Missed Eliquis Dose: Time Window for Late Administration
If you miss your scheduled Eliquis dose at the 12-hour mark, you should take it as soon as you remember on the same day, but do not take it if you are close to your next scheduled dose—instead, skip the missed dose entirely and resume your regular twice-daily schedule. 1
Specific Timing Guidelines for BID (Twice Daily) Dosing
For Eliquis, which is dosed twice daily (every 12 hours):
- Take the missed dose immediately if you remember within the same dosing day 1
- Do NOT take the missed dose if you are approaching your next scheduled dose (within a few hours) 1
- Never double up by taking two doses at once to make up for a missed dose 1
- Resume your normal twice-daily schedule starting with the next regularly scheduled dose 1
The "Wait-and-See" Strategy
The European Heart Rhythm Association guideline specifically addresses uncertainty about dose intake for twice-daily NOACs like Eliquis: it is generally advisable to not take another tablet, but to simply continue with the regular dose regimen starting with the next dose at the 12-hour interval. 1 This conservative approach prevents the risk of accidental overdosing while maintaining adequate anticoagulation given Eliquis's relatively short half-life of approximately 12 hours. 2
Critical Context: Why Timing Matters
- Eliquis has a plasma half-life of approximately 12 hours with normal renal function 2
- The anticoagulant effect diminishes over 2-3 days after the last dose 2
- Missing a single dose creates a temporary gap in anticoagulation protection, but this is preferable to taking a double dose which significantly increases bleeding risk 1
Common Pitfalls to Avoid
- Do not take two tablets at your next scheduled time if you missed the previous dose—this doubles your dose and dramatically increases bleeding risk 1
- Do not try to "catch up" by taking the missed dose if you're already close to your next scheduled dose 1
- Do not create your own dosing schedule—stick to the twice-daily regimen even after missing a dose 1
Risk Stratification Consideration
While the guideline provides general advice for all patients, the European guidance notes that for patients with very high thrombotic risk (CHA₂DS₂-VASc ≥3), there may be slightly more flexibility to take a late dose on the same day. However, for lower thrombotic risk (CHA₂DS₂-VASc <2), waiting until the next scheduled dose is recommended. 1 This distinction applies more to once-daily NOACs; for twice-daily Eliquis, the standard recommendation is to skip the missed dose if you're approaching your next scheduled time.
Prevention Strategy
To avoid dosing errors entirely, patients should use well-labeled weekly pill containers with separate spaces for each dose timing, though dabigatran (not Eliquis) must remain in its original bottle. 1