Apixaban

Apixaban is an anticoagulant that works by obstructing certain natural substances in the body that cause the formation of blood clots.

Overview

Apixaban belongs to a class of drugs known as anticoagulants or factor Xa inhibitors. This medicine is used for preventing the formation of serious blood clots in patients suffering from atrial fibrillation (a condition where patients experience irregular heartbeats). It is also approved to treat conditions like deep vein thrombosis (blood clot in the leg) and pulmonary embolism (blood clot in the lung). This medication works by blocking specific natural substances in the body that cause the formation of blood clots.

Patients suffering from atrial fibrillation (irregular heartbeat) have a high risk of forming blood clots, which can eventually lead to stroke. Taking apixaban can help prevent blood from clotting in patients suffering from irregular heartbeat disease. This drug doesn’t just prevent the formation of blood clots; it also treats already formed blood clots in parts of the body such as the lungs, brain, leg or heart. If left untreated, blood clots can cause blockages in your blood vessel and then stroke. Patients undergoing surgery or those with irregular heartbeats are likely to suffer from blood clots.

Apixaban is a relatively new medication for treating and preventing blood clots compared to warfarin, which has been around for many years. The biggest issue with warfarin as an anticoagulant is that patients are subjected to continuous blood tests in order to establish how fast their blood clots form, meaning doses change very often. Apixaban works differently because patients do not need to have frequent blood tests for the medicine to be administered. Apixaban is primarily available in the form of a tablet and is taken orally. This medication cannot be bought over-the-counter and must be prescribed by a doctor.

Conditions treated:

  • Atrial fibrillation (irregular heart beat)
  • Deep vein thrombosis (DVT)
  • Pulmonary embolism (PE)

Type of medicine:

  • Anticoagulant

Side effects

It’s important to note that taking apixaban causes several side effects. Each and every individual may experience side effects differently. However, there are several side effects that are considered common and should be experienced by almost all patients taking this medication.

Common side effects

  • Nose bleeding
  • Vaginal bleeding
  • Rectum bleeding
  • Rectum bleeding
  • Urethra bleeding
  • Bruising
  • Anemia
  • Blood in the urine
  • Feeling sick

Uncommon side effects

  • Thrombocytopenia
  • Bleeding in the eyes
  • Coughing up blood
  • Bleeding in the brain or spinal column
  • Alteration in results of liver function tests
  • Bleeding, weeping or bruising of a surgical wound
  • Bleeding in your gut
  • Elevated bilirubin levels leading yellowing of skin and eyes
  • Vomiting blood
  • Blood in the stools
  • Hypersensitivity reactions such as rash, itching, hives or swelling of the lips and face
  • Low blood pressure
  • Alteration in results of liver function tests

Rare side effects

  • Bleeding in the muscles

The unwanted effects mentioned above may not be a complete list of side effects as provided by the medicine's manufacturer. For more information on any other potential risks of taking apixaban, please do more research by checking out the printed leaflet that comes with the medication or consult with your doctor.

Dosage

Before beginning treatment, it’s crucial that you read the printed leaflet provided by the medicine’s producer inside the packaging. This leaflet contains all the information you need about using apixaban, including a full list of unwanted effects you’ll likely experience from using this drug.

Take apixaban as instructed by your doctor. 5 mg of this medicine should be taken orally twice a day (in the morning and evening) if you are a younger individual suffering from irregular heartbeat disorder. On the other hand, 2.5 mg taken twice a day is the dose recommended for older patients over 80 or people with reduced kidney function.

This medicine can be taken alone or together with food. It’s recommended that you swallow this medication with water. If you find it difficult to swallow the entire tablet, you should crush it, then mix it with two tablespoons of water or with sweeteners like apple juice or apple puree. Swallow the solution as soon as possible.

Try to take the recommended dose at the same time, however, if you miss a dose, ensure you take it the moment you remember. Never take two doses at the same time in order to make up for the missed dose.

Apixaban is available as a tablet and is taken orally or by mouth. In the case of using the drug to prevent blood clots for deep vein thrombosis (DVT) or pulmonary embolism (PE) after surgery, the initial dose should be taken within 12 to 24 hours after the surgical procedure is complete.

This medicine is normally taken for 12 days immediately after the knee surgery operation is complete. For hip replacement surgery, the medicine is taken for 35 days after the operation. Apixaban should be taken at the same period daily.

Follow the instructions of your doctor or pharmacist carefully and, if you don’t understand something, make sure you ask for clarification. Do not take more or less of the medication; follow the dosage recommended by your physician. Continue to take his medication even if your health improves. Do not stop taking this medication unless the doctor allows you to skip a dose. Patients who stop taking apixaban without the permission of the doctor risk worsening their condition.

To remedy blood clots in the lungs or leg, this medication is given in huge doses. It should be taken twice per day consistently for seven days before being reduced, then taken for three to six months. You should follow your doctor’s instructions if you are suffering from any of the two blood clot conditions.

In case of overdose, you should contact your local poison control center for further direction. In case a patient collapses because of overdosing on apixaban, call 911 immediately for help.

Common symptoms for overdose of this medicine may include:

  • Unusual bleeding or bruising
  • Red or black, tarry stools
  • Vomiting blood or coughing up blood
  • Red, brown, or pink urine

Drug interactions

It’s crucial to inform your physician or pharmacist about other medications you are using prior to starting treatment with this drug. This includes medicines you bought over-the-counter, as well as natural or herbal supplements. Also, do not take any medication once you start using apixaban until the doctor okays a given combination.

The medicines listed below interact with apixaban and can cause increased bleeding and other severe side effects. In short, you should not use apixaban together with the following medications:

  • Azole antifungal medicines
  • Ketoconazole
  • Posaconazole
  • Itraconazole
  • Voriconazole
  • Protease inhibitors:
  • Atazanavir
  • Boceprevir
  • Darunavir
  • Indinavir
  • Fosamprenavir
  • Lopinavir
  • Nelfinavir
  • Saquinavir
  • Ritonavir
  • Telaprevir
  • Tipranavir

Apixaban will increase the effect of other anticoagulant medication thus should never be used together. Do not use this medication with the following anticoagulants listed below:

  • Acenocoumarol
  • Argatroban
  • Bivalirudin
  • Fondaparinux
  • Dabigatran
  • Danaparoid
  • Heparin
  • Warfarin
  • Lepirudin
  • Phenindione
  • Rivaroxaban

If apixaban is used in combination with the following medicines, there’s a huge risk of a patient experiencing bleeding side effects. Talk to your doctor first before using any of these medications.

  • Aspirin
  • Clopidogrel
  • Dextran
  • Duloxetine
  • Dipyridamole
  • Abciximab
  • Eptifibatide
  • Tirofiban
  • Diclofenac
  • Ibuprofen
  • Naproxen
  • Prasugrel
  • Fluoxetine
  • Fluvoxamine
  • Paroxetine
  • Citalopram
  • Sulfinpyrazone
  • Alteplase
  • Streptokinase
  • Ticagrelor
  • Venlafaxine

The following medications can reduce the quantity of apixaban in your blood. This can cause this medicine to be less effective in preventing blood clots:

  • Carbamazepine
  • Phenobarbital
  • Phenytoin
  • Rifampicin
  • St.John's herbal solution

The list of medicines provided above is by no means complete. You can talk to your doctor or pharmacist for a complete list of drugs that interact with apixaban. Check with the manufacturer of the medicine if you want a definitive list.

Warnings

Inform your doctor if you notice any signs of bleeding while taking this medication. Watch out for the following bleeding symptom if you are taking apixaban: bleeding from gums, nosebleeds, blood in urine, coughing up blood, vomiting blood and bloodstained stools. The doctor will assess your situation and decide whether you should stop or continue with this medication. In some cases, the doctor may have to look for an alternative anticoagulant if the bleeding does not ease.

Talk to your doctor if you are planning to have surgery while taking this medicine. The doctor may order you to stop using this medication for some time until after you undergo surgery.

Inform your doctor if you are using any of these medicines while taking apixaban, as they can cause serious side effects:

  • Carbatrol
  • Epitol
  • Equetro
  • Tegretol, Teril)
  • Biaxin
  • Itraconazole (Onmel, Sporanox)
  • In Prevpac ketoconazole (Nizoral)
  • rifampin (in Rifater , Rifadin, Rimactane)
  • phenytoin (Dilantin, Phenytek)
  • citalopram (Celexa)
  • fluoxetine (Sarafem, Selfemra, in Symbyax, prozac)
  • ritonavir (Norvir, in Kaletra)
  • desvenlafaxine (Khedezla, Pristiq
  • asertraline (Zoloft)
  • duloxetine (Cymbalta)
  • milnacipran (Fetzima, Savella)
  • venlafaxine (Effexor)
  • fluvoxamine (Luvox)
  • paroxetine (Brisdelle, Paxil, Pexeva)

Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with apixaban, so be sure to tell your doctor about all the medicines you are taking, even those that do not appear on this list.

If you are suffering from a condition known as atrial fibrillation (Irregular heartbeat condition), then you must follow the instructions of the doctor fully in order for you to recover quickly. Discontinuing using apixaban for any reason puts you at risk of developing more blood clots and eventually stroke. Never stop taking the prescribed medication for any reason, only a doctor can permit you to do so. Ensure that you don’t run out of medication at any time to prevent missing a dose. However, you may stop using this medicine if the doctor decides to prescribe another anticoagulant to treat your blood clotting condition. You should not use this medication together with another anti-coagulant, as the side effects produced can be severe.

If you have kidney or liver issues, inform your doctor before using this medication as these conditions can cause severe bleeding and bruising. Use this medicine with caution if you have any of the following conditions:

  • Decreased kidney function
  • Decreased liver function
  • Haemophilia
  • Thrombocytopenia
  • High blood pressure
  • Epidural anesthesia

You shouldn’t use apixaban if you suffer from any of the following conditions. Speak with your doctor to assess your condition. Only the doctor can permit the use of this medication:

  • Severe bleeding
  • Active bleeding
  • Peptic ulcers
  • Ulcerative colitis
  • Cancer
  • Liver cirrhosis
  • Bleeding of the skull
  • Blood vessels abnormality
  • Liver disease
  • Kidney failure
  • Hip fracture
  • Artificial heart valve

This medication should not be used by children under the age of 18 years. Its safety for the age group hasn’t yet been established. Additionally, stop using apixaban immediately if you are allergic to its ingredients. Inform your doctor as soon as possible if you notice any allergic reactions while using this medication.

Pregnancy and breastfeeding

Certain medications cannot be used during pregnancy or when a mother is breastfeeding. However, some medications may be allowed during pregnancy so long as they don't endanger the life of the unborn baby. It is highly recommended that you consult your doctor if you are pregnant or planning to get pregnant while taking apixaban. The safety of this medicine has not yet been established after a number of clinical trials, so pregnant women should avoid taking it.

Storage

Apixaban should be stored properly just like other medications. You should make sure that the medication is stored safely and away from the reach of kids. The container should be closed after use to prevent any chance of the medicine spilling out. Spillage usually occurs because of the failure to close the medication tightly. As such, it's good to always confirm that your medicine bottle is closed the right way.

The ideal temperature to store this medication is room temperature. Do not store apixaban in a room where there is heat or moisture. For example, do not store this medication in the bathroom because of the moist conditions in such a place.

When it comes to disposing of vthis medication, ensure that you dispose of it properly so that other people or pets may not consume it. Flushing this medicine down your toilet isn’t encouraged. Instead, dispose your medicine through a local take-back initiative in your community. Ask your garbage collector or pharmacist about take-back programs in your area if you can’t find one. You can also use the internet to find contact information for all the organizations that can help you dispose of your medications safely. This medicine can be poisonous if it gets into the wrong hands, so it's good to take safety measures.

Summary

Apixaban is an effective anticoagulant medication used for treating and preventing blood clot symptoms. It is used to prevent blood clots from forming in patients suffering from atrial fibrillation, a condition where patients have to endure irregular heartbeats. If not stopped early, the formation of blood clots not only blocks your blood vessels but can also cause strokes.

This medication is also used for other blood clot disorders such as deep vein thrombosis (DVT) and pulmonary embolism (PE). The medication has gained popularity over older alternatives such as warfarin because the patients don't have to undergo blood testing before medication can be prescribed.

Taking apixaban helps to prevent blood clots from forming in the body. However this medicine comes with its own fair share of unwanted side effects. Some of the common side effects you are likely to experience if you are using this medicine include bleeding in one or many parts of the body such as rectum, nose, vagina and urethra. It is important to note that bleeding occurs differently, depending the person using the medication. You should speak with your doctor for more information on how to deal with bleeding and bruising while using apixaban. Other less common side effects that could occur while using this medication include Thrombocytopenia, Bleeding in the eyes, coughing up blood, bleeding in the brain or spinal column etc.

Apixaban should be taken as prescribed by the doctor. You should not increase or decrease the dosage amount under any situation. Patients dealing with atrial fibrillation should take 5 mg of the medication orally twice a day. The medication should be taken preferably at the same period each day and should be taken alone or together with food. If you struggle to swallow the whole tablet, then you should consider crushing it, mixing it with water or apple juice.

Tell the doctor if you are using any other medications to prevent drug interactions. In addition, stop using this medicine if it causes allergic reactions and seek urgent medical attention. Pregnant women should not use this drug because its safety is not guaranteed.

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Last Reviewed:
December 26, 2017
Last Updated:
December 22, 2017