From the Guidelines
It is recommended to crush Eliquis (apixaban) tablets only when necessary, such as for nasogastric or gastric feeding tube administration, and the crushed tablets should be suspended in 60 mL of water or D5W and administered immediately. According to the NCCN clinical practice guidelines in oncology 1, for patients who require enteral feeding tube administration, apixaban tablets can be crushed and suspended in water or D5W. The guidelines specify that crushed apixaban tablets are stable in water and D5W for up to 4 hours, but bioavailability is reduced if administered distal to the stomach.
- Key considerations for crushing Eliquis tablets include:
- The tablets should be crushed and mixed with a liquid immediately before administration
- The mixture should be administered within a specific timeframe to ensure stability and effectiveness
- Bioavailability may be affected if the crushed tablet mixture is administered distal to the stomach
- It is essential to consult with a healthcare provider before making any changes to how Eliquis is taken, especially if alternative administration methods are required 1.
From the FDA Drug Label
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 [see Clinical Pharmacology (12.3)]. Alternatively, apixaban tablets may be crushed and suspended in 60 mL of water or D5W and promptly delivered through a nasogastric tube [see Clinical Pharmacology (12. 3)]. Crushed apixaban tablets are stable in water, D5W, apple juice, and applesauce for up to 4 hours.
Yes, apixaban tablets, also known as Eliquis, can be crushed for patients who are unable to swallow whole tablets. The crushed tablets can be mixed with water, 5% dextrose in water (D5W), apple juice, or applesauce and administered orally, or delivered through a nasogastric tube 2.
From the Research
Crushing Eliquis Pill
- The practice of crushing tablets or opening up capsules to be taken orally, when it is not prescribed, can affect the efficacy of a treatment, or even cause an adverse event 3.
- However, a study specifically evaluating the relative bioavailability of crushed apixaban tablets (Eliquis) found that apixaban tablets can be administered crushed or whole, with or without food, with no clinically significant exposure reductions 4.
- The study compared the bioavailability of whole apixaban tablets with crushed tablets suspended in water or mixed with applesauce, and found that crushed tablets in water met bioequivalence criteria 4.
- Another study highlighted the importance of discussing medication administration with patients, especially older adults, to avoid unrecognized hazards such as splitting or crushing medications without proper guidance 5.
- It is essential for patients to consult with their healthcare provider or pharmacist before crushing any medication, including Eliquis, to ensure safe and effective administration 5, 3.