What is the dosing frequency of Eliquis (apixaban) for non-valvular atrial fibrillation?

Eliquis Dosing Frequency for Atrial Fibrillation

Eliquis (apixaban) is dosed twice daily for atrial fibrillation—specifically 5 mg orally twice daily for most patients, or 2.5 mg orally twice daily only when at least two dose-reduction criteria are met. 1

Standard Dosing Regimen

• The FDA-approved dosing is 5 mg orally twice daily for the majority of patients with nonvalvular atrial fibrillation 1
• This twice-daily dosing schedule must be maintained consistently, with doses taken approximately 12 hours apart 1
• The American Heart Association confirms this standard dose of 5 mg twice daily based on the ARISTOTLE trial evidence 2, 3

Dose Reduction Criteria (2.5 mg Twice Daily)

The reduced dose of 2.5 mg twice daily is only appropriate when the patient meets at least TWO of the following three criteria: 1

• Age ≥80 years
• Body weight ≤60 kg
• Serum creatinine ≥1.5 mg/dL

Critical point: Meeting only ONE criterion does NOT justify dose reduction to 2.5 mg twice daily. 3, 4

Common Dosing Errors to Avoid

• Underdosing is the most frequent error, occurring in approximately 12-61% of patients in real-world studies, where providers inappropriately reduce the dose when only one criterion is met 5, 6
• The most common single criterion leading to inappropriate dose reduction is age ≥80 years (56% of underdosed patients) 5
• Patients inappropriately receiving 2.5 mg twice daily when they should receive 5 mg twice daily face increased risk of stroke and systemic embolism due to inadequate anticoagulation 3

Missed Dose Instructions

• If a dose is missed, take it as soon as possible on the same day and resume the twice-daily schedule 1
• Never double the dose to make up for a missed dose 1

Clinical Context

• The twice-daily dosing of apixaban differs from rivaroxaban (once daily) and is similar to dabigatran (twice daily) 7, 2
• The ARISTOTLE trial demonstrated that apixaban 5 mg twice daily reduced stroke/systemic embolism by 21% compared to warfarin (HR 0.79,95% CI 0.66-0.95) and reduced major bleeding by 31% 7, 2
• No routine coagulation monitoring is required with this twice-daily regimen 4