From the Guidelines
Apixaban is given orally, typically as a tablet taken twice daily, with a standard dose of 5 mg twice daily, although some patients may require a reduced dose of 2.5 mg twice daily, as recommended for those meeting at least two of the following criteria: age ≥80 years, serum creatinine ≥1.5 mg/dL, as indicated in the 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation 1.
Key Considerations for Apixaban Administration
- The dose may need to be adjusted based on renal function, with a reduced dose of 2.5 mg twice daily recommended for patients with certain renal impairments, as outlined in the guideline 1.
- Apixaban can be taken with or without food and should be taken at approximately the same times each day to maintain consistent blood levels.
- If a dose is missed, it should be taken as soon as remembered unless it's close to the next scheduled dose.
- For patients unable to swallow tablets, apixaban tablets can be crushed and suspended in water, apple juice, or applesauce for immediate administration.
Initial Treatment Dosing
- For initial treatment of VTE, apixaban may be given at a dose of 10 mg orally twice daily for the first 7 days of therapy, followed by 5 mg orally twice daily, as indicated in the 2020 ACC expert consensus decision pathway for anticoagulant and antiplatelet therapy 1.
Mechanism of Action
- Apixaban works by directly inhibiting factor Xa in the coagulation cascade, preventing the formation of thrombin and subsequent clot formation, making consistent dosing important for maintaining its anticoagulant effect.
Important Interactions and Precautions
- Patients receiving apixaban 5 mg twice daily should have their dose reduced to 2.5 mg twice daily when combined with p-glycoprotein and strong CYP3A4 inhibitors, such as itraconazole, systemic ketoconazole, clarithromycin, or ritonavir, as recommended in the guideline 1.
From the FDA Drug Label
5 mg taken orally twice daily after at least 6 months of treatment for DVT or PE 2.6 Administration Options For patients who are unable to swallow whole tablets, 5 mg and 2. 5 mg apixaban tablets may be crushed and suspended in water, 5% dextrose in water (D5W), or apple juice, or mixed with applesauce and promptly administered orally Alternatively, apixaban tablets may be crushed and suspended in 60 mL of water or D5W and promptly delivered through a nasogastric tube
Apixaban is given orally, with a typical dose of 5 mg twice daily. For patients who have difficulty swallowing, the tablets can be crushed and mixed with water, D5W, apple juice, or applesauce, or delivered through a nasogastric tube 2.
From the Research
Administration of Apixaban
- Apixaban is administered orally, with a normal dosage of 5 mg twice daily 3.
- The dosage may be reduced to 2.5 mg twice daily based on individual factors such as age, renal function, and body weight, as well as the concomitant use of potent dual inhibitors of cytochrome P450 3A4 and P-glycoprotein 3.
- Patients with atrial fibrillation and advanced age, low body weight, or high creatinine levels may receive a reduced dose of apixaban, but the 5 mg twice daily dose is still safe and efficacious for patients with only one dose-reduction criterion 4.
Special Considerations
- Apixaban has a half-life of about 12 hours 3.
- Patients with severe renal impairment, including those with end-stage renal disease, may still be safely treated with apixaban, with some studies suggesting a lower prevalence of bleeding and thromboembolic events compared to warfarin therapy 5.
- The absorption of apixaban is dependent on the intestinal P-glycoprotein system, and concomitant medication with certain drugs may increase or decrease its bioavailability 6.