Accidentally Taking a Double Dose of Eliquis (Apixaban)
You will almost certainly be fine after accidentally taking 2 doses of Eliquis instead of 1, as the FDA label confirms that healthy subjects tolerated up to 50 mg daily (10 times your likely dose) for up to 7 days without clinically relevant adverse effects. 1
Immediate Safety Assessment
- No reversal agent is needed for a single accidental double dose, as this does not constitute a true overdose requiring intervention 1
- The primary risk from apixaban overdose is bleeding, but a single double dose creates minimal additional bleeding risk compared to therapeutic dosing 1
- Apixaban has a half-life of approximately 12 hours with normal renal function, meaning the excess medication will be eliminated within 24-48 hours 2
What to Do Next
Skip your next scheduled dose and resume your normal dosing schedule after that. This prevents further accumulation while allowing the medication level to normalize.
- Do not take activated charcoal unless directed by a physician, though the FDA notes it can reduce apixaban absorption by 50% if given within 2 hours of ingestion 1
- Monitor yourself for signs of bleeding over the next 24-48 hours, including unusual bruising, bleeding gums, blood in urine or stool, or prolonged bleeding from cuts 1
- Contact your physician if you develop any bleeding symptoms, but routine medical evaluation is not necessary for an asymptomatic accidental double dose 1
Critical Context About Apixaban Dosing
- Standard dosing for atrial fibrillation is 5 mg twice daily, with dose reduction to 2.5 mg twice daily only when patients meet at least 2 of 3 criteria: age ≥80 years, weight ≤60 kg, or serum creatinine ≥1.5 mg/dL 3, 4
- A common pitfall is inappropriate dose reduction (occurring in up to 40% of apixaban prescriptions), which actually increases your risk of stroke more than a single accidental double dose increases bleeding risk 3
- Approximately 80% of DOAC dosing errors are caught by pharmacists in hospital settings, highlighting how common dosing confusion is 5
Why This Is Not Dangerous
The safety margin for apixaban is substantial. In clinical trials, doses up to 25 mg twice daily (5 times the standard dose) for 7 consecutive days produced no clinically significant adverse effects in healthy volunteers 1. Your single accidental double dose represents far less total drug exposure than these safety studies.
The much greater danger would be stopping your apixaban entirely out of fear, as discontinuation increases your stroke risk by 2-fold (HR 2.00,95% CI 1.03-3.87) and death risk by 2.28-fold (HR 2.28,95% CI 1.85-2.80) 6.