Half-Life of Eliquis (Apixaban)
The half-life of Eliquis (apixaban) is approximately 12 hours in healthy individuals, but can range from 8-15 hours depending on patient factors. 1
Detailed Information on Apixaban Half-Life
Apixaban demonstrates consistent pharmacokinetics with the following characteristics:
- Standard half-life: Approximately 12 hours in healthy individuals 2, 1
- Terminal elimination half-life: After oral administration, apixaban has an apparent half-life of approximately 12 hours 2
- Absorption: Rapidly absorbed with maximum concentration occurring 3-4 hours after oral administration 1
- Bioavailability: Approximately 50% for doses up to 10 mg 2
Factors Affecting Apixaban Half-Life
The half-life of apixaban can be significantly affected by several patient-specific factors:
Renal Function
Half-life varies based on creatinine clearance (CrCl) 3:
- Normal renal function (CrCl ≥80 mL/min): 6-15 hours
- Mild impairment (CrCl 50-79 mL/min): 6-15 hours
- Moderate impairment (CrCl 30-49 mL/min): 6-15 hours
- Severe impairment (CrCl 15-29 mL/min): 17 hours
- End-stage renal disease (CrCl <15 mL/min): 17 hours (off dialysis)
Age
- Older patients (>75 years): Half-life extends to 11-13 hours 3
Hepatic Function
- Mild to moderate hepatic impairment: Similar pharmacokinetics to healthy subjects, but caution is advised 2
- Severe hepatic impairment: Not well studied and generally contraindicated 4
Elimination Pathway
Apixaban has multiple elimination pathways 2, 1:
- Renal excretion: Approximately 27% of total clearance
- Hepatic metabolism: Primarily via CYP3A4 with minor contributions from CYP1A2, 2C8, 2C9, 2C19, and 2J2
- Biliary excretion and direct intestinal excretion account for the remainder
Clinical Implications of Apixaban's Half-Life
The 12-hour half-life of apixaban has important clinical implications:
Dosing frequency: The half-life supports twice-daily dosing regimen 4
Perioperative management:
- For procedures with low bleeding risk: Discontinue apixaban at least 24 hours before (2 half-lives)
- For procedures with high bleeding risk: Discontinue apixaban at least 48 hours before (4 half-lives) 3
Overdose management: In case of overdose, the anticoagulant effect can be expected to persist for at least 24 hours (approximately 2 drug half-lives) 2, 5
Drug interactions: Strong inhibitors of both CYP3A4 and P-glycoprotein can significantly increase apixaban plasma concentrations and effectively prolong its half-life 2
Important Considerations
- Hemodialysis: Has minimal impact on apixaban exposure due to high protein binding (87%) 2
- Reversal agents: Andexanet alfa is available as a specific reversal agent for factor Xa inhibitors including apixaban 2
- Monitoring: Unlike warfarin, routine coagulation monitoring is not required for apixaban 4
The predictable half-life and pharmacokinetics of apixaban allow for reliable anticoagulation in most patients, with dosing adjustments primarily needed for patients with specific risk factors such as renal impairment, advanced age, or low body weight.