What is Apixaban?

Reducing the risk of stroke and serious blood clots in certain patients with atrial fibrillation. It is also used to prevent blood clots in people who have had a hip or knee replaced. It may also be used for other conditions as determined by your doctor.

Apixaban is a direct factor Xa inhibitor. It works by blocking the formation of blood clots.

Do Not use apixaban if:

  • you are allergic to any ingredient in apixaban
  • you have certain types of abnormal bleeding (eg, active major bleeding)
  • you have severe liver problems or an artificial heart valve
  • you are taking carbamazepine, phenytoin, rifampin, or St. John’s wort
  • Contact your doctor or health care provider right away if any of these apply to you.

Before using apixaban:

Some medical conditions may interact with apixaban. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

  • if you are pregnant, planning to become pregnant, or are breast-feeding
  • if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
  • if you have allergies to medicines, foods, or other substances
  • if you have a history of bleeding or clotting problems, high blood pressure, blood vessel problems (especially in the eyes, brain, or spinal column), anemia or other blood problems, low blood platelet levels or other platelet problems, stomach or bowel ulcers, stroke, or kidney or liver problems
  • if you have an infection of the heart
  • if you are at increased risk of bleeding
  • if you have recently had or are scheduled to have certain procedures (eg, surgery, including brain, spine, or eye surgery; dental procedures; a spinal or epidural procedure)

Some MEDICINES MAY INTERACT with apixaban. Tell your health care provider if you are taking any other medicines, especially any of the following:

Abciximab, alteplase, other anticoagulants (eg, enoxaparin, heparin, warfarin), aspirin, bivalirudin, dabigatran, desirudin, eptifibatide, nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen, ketorolac), platelet inhibitors (eg, clopidogrel, prasugrel, ticlopidine), selective serotonin reuptake inhibitors (SSRIs) (eg, paroxetine), serotonin-norepinephrine reuptake inhibitors (SNRIs) (eg, venlafaxine), or tirofiban because the risk of bleeding may be increased

Azole antifungals (eg, fluconazole, itraconazole, ketoconazole, voriconazole), clarithromycin, cobicistat, erythromycin, mifepristone, nefazodone, protease inhibitors (eg, boceprevir, ritonavir), or telithromycin because they may increase the risk of apixaban’s side effects, such as bleeding

Carbamazepine, enzalutamide, hydantoins (eg, phenytoin), phenobarbital, rifamycins (eg, rifampin ), or St. John’s wort because they may decrease apixaban’s effectiveness

This may not be a complete list of all interactions that may occur. Ask your health care provider if apixaban may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use apixaban:

Use apixaban as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Apixaban comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get apixaban refilled.

Take apixaban by mouth with or without food.

Taking apixaban at the same time each day will help you remember to take it.

Be sure to take apixaban for the full course of treatment. If you do not, you may be at increased risk of developing blood clots. Keep taking it even if you feel well.

If you miss a dose of apixaban, take it as soon as possible on the same day you missed the dose then go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use apixaban.

Important safety information:

Do not change your dose or stop taking apixaban without checking with your doctor. Stopping apixaban may increase the risk of developing a blood clot, including stroke in certain patients. If you need to stop taking apixaban, follow your doctor’s directions carefully.

When your medicine supply is low, get more from your doctor or pharmacist as soon as you can. Do not run out of apixaban.

Apixaban increases the risk of bleeding and can cause severe and sometimes deadly bleeding. Avoid activities that may cause bruising or injury. Tell your doctor if you have unusual bruising or bleeding; pink or brown urine; black, tarry, or bloody stools; coughing up blood; or vomit that looks like blood or coffee grounds.

Call your doctor right away if you fall or injure yourself, especially if you hit your head. You may need to be checked by your doctor.

Tell your doctor or dentist that you take apixaban before you receive any medical or dental care, emergency care, or surgery. Apixaban may need to be stopped before certain types of surgery, as directed by your doctor. If apixaban is stopped, your doctor will tell you when to start taking apixaban again after your surgery or procedure.

Use apixaban with caution in the ELDERLY; they may be more sensitive to its effects.

PREGNANCY and BREAST-FEEDING: It is not known if apixaban can cause harm to the fetus. If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using apixaban while you are pregnant. It is not known if this medicine is found in breast milk. Do not breast-feed while taking apixaban.

Why is this medication prescribed?

Apixaban is used help prevent strokes or blood clots in people who have atrial fibrillation (a condition in which the heart beats irregularly, increasing the chance of clots forming in the body and possibly causing strokes) that is not caused by heart valve disease. Apixaban is also used to prevent deep vein thrombosis (DVT; a blood clot, usually in the leg) and pulmonary embolism (PE; a blood clot in the lung) in people who are having hip replacement or knee replacement surgery. Apixaban is also used to treat DVT and PE and may be continued to prevent DVT and PE from happening again after the initial treatment is completed. Apixaban is in a class of medications called factor Xa inhibitors. It works by blocking the action of a certain natural substance that helps blood clots to form.

How should this medicine be used?

Apixaban comes as a tablet to take by mouth. It is usually taken with or without food twice a day. When apixaban is taken to prevent DVT and PE after hip or knee replacement surgery, the first dose should be taken at least 12 to 24 hours after surgery. Apixaban is usually taken for 35 days after a hip replacement surgery and for 12 days after knee replacement surgery. Take apixaban at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take apixaban exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

If you are unable to swallow the tablets, you can crush them and mix with water, apple juice, or applesauce. Swallow the mixture right after you prepare it. Apixaban can also be given in certain types of feeding tubes. Ask your doctor if you should take this medication in your feeding tube. Follow your doctor’s directions carefully.

Possible side effects of apixaban:

Major Side Effects

You should check with your doctor immediately if any of these side effects occur when taking apixaban:

Rare

  • Blood in the eyes
  • blood in the urine
  • bloody or black, tarry stools
  • bruising or purple areas on the skin
  • confusion
  • constipation
  • coughing up blood
  • decreased alertness
  • difficulty swallowing
  • dizziness
  • fainting
  • fast heartbeat
  • headache
  • hives, itching, skin rash
  • joint pain or swelling
  • nausea and vomiting
  • nosebleeds
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • redness of the eye
  • severe stomach pain
  • shortness of breath
  • tightness in the chest
  • unusual tiredness or weakness
  • vomiting of blood or material that looks like coffee grounds

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