Eliquis: Advanced Stroke Prevention in Atrial Fibrillation
| Product dosage: 2.5mg | |||
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| 60 | $4.18
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| Product dosage: 5mg | |||
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| 60 | $5.36
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Synonyms | |||
Eliquis (apixaban) is a next-generation oral anticoagulant designed to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. As a direct Factor Xa inhibitor, it offers a targeted mechanism of action with predictable pharmacokinetics, reducing reliance on routine coagulation monitoring. Its clinical profile is supported by robust trial data demonstrating efficacy in thromboembolic risk reduction alongside a favorable safety margin regarding major bleeding events. This medication represents a significant advancement in long-term anticoagulation therapy for appropriate patient populations.
Features
- Contains apixaban as the active pharmaceutical ingredient
- Available in 2.5 mg and 5 mg film-coated tablets
- Direct, selective, and reversible Factor Xa inhibition
- Predictable anticoagulant effect with rapid onset
- Dual elimination pathway (renal and hepatic)
- No requirement for routine INR monitoring
- Standardized dosing without need for dose titration
Benefits
- Significantly reduces risk of stroke and systemic embolism in atrial fibrillation patients
- Lower rates of major bleeding compared to warfarin in clinical trials
- Consistent anticoagulant effect without dietary restrictions
- Fixed dosing regimen enhances medication adherence
- No routine blood monitoring required reduces treatment burden
- Demonstrated mortality benefit in appropriate clinical populations
Common use
Eliquis is primarily indicated for reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. It is also approved for the prophylaxis of deep vein thrombosis (DVT) following hip or knee replacement surgery, and for the treatment of DVT and pulmonary embolism (PE), including reduction in the risk of recurrent DVT and PE following initial therapy.
Dosage and direction
The recommended dose for stroke prevention in atrial fibrillation is 5 mg taken orally twice daily. For patients with at least two of the following characteristics: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL, the recommended dose is 2.5 mg twice daily. For DVT/PE treatment: 10 mg twice daily for 7 days, followed by 5 mg twice daily. For postoperative thromboprophylaxis: 2.5 mg twice daily for 35 days (hip replacement) or 12 days (knee replacement). Tablets should be swallowed whole with water, with or without food.
Precautions
Regular assessment of renal function is recommended, with dosage adjustment necessary for severe renal impairment. Use with caution in patients with moderate hepatic impairment (Child-Pugh B); contraindicated in severe hepatic impairment. Monitor for signs of bleeding or anemia. Consider discontinuation 48 hours prior to elective surgery or invasive procedures with moderate-to-high bleeding risk. Not recommended in patients with prosthetic heart valves or hemodynamically significant mitral stenosis.
Contraindications
Active pathological bleeding; severe hypersensitivity reaction to apixaban; concomitant use with strong dual inhibitors of CYP3A4 and P-glycoprotein such as ketoconazole, itraconazole, ritonavir, or clarithromycin; severe renal impairment (CrCl <15 mL/min) or dialysis-dependent patients; triple positive antiphospholipid syndrome due to increased thrombotic risk.
Possible side effects
- Increased risk of bleeding events (ranging from minor bruising to major hemorrhage)
- Nausea
- Anemia
- Post-procedural hemorrhage
- Hypersensitivity reactions (including rash, urticaria)
- Elevated liver enzymes (transaminases)
- Syncope (rare)
- Thrombocytopenia (rare)
Drug interaction
Strong dual inducers of CYP3A4 and P-glycoprotein (rifampin, carbamazepine, phenytoin, St. John’s wort) may decrease apixaban exposure. Anticoagulants, antiplatelet agents, NSAIDs, and SSRIs may increase bleeding risk. Combined P-gp and strong CYP3A4 inhibitors may increase apixaban exposure. Use with caution when coadministered with drugs affecting hemostasis. Monitor patients closely when initiating or discontinuing concomitant medications.
Missed dose
If a dose is missed, the patient should take it as soon as possible on the same day and resume the twice-daily regimen. Do not double the dose to make up for a missed dose. The next dose should be taken at the regularly scheduled time.
Overdose
There is no specific antidote for apixaban overdose. Management should focus on symptomatic treatment and supportive care. Activated charcoal may reduce absorption if administered within hours of ingestion. In cases of life-threatening bleeding, consider procoagulant agents such as prothrombin complex concentrate (PCC), activated PCC, or recombinant Factor VIIa, though their effectiveness has not been established in clinical studies. Dialysis is not expected to enhance elimination due to high protein binding.
Storage
Store at room temperature (20-25°C or 68-77°F); excursions permitted between 15-30°C (59-86°F). Keep in original container with desiccant to protect from moisture. Keep tightly closed and out of reach of children. Do not transfer to other containers. Discard any unused medication after the expiration date.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Treatment decisions should be made by qualified healthcare professionals based on individual patient characteristics. Always follow the prescribing information provided with the medication and consult with a healthcare provider regarding any questions about medical conditions or treatment.
Reviews
Clinical trials demonstrate Eliquis significantly reduces stroke risk compared to warfarin (HR 0.79, 95% CI 0.66-0.95) with lower major bleeding rates (HR 0.69, 95% CI 0.60-0.80). Real-world evidence supports maintained efficacy and safety in diverse populations. Healthcare providers report high patient satisfaction due to fixed dosing and lack of monitoring requirements. Some patients note convenience compared to vitamin K antagonists, though cost considerations may affect accessibility. Ongoing studies continue to evaluate long-term outcomes in various clinical scenarios.