Apixaban Dosing Timing for Pulmonary Embolism
The next dose should be taken approximately 12 hours after the initial 2 pm dose, which would be around 2 am (or at bedtime if that falls close to the 12-hour mark), as apixaban must be dosed twice daily at approximately 12-hour intervals to maintain therapeutic anticoagulation. 1
Rationale for Twice-Daily Dosing
- Apixaban has a half-life of approximately 12 hours, requiring twice-daily administration to maintain consistent therapeutic levels 2
- The FDA-approved dosing regimen for PE treatment is 10 mg taken orally twice daily for the first 7 days of therapy 1
- Maximum plasma concentration occurs 3-4 hours after oral administration, and the pharmacodynamic effect is closely correlated with plasma concentration 2
Practical Timing Considerations
- If the first dose was given at 2 pm, the next dose should ideally be taken at 2 am to maintain the 12-hour interval 1
- However, for practical purposes, taking the dose before bed (e.g., 10-11 pm) and then resuming a more convenient twice-daily schedule the following morning is acceptable, as long as subsequent doses maintain approximately 12-hour intervals 1
- After establishing the timing with the second dose, the patient should continue twice-daily dosing at consistent times (e.g., morning and evening) 3
Critical Dosing Instructions
- If a dose is missed, it should be taken as soon as possible on the same day, and twice-daily administration should be resumed—the dose should not be doubled to make up for a missed dose 1
- The 10 mg twice-daily regimen must continue for the full 7 days before reducing to the maintenance dose of 5 mg twice daily 3, 1
- No initial parenteral anticoagulation is required before or during apixaban therapy, unlike warfarin-based regimens 3