From the Guidelines
The standard starting dose for Eliquis (apixaban) is 5 mg taken orally twice daily, as recommended by the 2024 ESC guidelines for the management of atrial fibrillation 1. However, a reduced dose of 2.5 mg twice daily is recommended for patients who meet at least two of the following criteria: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥133 mmol/L.
- The dose reduction criteria are based on the European Medicines Association Summary of Product Characteristics for apixaban, as outlined in the 2024 ESC guidelines 1.
- It is essential to assess baseline kidney function, liver function, and complete blood count before starting Eliquis, and to counsel patients about bleeding risks and advise them to report any unusual bleeding or bruising.
- The medication should be taken consistently at approximately 12-hour intervals with or without food.
- According to the 2023 ACC/AHA/ACCp/HRS guideline for the diagnosis and management of atrial fibrillation, apixaban is a Factor Xa inhibitor with a half-life of 12 hours, and its metabolism is minimal, with 27% renal excretion and 73% biliary and intestinal excretion 1.
- The guideline also notes that apixaban is a P-glycoprotein substrate, and its dose should be reduced to 2.5 mg twice daily in patients receiving concomitant therapy with combined P-glycoprotein and strong CYP3A4 inhibitors.
From the FDA Drug Label
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
The starting dose of apixaban (Eliquis) for this patient is 5 mg taken orally twice daily, unless the patient has at least two of the specified characteristics, in which case the dose would be 2.5 mg twice daily 2.
From the Research
Dosage of Eliquis (Apixaban)
To determine the appropriate dosage of Eliquis (apixaban) for a patient, several factors must be considered, including the patient's renal function, age, weight, and the presence of other dose-reduction criteria.
- The standard dose of apixaban is 5 mg twice daily, but patients with at least two dose-reduction criteria (age 80 years or older, weight 60 kg or less, and creatinine level 1.5 mg/dL or higher) should receive a reduced dose of 2.5 mg twice daily 3.
- For patients with advanced chronic kidney disease (CKD), apixaban has been shown to be safe and effective, with a lower risk of bleeding compared to warfarin 4, 5, 6.
- The pharmacokinetic profile of apixaban is not significantly affected by renal function, and the area under the curve values for patients with CKD are similar to those with normal renal function 4.
- A systematic review and meta-analysis found no difference in the efficacy and safety of twice-daily versus once-daily dosing of direct oral anticoagulants, including apixaban 7.
Specific Patient Considerations
When determining the dosage of apixaban for a specific patient, the following factors should be considered:
- Renal function: Patients with advanced CKD (stage 4 or 5) may require a reduced dose of apixaban, but the standard dose of 5 mg twice daily may be appropriate for patients with mild to moderate CKD 4, 5.
- Age and weight: Patients who are 80 years or older or weigh 60 kg or less may require a reduced dose of apixaban 3.
- Presence of other dose-reduction criteria: Patients with a creatinine level of 1.5 mg/dL or higher may require a reduced dose of apixaban 3.
It is essential to consult the prescribing information and consider the individual patient's characteristics and medical history when determining the appropriate dosage of apixaban.