Can Eliquis (Apixaban) Tablets Be Broken in Half?
No, Eliquis (apixaban) tablets should not be broken in half as this practice is not recommended and may affect the precise dosing required for this anticoagulant medication.
Rationale for Not Splitting Eliquis Tablets
Dosing Precision Requirements
Apixaban is a direct factor Xa inhibitor with a narrow therapeutic window that requires precise dosing to maintain its efficacy and safety profile 1. Unlike some medications, Eliquis has specific dosing requirements:
- Standard dose: 5 mg twice daily
- Reduced dose: 2.5 mg twice daily (for patients meeting specific criteria) 1
The reduced dose is already available as a separate formulation specifically designed for patients who meet dose reduction criteria:
- Age ≥80 years
- Body weight ≤60 kg
- Serum creatinine ≥1.5 mg/dL (133 μmol/L) 1
Pharmacokinetic Considerations
Apixaban has specific pharmacokinetic properties that make precise dosing critical:
- Half-life: 9-14 hours
- Bioavailability: 50%
- Excretion: 27% renal, 73% biliary and intestinal 1
These properties require consistent and accurate dosing to maintain therapeutic anticoagulation levels and prevent complications.
Risks of Tablet Splitting
Dosing Inaccuracy
Research on tablet splitting shows significant concerns:
- Up to 16.2% of split tablets fall outside acceptable weight uniformity standards 2
- Up to 15% of split tablets fail to meet drug content uniformity specifications 2
For anticoagulants like Eliquis, these variations could lead to:
- Underdosing - potentially increasing thrombotic risk
- Overdosing - potentially increasing bleeding risk
Physical Tablet Characteristics
While some tablets are designed with score lines to facilitate splitting, Eliquis tablets are not scored, indicating they are not intended to be split 3. Splitting unscored tablets can result in:
- Uneven breaking
- Loss of medication through powdering
- Inaccurate dosing 4
Alternative Approaches
Instead of splitting Eliquis tablets, healthcare providers should:
Use appropriate dose formulations: Eliquis is available in both 5 mg and 2.5 mg tablets specifically to accommodate different dosing needs 1
Follow established dose reduction criteria: For patients requiring dose adjustments, use the manufacturer-provided 2.5 mg tablets rather than splitting the 5 mg tablets 1
Consider medication cost programs: If cost is a concern, explore patient assistance programs rather than splitting tablets to save money
Clinical Implications
Maintaining precise anticoagulation with Eliquis is critical for:
- Preventing stroke and systemic embolism in atrial fibrillation patients
- Reducing major bleeding events
- Minimizing mortality risk 1
The ARISTOTLE trial demonstrated that apixaban reduced stroke/systemic embolism by 21% compared with warfarin, with a 31% reduction in major bleeding 1. These benefits depend on accurate dosing.
Conclusion
Given the narrow therapeutic window of apixaban, the lack of scoring on the tablets, and the availability of appropriate dose formulations, splitting Eliquis tablets should be avoided to ensure optimal efficacy and safety outcomes.