Managing a Missed Dose of Eliquis (Apixaban)
If you are taking Eliquis (apixaban) on a twice-daily schedule and it has been 3 hours after your 12-hour window, you should skip the missed dose and resume your regular dosing schedule with the next planned dose. 1
Understanding Eliquis Dosing and Missed Doses
Eliquis (apixaban) is a direct oral anticoagulant (DOAC) that is typically prescribed on a twice-daily (BID) dosing regimen. When dealing with missed doses, the following guidance applies:
For twice-daily regimens (like Eliquis): If you're uncertain about dose intake, it's generally advisable to not take another tablet/capsule, but to simply continue with your regular dosing schedule, starting with the next dose at the 12-hour interval. 1
Timing considerations: Given the relatively short plasma half-life of Eliquis (approximately 12 hours), a "wait-and-see" strategy can be used in most cases without active bleeding. 1
Why Skipping the Missed Dose Is Recommended
Taking Eliquis 3 hours after the 12-hour window (effectively 15 hours after your last dose) puts you closer to your next scheduled dose than to your missed dose. Taking the missed dose now could:
- Lead to excessive anticoagulation when you take your next regularly scheduled dose
- Increase your risk of bleeding complications
- Disrupt your established dosing pattern
Proper Management of Missed Doses
Follow this algorithm for managing missed Eliquis doses:
If you remember within a few hours of the scheduled time: Take the missed dose as soon as you remember.
If it's been more than a few hours (as in your case, 3 hours past the window):
- Skip the missed dose
- Take your next dose at the regularly scheduled time
- Do not double the dose to make up for the missed one 1
If you're unsure if you took your dose: Do not take another tablet; wait until your next scheduled dose. 1
Important Considerations
Half-life: Eliquis has a half-life of approximately 12 hours, which means that even with a missed dose, you still have some anticoagulant effect in your system. 2
Bleeding risk: Taking doses too close together increases your risk of bleeding complications.
Stroke risk: While missing a single dose is not ideal, the risk of a thromboembolic event from a single missed dose is relatively low compared to the risk of excessive anticoagulation from doses taken too close together.
When to Contact Your Healthcare Provider
Contact your healthcare provider immediately if you:
- Have missed multiple doses
- Experience signs of bleeding (unusual bruising, nosebleeds, blood in urine or stool)
- Experience symptoms suggesting a possible blood clot (sudden severe headache, chest pain, shortness of breath, leg swelling or pain)
Remember that maintaining a consistent dosing schedule is crucial for the effectiveness of Eliquis. Consider using medication reminder tools or weekly pill containers (though Eliquis should be kept in its original packaging until just before taking) to help prevent missed doses in the future. 1