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Eliquis
Eliquis (Apixaban) is a brand-name prescription approved by the FDA to prevent and treat dangerous blood clots in various conditions, such as reducing the risk of stroke in individuals with nonvalvular atrial fibrillation (NVAF). It is also prescribed for the treatment and prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE), as well as to prevent these conditions after knee or hip replacement surgery. It is an oral anticoagulant and works by blocking the activity of a clotting substance called factor Xa in the blood. Available in 2.5mg and 5mg tablets, its dosage varies based on the condition being treated. Patients are advised to follow their doctor’s instructions closely to minimize risks, including serious bleeding.
Product Overview
Eliquis, also known as Apixaban, is a medication used to prevent and treat blood clots, significantly reducing the risk of strokes in people with a heart condition called nonvalvular atrial fibrillation. This condition causes an irregular heartbeat, which can lead to dangerous clots forming in the heart and traveling to other parts of the body. Eliquis effectively treats deep vein thrombosis (DVT), which is a clot in the legs, and pulmonary embolism (PE), where clots move to the lungs. It’s also used to prevent these clots from happening again after initial treatment and to prevent clot formation after knee or hip replacement surgery.
Taking Eliquis correctly, as prescribed by your doctor, is crucial. It works by blocking a specific protein in the blood that helps it to clot, known as factor Xa. This reduces the likelihood of clots forming. While Eliquis is an important medication for many, it can cause side effects. These range from minor issues like nausea and easy bruising to more serious problems such as significant bleeding or allergic reactions.
It’s important not to take Eliquis if you have severe kidney or liver issues, are currently bleeding, or are taking other blood-thinning medications. Also, it’s not recommended for use during breastfeeding. Unlike some other blood thinners, you don’t need regular blood tests to monitor Eliquis’s effectiveness. For safety and the best outcomes, always discuss your medical history and any other medications you take with your healthcare provider before starting Eliquis. This ensures that the medicine is a safe choice for you and helps avoid potential complications.
Uses of Eliquis
Eliquis is used for several purposes:
- To lower the chance of stroke and blood clots in people with a type of irregular heartbeat known as nonvalvular atrial fibrillation (NVAF).
- For treating deep vein thrombosis (DVT), a condition usually happens in the legs (where blood clots form in the deep veins).
- For treating pulmonary embolism (PE), which occurs when a blood clot travels to the lungs.
- To decrease the risk of deep vein thrombosis and pulmonary embolism happening again after initial treatment.
- As a preventive measure against deep vein thrombosis, which can lead to pulmonary embolism, in patients who have had hip replacement surgery.
- For preventing deep vein thrombosis, which can lead to pulmonary embolism, in patients who have undergone knee replacement surgery.
How to Use Eliquis?
Dosage
It comes in the form of an oral tablet and has two strengths:
- Eliquis 2.5mg tablets
- Eliquis 5mg tablets
Recommended Dosage for Different Patients
Reducing the risk of systemic/stroke embolism in NVAF
- 5 mg two times daily
- For patients with NVAF, a dosage of 2.5 mg two times a day is recommended for those who have at least 2 of the following characteristics:
- age ≥80 years
- body weight ≤60 kg
- serum creatinine ≥1.5 mg/dL
Treatment of DVT/PE
- 10 mg two times daily for the first seven days
- After seven days- transition to 5 mg two times daily
Reducing the risk of recurrent PE/DVT after initial therapy
- 2.5 mg two times daily at least after six months of treatment for PE or DVT
Prophylaxis of DVT, which can lead to PE after knee or hip replacement surgery
- 2.5 mg twice daily for 12 days, starting 12 to 24 hours after knee replacement surgery
- 2.5 mg twice daily for 35 days, starting 12 to 24 hours after hip replacement surgery
[Note: Remember these recommendations may vary depending on person to person. Discuss it with your doctor, and they’ll customize your dosage accordingly.]
How to Take It?
- Use the medicine exactly as your doctor has instructed. Don’t use more than suggested, don’t use it more frequently, and don’t use it longer than your doctor recommended.
- If you’re about to run out of Eliquis, contact your doctor or pharmacist in advance. Avoid running out of medicine.
- If swallowing whole tablets is difficult for you, there are other options. The tablets can be crushed and mixed with D5W (IV solution), water, apple juice, or applesauce.
- Alternatively, if you’re using a nasogastric tube (NGT), which is a tube that goes through the nose to the stomach, you can mix the crushed tablets with 60 mL of water or D5W and administer it that way.
[Note: Carefully follow the instructions and consult your doctor if you have any questions.]
How Does Eliquis Work?
Eliquis works by binding to a specific protein involved in blood clotting, known as factor Xa. The liver produces this protein and plays a crucial role in the formation of blood clots. By inhibiting the activity of factor Xa, Eliquis effectively reduces the blood’s capacity to form clots.
Important Safety Information
Side Effects
Mild or common side effects of Eliquis include:
- Mild bleeding
- Anemia (low level of red blood cells)
- Bruising more easily than usual
- Nausea
Usually, these side effects should lessen or disappear within a few days to two weeks. However, if they worsen or persist, you should consult your doctor or pharmacist.
Serious side effects of Eliquis include:
- Allergic reaction
- Increased risk for blood clots if you stop Eliquis treatment early
- Serious bleeding
- Blood clots in your spine with spinal procedures
[Note: Remember, this list may not cover all possible side effects. Always consult with your healthcare giver for medical advice about side effects.]
Warnings
Stopping Eliquis Too Soon Increases Clotting Risk: If you stop taking Eliquis too soon, it raises the risk of blood clot-related issues. Stopping any oral anticoagulant, like Eliquis, prematurely can lead to this increased risk. If you need to stop taking Eliquis for reasons other than severe bleeding or finishing your prescribed course of treatment, it’s important to think about switching to a different blood thinner.
Risk of Spinal or Epidural Blood Clots: People taking Eliquis who have spinal anesthesia or a spinal tap can develop blood clots in the spinal area. These clots can cause long-term or permanent paralysis. Be aware of these risks when planning spinal procedures. Factors that raise the risk of these clots include:
- Having a catheter placed in the epidural space
- Using other medications that affect blood clotting, such as NSAIDs, platelet inhibitors, or other blood thinners
- A history of difficult or multiple spinal taps or punctures
- A history of spinal deformity or surgery
- The best timing between taking Eliquis and having a spinal procedure is not clear
[Note for Doctors: Regularly check patients for any signs of nerve or spinal problems. If there are signs of nerve issues, immediate medical attention is needed. Weigh the pros and cons carefully before doing any spinal procedures in patients who are taking or will take blood thinners.]
Precautions
Allergies and Inactive Ingredients: Before starting Apixaban, let your doctor or pharmacist know if you are allergic to it or if you have any allergies. Sometimes, this medication contains ingredients that might trigger allergies or other problems. You can discuss this with your pharmacist for more information.
Your Medical History Matters: It’s important to share your medical history with your doctor or pharmacist before using this medication. Especially if you have:
- Liver or kidney disease
- Previous bleeding problems, like bleeding in the stomach, intestines, or brain
- Blood disorders, such as anemia, hemophilia, or thrombocytopenia
- A recent major injury or surgery
- History of stroke
- A clotting disorder called antiphospholipid syndrome
- A tendency to experience frequent falls or injuries
Before Surgery or Medical/Dental Procedures: If you’re planning to have surgery or any medical or dental procedures, especially those involving spinal puncture or spinal/epidural anesthesia, make sure to inform your doctor or dentist that you are taking Apixaban. They might advise you to temporarily stop taking the medication. It’s essential to follow their instructions regarding when to stop and restart Apixaban.
Alcohol and Stomach Bleeding: Eliquis (Apixaban) can lead to stomach bleeding, and consuming alcohol daily while using this medicine can increase this risk. Therefore, it’s advisable to limit your alcohol intake. If you have questions about how much alcohol you can safely drink, consult your doctor or pharmacist.
Risk of Heavy Bleeding: This medication may increase the likelihood of heavy bleeding. To reduce the chances of getting cut, bruised, or injured:
- Be cautious when handling sharp objects like razors and nail cutters.
- Avoid engaging in activities like contact sports.
- Opt for an electric razor when shaving.
- Use a soft toothbrush when brushing your teeth.
- If you happen to fall or injure yourself, especially if you hit your head, contact your doctor promptly. They may need to examine you to ensure your safety.
Other Important Precautions
Pregnant and Breastfeeding Women: Current information about the use of Eliquis during pregnancy is not enough to determine its potential risks, including birth defects, miscarriage, or negative effects on the baby’s development. Using this medication might raise the chances of bleeding in both the mother and infant during pregnancy and childbirth. Breastfeeding is not recommended with the treatment of Eliquis.
Women Planning for Pregnancy: Women who can have children and need blood-thinning medication should talk with their doctor about planning for pregnancy. It’s important to evaluate the risk of serious bleeding in the uterus, which might need surgical treatment by a gynecologist, especially when using oral anticoagulants like Eliquis. This is particularly important for women who experience unusual bleeding from the uterus.
Labor or Delivery: During childbirth, women who are taking Eliquis and also receiving an epidural or spinal anesthesia should be aware of the risk of bleeding complications, such as epidural or spinal hematomas. It may be advisable to switch to a different anticoagulant that has a shorter duration of action as the time of delivery gets closer.
Contraindications
- Active pathological bleeding
- Severe hypersensitivity reaction (such as anaphylactic reactions)
Missed Dose
If you miss a dose of Eliquis, take it immediately. But if it’s nearly time for your next dose, just skip the one you missed and continue with your normal schedule. Remember, don’t take two doses at once.
[Note: Always adhere to the instructions given by your doctor to use your medications safely and effectively.]
Overdose
Call your doctor immediately if you’ve taken too much Eliquis or notice any of these symptoms of Eliquis overdose:
- Vomiting blood
- Coughing up blood
- Having blood in your stool or urine
- Non-stop bleeding, such as from a wound
[Note: If you consumed more than recommended dose, get medical help right away, or call the Poison Help line at 1-800-222-1222.]
Storage
- Store this medicine at room temperature in a closed container.
- Keep it away from moisture, heat, and direct light.
- Do not freeze it.
- Keep it out of the reach of children.
- Dispose of the medicine if it’s outdated or no longer in need.
[Note: Consult your doctor for any questions you may have regarding storing or disposing of this medication.]
Eliquis Interactions
When Eliquis (Apixaban) is used with certain other drugs, there can be an increased risk of bleeding. These interactions are important to understand and manage:
Combined P-gp and Strong CYP3A4 Inhibitors
Some medications can increase the level of Apixaban in the body, raising the risk of bleeding. These include drugs that inhibit both P-glycoprotein (P-gp) and cytochrome P450 3A4 (CYP3A4). Examples are ketoconazole, itraconazole, and ritonavir. If a patient takes 5 mg or 10 mg of Eliquis twice a day, the dose should be cut in half when any of these inhibitors are used simultaneously. However, if a patient is already on a lower dose of Eliquis (2.5 mg twice daily), it’s best to avoid these inhibitors altogether. An exception is clarithromycin; despite being a combined P-gp and CYP3A4 inhibitor, it doesn’t require a dose adjustment when used with Eliquis.
Combined P-gp and Strong CYP3A4 Inducers
There are certain drugs that lower the effectiveness of Apixaban by reducing its level in the body. These are known as combined P-gp and strong CYP3A4 inducers, such as rifampin, carbamazepine, phenytoin, and St. John’s wort. It’s advised to avoid using these drugs alongside Eliquis to maintain its efficacy.
Anticoagulants and Antiplatelet Agents
The use of Eliquis with other drugs that affect blood clotting (like antiplatelet agents, fibrinolytics, heparin, aspirin, and NSAIDs) also increases the risk of bleeding. A clinical trial (APPRAISE-2) involving high-risk patients after a heart attack showed a higher rate of bleeding in those treated with Apixaban and aspirin or a combination of aspirin and clopidogrel compared to those who received a placebo.
[Note: This isn’t a complete list, and there could be other drugs that interact with Eliquis. Make sure to tell your doctor any prescription, over-the-counter medicines, and herbal products you’re taking.]
Alternatives of Eliquis (Apixaban)
- Pradaxa (dabigatran)
- Xarelto (rivaroxaban)
- Savaysa (edoxaban)
- Coumadin or Jantoven (warfarin)
- Heparin
- Lovenox (enoxaparin)
- Acova (argatroban)
- Fragmin (dalteparin)
- Iprivask (desirudin)
- Arixtra (fondaparinux)
- Angiomax (bivalirudin)
[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.]
Quick Tips
- How to manage side effects of Eliquis
- Foods to avoid on Eliquis
- What happens if you drink alcohol while on blood thinners?
- Benefits of using Eliquis 2.5 mg
- What happens if you use probiotics with Eliquis
Frequently Asked Questions
Can I cut the Eliquis 2.5mg Tablet?
If you find it hard to swallow the whole Eliquis 2.5mg tablet, you can crush the tablet and mix it with water, 5% dextrose in water, apple juice, or apple puree. Just make sure to crush the medicine right before you take it. Talk to your doctor if you’re still unsure how to take your medicine.
What’s the Eliquis dosage for older adults?
The dosage of Eliquis for older adults can vary depending on the reason for its use. In some cases, the dosage is the same for older adults and younger individuals. This applies when Eliquis is prescribed to treat or prevent conditions like deep vein thrombosis (DVT) or pulmonary embolism (PE).
However, if Eliquis is prescribed to prevent stroke or blood clots related to atrial fibrillation (A-fib) in older adults, the doctor may recommend a lower dosage under certain circumstances. Specifically, a lower dosage may be prescribed if at least two of the following factors apply to the older adult:
- They are 80 years of age or older.
- They weigh 60 kilograms (about 132 pounds) or less.
- They have a kidney problem.
Consult your doctor or pharmacist, and they will determine the most suitable dosage for your specific needs.
How long does Eliquis stay in your system?
Eliquis typically remains in your body for approximately 2 to 3 days after discontinuing its use. This means that if you have a major surgery planned, especially one that carries a higher risk of bleeding, it’s advisable to stop taking Eliquis at least 48 hours before the procedure. If your surgery has a lower risk of bleeding, you should pause Eliquis at least 24 hours in advance. Discuss with your healthcare provider about temporarily discontinuing your Eliquis treatment if you have a scheduled surgery.
Are there any foods I should avoid while using Eliquis?
During your treatment with Eliquis, avoid consuming grapefruit and its juice. This is because it is processed in your liver by a protein called CYP3A4. Eating grapefruit or drinking grapefruit juice can interfere with how this protein works and make it less effective. As a result, the level of Eliquis in your body might become too high, increasing the risk of serious side effects. If you’re unsure or have questions about eating grapefruit or other foods while on Eliquis, it’s best to consult your doctor.
Does Eliquis 2.5 mg tablets cause joint pain?
Yes, Eliquis can lead to joint pain, particularly in patients who start taking it following major surgeries, such as operations on the hip or knee. If you notice any joint pain or swelling after undergoing surgery, it’s important to consult your doctor promptly. These symptoms could be a sign of a more serious condition.
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