From the Guidelines
Eliquis (apixaban) dosing should be reduced to 2.5 mg twice daily if a patient meets at least two of the following criteria: age 80 years or older, body weight 60 kg (132 lbs) or less, or serum creatinine 1.5 mg/dL or higher, as recommended by the most recent guidelines 1. The standard dose of 5 mg twice daily is typically prescribed for patients without these specific conditions.
- Dose reduction may also be necessary for patients taking certain medications that interact with Eliquis, such as strong CYP3A4 and P-gp inhibitors like ketoconazole or HIV protease inhibitors.
- Additionally, patients with severe renal impairment (creatinine clearance 15-29 mL/min) typically require the lower dose, as indicated in the guidelines 1. It is essential to note that the decision to reduce the dose of Eliquis should always be made under the guidance of a healthcare provider, as improper dosing could lead to either bleeding complications or insufficient protection against clots 1. If you experience unusual bleeding, bruising, or other concerning symptoms while taking Eliquis, contact your healthcare provider immediately rather than adjusting the dose yourself. The most recent guidelines from the American College of Cardiology and the European Society of Cardiology provide the framework for dosing adjustments, emphasizing the importance of individualized care and careful consideration of patient-specific factors 1.
From the FDA Drug Label
For patients receiving apixaban tablets doses of 5 mg or 10 mg twice daily, reduce the dose by 50% when apixaban tablet is coadministered with drugs that are combined P-glycoprotein (P-gp) and strong cytochrome P450 3A4 (CYP3A4) inhibitors (e.g., ketoconazole, itraconazole, ritonavir) The recommended dose of apixaban tablets is 2.5 mg twice daily in patients with at least two of the following characteristics: • age greater than or equal to 80 years • body weight less than or equal to 60 kg • serum creatinine greater than or equal to 1.5 mg/dL
The dose of Eliquis (apixaban) should be reduced in the following situations:
- When coadministered with combined P-glycoprotein (P-gp) and strong cytochrome P450 3A4 (CYP3A4) inhibitors, the dose should be reduced by 50%.
- In patients with at least two of the following characteristics:
- Age greater than or equal to 80 years
- Body weight less than or equal to 60 kg
- Serum creatinine greater than or equal to 1.5 mg/dL, the recommended dose is 2.5 mg twice daily 2
From the Research
Dosing Considerations for Eliquis (Apixaban)
- The optimal dosing of apixaban in patients with atrial fibrillation and severe chronic kidney disease is still a topic of debate, with different recommendations from the US Food and Drug Administration and the European Medicines Agency 3.
- A study found that apixaban 5 mg was associated with a higher risk of bleeding compared to 2.5 mg in patients with atrial fibrillation and severe chronic kidney disease, with no difference in the risk of stroke/systemic embolism or death 3.
- Another study found that variation in apixaban prescribing practices for the treatment of venous thromboembolism in dialysis patients is common, suggesting an urgent need for prospective studies and updated dosing guidance 4.
- A real-world study found that apixaban was associated with a lower risk of major bleeding compared to warfarin and rivaroxaban in patients with atrial fibrillation and severe chronic kidney disease, with similar risks for stroke/systemic embolism and death 5.
Patient Factors to Consider
- History of bleeding: patients with a history of bleeding may be at higher risk of major bleeding with apixaban, particularly at higher doses 6, 3.
- Kidney function: patients with severe chronic kidney disease may require dose adjustments, with the European Medicines Agency recommending a lower dose of 2.5 mg twice daily 3.
- Age and weight: older patients and those with lower body weight may be at higher risk of bleeding with apixaban 3.