What is the loading dose and initial dosage for Apixaban (Eliquis)?

From the Guidelines

The initial dosage for Apixaban is 10 mg orally twice daily for the first 7 days of therapy, followed by 5 mg orally twice daily for the treatment of VTE, as recommended by the 2020 ACC expert consensus decision pathway 1. This dosage is specific to the treatment of venous thromboembolism (VTE) and is based on the most recent and highest quality study available.

• The standard initial dosage for non-valvular atrial fibrillation is 5 mg taken orally twice daily, with a reduced dose of 2.5 mg twice daily recommended for patients who meet at least two of the following criteria: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL, as stated in the 2024 ESC guidelines for the management of atrial fibrillation 1.
• For treatment of deep vein thrombosis (DVT) or pulmonary embolism (PE), the initial dosage is 10 mg twice daily for the first 7 days, followed by 5 mg twice daily thereafter, as per the 2020 ACC expert consensus decision pathway 1.
• Apixaban should be taken with or without food at approximately 12-hour intervals, and renal function should be assessed before initiating therapy, as dosage adjustments may be necessary for patients with severe renal impairment.
• The medication works by directly inhibiting factor Xa in the coagulation cascade, preventing thrombin formation and subsequent clot development, as described in the 2016 ESC guidelines for the management of atrial fibrillation 1.

From the FDA Drug Label

2.1 Recommended Dose Reduction of Risk of Stroke and Systemic Embolism in Patients with Nonvalvular Atrial Fibrillation The recommended dose of apixaban tablets for most patients is 5 mg taken orally twice daily. 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 Prophylaxis of Deep Vein Thrombosis Following Hip or Knee Replacement Surgery The recommended dose of apixaban tablets is 2.5 mg taken orally twice daily. The initial dose should be taken 12 to 24 hours after surgery.

2.5 Combined P-gp and Strong CYP3A4 Inhibitors 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 loading dose for Apixaban is 10 mg taken orally twice daily for the first 7 days of therapy for the treatment of DVT and PE. The initial dosage for Apixaban varies depending on the indication:

• For nonvalvular atrial fibrillation, the recommended dose is 5 mg taken orally twice daily for most patients, or 2.5 mg twice daily for patients with certain characteristics.
• For prophylaxis of deep vein thrombosis following hip or knee replacement surgery, the recommended dose is 2.5 mg taken orally twice daily, with the initial dose taken 12 to 24 hours after surgery. 2

From the Research

Apixaban Dosage

• The loading dose for Apixaban is not explicitly stated in the provided studies 3, 4, 5, 6, 7.
• The initial dosage and maintenance dosage for Apixaban can vary depending on the patient's condition and the clinical guidelines being followed.
• According to general clinical guidelines, the typical initial dosage for Apixaban is 10 mg twice daily for the first 7 days, followed by 5 mg twice daily for stroke prevention in non-valvular atrial fibrillation.
• However, it's essential to consult the specific clinical guidelines or the prescribing information for the most accurate and up-to-date dosage recommendations.

Loafing Dose

• There is no mention of a "loafing dose" in the provided studies 3, 4, 5, 6, 7.
• The term "loafing dose" is not a standard medical term and may be a misunderstanding or miscommunication.
• If you meant to ask about the loading dose, it's essential to consult the specific clinical guidelines or the prescribing information for the most accurate and up-to-date dosage recommendations.

Important Considerations

• When prescribing Apixaban, it's crucial to consider the patient's renal function, as Apixaban is contraindicated in patients with severe renal impairment 4, 5.
• The dosage of Apixaban may need to be adjusted based on the patient's renal function and other clinical factors.
• Regular monitoring of the patient's condition and renal function is essential to ensure the safe and effective use of Apixaban.