixaban) starter and then therapeutic doses?

From the Guidelines

To order Eliquis (apixaban), the standard full dose is 5 mg twice daily, with a reduced dose of 2.5 mg twice daily only if the patient meets two out of three criteria: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥133 mmol/L, as recommended by the 2024 ESC guidelines 1. When initiating Eliquis therapy, it is essential to consider the patient's individual characteristics, such as age, weight, and renal function, to determine the appropriate dose.

• The standard full dose of 5 mg twice daily is recommended for most patients, as it provides optimal prevention of thromboembolism related to atrial fibrillation.
• A reduced dose of 2.5 mg twice daily may be necessary for patients who meet two out of three specific criteria, including age ≥80 years, body weight ≤60 kg, or serum creatinine ≥133 mmol/L, as outlined in the 2024 ESC guidelines 1.
• It is crucial to note that antiplatelet agents should be stopped in most patients when commencing a DOAC, such as Eliquis, and that several drug interactions exist with each DOAC, which should be taken into consideration 1.
• When ordering Eliquis, healthcare providers should specify both the initial starter pack and maintenance dose, and patients should take the medication exactly as prescribed, at the same times each day, with or without food, and never stop taking it without consulting their doctor.

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 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.

To order Eliquis (apixaban) starter and then therapeutic doses:

• For treatment of DVT and PE, the starter dose is 10 mg twice daily for the first 7 days, then the therapeutic dose is 5 mg twice daily.
• For most patients, the therapeutic dose is 5 mg twice daily.
• For patients with specific characteristics (age ≥ 80 years, body weight ≤ 60 kg, serum creatinine ≥ 1.5 mg/dL), the therapeutic dose is 2.5 mg twice daily 2.

From the Research

Apixaban Dosing

To order Eliquis (apixaban) starter and therapeutic doses, consider the following:

• The normal dosage of apixaban is 5 mg orally twice daily 3
• The dose may be reduced to 2.5 mg twice daily based on individual factors such as age, renal function, and body weight, as well as the concomitant use of potent dual inhibitors of cytochrome P450 3A4 and P-glycoprotein 3
• For patients with nonvalvular atrial fibrillation, apixaban dose adjustment is based on age, weight, and serum creatinine 4
• However, clinical data suggest that among patients >75 years, <60 kg, and with estimated glomerular filtration rate <50 mL/min, including those on dialysis, there is no reduction in apixaban safety or efficacy 4

Special Considerations

• In patients with advanced chronic kidney disease, apixaban has been shown to cause less major bleeding compared to warfarin 5
• The pharmacokinetic profile of apixaban is affected by renal function, with increased exposure in patients with advanced renal impairment 5
• However, the area under the curve values for patients with creatinine clearance 25 to 30 mL/min fell within the ranges demonstrated for patients with creatinine clearance >30 mL/min, supporting conventional dosing in patients with creatinine clearance 25 to 30 mL/min 5

Dosing Adjustment Criteria

• The current dosing adjustment criteria for apixaban may need to be re-evaluated, as clinical data show that dose adjustment based on age, weight, and serum creatinine may not be necessary in all cases 4
• Pharmacokinetic studies demonstrate increased apixaban exposure in patients with advanced renal impairment, but clinical data suggest that this may not necessarily lead to reduced safety or efficacy 4