Recommended Dosing of Eliquis (Apixaban)
The standard dose of Eliquis (apixaban) is 5 mg twice daily for most patients, with a reduced dose of 2.5 mg twice daily for patients who have at least two of the following characteristics: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL. 1, 2, 3
Standard Dosing for Atrial Fibrillation
For patients with nonvalvular atrial fibrillation:
- Standard dose: 5 mg twice daily
- Reduced dose: 2.5 mg twice daily if patient has at least two of:
- Age ≥80 years
- Body weight ≤60 kg
- Serum creatinine ≥1.5 mg/dL
Renal Function Considerations
Apixaban dosing based on renal function:
- CrCl >30 mL/min: 5 mg twice daily (standard dose) or 2.5 mg twice daily (if dose reduction criteria met)
- CrCl 15-30 mL/min: 5 mg twice daily or 2.5 mg twice daily (if dose reduction criteria met)
- CrCl <15 mL/min or on dialysis: 5 mg twice daily or 2.5 mg twice daily (if dose reduction criteria met) 2
Other Indications
For DVT/PE treatment:
- Initial treatment: 10 mg twice daily for the first 7 days
- Continued treatment: 5 mg twice daily after the initial 7 days 1
For DVT prophylaxis after hip or knee replacement:
- Dose: 2.5 mg twice daily
- Duration: 35 days for hip replacement; 12 days for knee replacement 1
For reduction in risk of recurrent DVT/PE:
- Dose: 2.5 mg twice daily after at least 6 months of treatment 1
Drug Interactions
- In patients receiving apixaban 5 mg twice daily, reduce dose to 2.5 mg twice daily when combined with strong CYP3A4 and P-glycoprotein inhibitors (e.g., ketoconazole, itraconazole, ritonavir, clarithromycin) 2
- If patients are already on 2.5 mg twice daily, avoid apixaban use with these inhibitors 2
- Avoid concomitant use with strong CYP3A4 and P-glycoprotein inducers (e.g., rifampin, carbamazepine, phenytoin, St. John's wort) 2, 3
Administration Guidelines
- If a dose is missed, take it as soon as possible on the same day and resume twice-daily dosing
- Do not double the dose to make up for a missed dose 1
- Apixaban can be taken with or without food 3
- For patients unable to swallow tablets, apixaban can be crushed and administered via nasogastric tube without altering bioavailability 3
Perioperative Management
For elective procedures:
- High bleeding risk procedures: Discontinue apixaban 48 hours before procedure
- Low bleeding risk procedures: Discontinue apixaban 24 hours before procedure
- Resume apixaban as soon as adequate hemostasis is achieved 2, 1
Important Considerations
- Clinical data from ARISTOTLE showed that patients with only one dose-reduction criterion who received the standard 5 mg twice daily dose had similar benefits compared to warfarin as those with no dose-reduction criteria 4
- Regular monitoring of renal function is important, especially in elderly patients 3
- Apixaban is contraindicated in patients with mechanical heart valves or significant mitral stenosis 3
Remember that premature discontinuation of apixaban increases the risk of thrombotic events, so if anticoagulation needs to be discontinued for reasons other than bleeding, consider coverage with another anticoagulant 1.