How to Take Eliquis 5mg Twice Daily
Eliquis 5mg should be taken twice daily, approximately 12 hours apart (e.g., morning and evening), and can be taken with or without food. 1
Timing and Administration
Take doses approximately 12 hours apart to maintain consistent anticoagulation throughout the day—for example, at 8 AM and 8 PM, or any other 12-hour interval that fits your daily routine 1
Eliquis can be taken with or without food, providing flexibility in timing around meals 1
Strict adherence is critical because apixaban has a rapid offset of action; missing even a single dose creates a period without thromboembolic protection 2
Missed Dose Protocol
If you miss a dose, take it as soon as you remember on the same day, then resume the twice-daily schedule 1
Never double the dose to make up for a missed dose 1
The key is to get back on your regular twice-daily schedule as quickly as possible while avoiding taking two doses too close together 1
Important Clinical Considerations
Swallowing whole tablets is preferred, but for patients unable to swallow whole tablets, alternative administration methods exist (crushing and mixing with water or applesauce, or administering via nasogastric tube) 1
The 5mg twice-daily dose is appropriate for most patients with atrial fibrillation who do not meet dose-reduction criteria 2, 3
Dose reduction to 2.5mg twice daily is only indicated when at least 2 of the following 3 criteria are present: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL 2, 3, 1
Patients with only 1 dose-reduction criterion should continue taking 5mg twice daily, as this dose has been shown to be safe and effective in this population 4
Drug Interactions Requiring Dose Adjustment
If taking combined P-gp and strong CYP3A4 inhibitors (such as ketoconazole, itraconazole, or ritonavir), the dose should be reduced by 50% from 5mg twice daily to 2.5mg twice daily 5, 1
With strong CYP3A4 inhibitors alone, reduce dose by 50% 5
With P-gp inhibitors alone, reduce dose by 25% (e.g., 5mg in morning and 2.5mg in evening) 6, 5
Common Pitfalls to Avoid
Do not assume you need the lower 2.5mg dose based on age alone—you must meet at least 2 of the 3 dose-reduction criteria 2, 3
Avoid NSAIDs when possible, as NSAID use is strongly associated with increased major bleeding risk (hazard ratio 10.25) 7
Do not stop Eliquis abruptly without medical guidance, especially before procedures—specific timing protocols exist based on bleeding risk 6, 2, 5