apixaban

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Pronunciation: a PIX a ban

Brand: Eliquis

What is the most important information I should know about apixaban?

You should not take apixaban if you have an artificial heart valve, or if you have any active bleeding from a surgery, injury, or other cause.

Apixaban can cause a very serious blood clot around your spinal cord if you undergo a spinal tap or receive spinal anesthesia (epidural), especially if you have a genetic spinal defect, if you have a spinal catheter in place, if you have a history of spinal surgery or repeated spinal taps, or if you are also using other drugs that can affect blood clotting. This type of blood clot can lead to long-term or permanent paralysis.

Get emergency medical help if you have symptoms of a spinal cord blood clot such as back pain, numbness or muscle weakness in your lower body, or loss of bladder or bowel control.

Do not stop taking apixaban unless your doctor tells you to. Stopping suddenly can increase your risk of blood clot or stroke.

What is apixaban?

Apixaban blocks the activity of certain clotting substances in the blood.

Apixaban is used to lower the risk of stroke caused by a blood clot in people with a heart rhythm disorder called atrial fibrillation.

Apixaban is also used after hip or knee replacement surgery to prevent a type of blood clot called deep vein thrombosis (DVT), which can lead to blood clots in the lungs (pulmonary embolism).

Apixaban is also used to treat DVT or pulmonary embolism (PE), and to lower your risk of having a repeat DVT or PE.

Apixaban may also be used for purposes not listed in this medication guide.

What should I discuss with my healthcare provider before taking apixaban?

You should not take apixaban if you are allergic to it, if you have an artificial heart valve, or if you have any active bleeding from a surgery, injury, or other cause.

Apixaban may cause you to bleed more easily, especially if you have a bleeding disorder that is inherited or caused by disease.

To make sure apixaban is safe for you, tell your doctor if you have:

  • kidney disease (or if you are on dialysis);
  • liver disease;
  • if you are older than 80; or
  • if you weigh less than 132 pounds.

Apixaban can cause a very serious blood clot around your spinal cord if you undergo a spinal tap or receive spinal anesthesia (epidural). This type of blood clot could cause long-term paralysis, and may be more likely to occur if:

  • you have a spinal catheter in place or if a catheter has been recently removed;
  • you have a history of spinal surgery or repeated spinal taps;
  • you have recently had a spinal tap or epidural anesthesia;
  • you are taking an NSAID (nonsteroidal anti-inflammatory drug)--ibuprofen (Advil, Motrin), naproxen (Aleve), diclofenac, indomethacin, meloxicam, and others; or
  • you are using other medicines to treat or prevent blood clots.

This medicine is not expected to harm an unborn baby. However, taking this medicine during pregnancy may increase the risk of bleeding while you are pregnant or during your delivery. Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether apixaban passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

How should I take apixaban?

Apixaban is usually taken twice per day. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

You may take apixaban with or without food.

To make swallowing easier, you may crush an apixaban tablet and mix the medicine with water or apple juice, or with a spoonful of applesauce. Swallow the mixture right away without chewing. Do not save it for later use. The mixture will no longer be good after 4 hours.

Apixaban can be given through a nasogastric (NG) feeding tube. Crush the tablet and mix the medicine in a syringe with 60 milliliters of 5% dextrose in water (D5W). Give this mixture right away through the NG tube. Do not save for later use. Do not give this mixture by mouth.

Because apixaban keeps your blood from coagulating (clotting) to prevent unwanted blood clots, this medicine can also make it easier for you to bleed, even from a minor injury such as a fall or a bump on the head. Contact your doctor or seek emergency medical attention if you fall or hit your head, or have any bleeding that will not stop.

If you need surgery or dental work, tell the doctor or dentist ahead of time if you have taken apixaban within the past 24 hours. You may need to stop taking apixaban for a short time before you have surgery or other medical procedures.

Do not stop taking apixaban unless your doctor tells you to. Stopping suddenly can increase your risk of blood clot or stroke.

If you stop taking apixaban for any reason, your doctor may prescribe another medication to prevent blood clots until you start taking apixaban again.

Use apixaban regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose on the same day you remember it. Take your next dose at the regular time and stay on your twice-daily schedule. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking apixaban?

Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth.

Grapefruit and grapefruit juice may interact with apixaban and lead to unwanted side effects. Discuss the use of grapefruit products with your doctor.

What are the possible side effects of apixaban?

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Also seek emergency medical attention if you have symptoms of a spinal blood clot: back pain, numbness or muscle weakness in your lower body, or loss of bladder or bowel control.

Call your doctor at once if you have:

  • easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), bleeding from wounds or needle injections, any bleeding that will not stop;
  • heavy menstrual periods;
  • headache, dizziness, weakness, feeling like you might pass out;
  • urine that looks red, pink, or brown; or
  • black or bloody stools, coughing up blood or vomit that looks like coffee grounds.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect apixaban?

Many drugs can interact with apixaban. Not all possible interactions are listed here. Tell your doctor about all your medications and any you start or stop using during treatment with apixaban, especially:

  • St. John's wort;
  • an antibiotic--clarithromycin, rifampin, telithromycin;
  • antifungal medicine--itraconazole, ketoconazole, posaconazole, voriconazole;
  • the hepatitis C medications boceprevir or telaprevir;
  • HIV or AIDS medication--atazanavir, cobicistat (Evotaz, Stribild, Prezcobix, Tybost), fosamprenavir, indinavir, nelfinavir, ritonavir, saquinavir; or
  • seizure medicine--carbamazepine, fosphenytoin, phenobarbital, phenytoin.

Many other drugs (including some over-the-counter medicines) can increase your risk of bleeding, or your risk of developing blood clots around the brain or spinal cord during a spinal tap or epidural. It is very important to tell your doctor about all medicines you have recently used, especially:

  • dabigatran, dalteparin, enoxaparin, fondaparinux, heparin, tinzaparin, warfarin, Coumadin, Jantoven;
  • an antidepressant such as citalopram, duloxetine, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, venlafaxine, vilazodone;
  • an NSAID such as ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others; or
  • salicylates such as aspirin, Nuprin Backache Caplet, Kaopectate, KneeRelief, Pamprin Cramp Formula, Pepto-Bismol, Tricosal, Trilisate, and others.

These lists are not complete and many other medicines can interact with apixaban. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.

Where can I get more information?

Your pharmacist can provide more information about apixaban.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

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