Section 13 · Monograph
Apixaban
Reviewed Nov 2026FDA label
EliquisFactor Xa inhibitor (DOAC)
- Forms
- Tab: 2.5, 5mg
- Dose
- AF stroke prevention: 5mg BID (2.5mg BID if 2 of: age 80+, weight 60kg or less, creatinine 1.5+)
- MOA
- Direct factor Xa inhibition
Black Box Warning
- Premature discontinuation increases the risk of thrombotic events including stroke — if stopped for a reason other than bleeding, cover with another anticoagulant
- Spinal/epidural hematoma risk with neuraxial anesthesia or puncture, potentially causing long-term or permanent paralysis
Indications
- Reduce risk of stroke and systemic embolism in nonvalvular atrial fibrillationFDA-labeled
- Treatment and secondary prevention of DVT/PE; postoperative VTE prophylaxisFDA-labeled
Mechanism of Action
- Direct, selective, reversible factor Xa inhibitor
Full Dosing
Adult / usual
- AF: 5mg twice daily; 2.5mg twice daily if at least 2 of: age 80 or older, weight 60kg or less, serum creatinine 1.5mg/dL or more
- Strong dual CYP3A4/P-gp inhibitors: reduce dose by 50% (avoid if already 2.5mg twice daily)
- Hold before procedures according to bleeding risk
Contraindications
- Active pathological bleeding
- Severe hypersensitivity to apixaban
Drug Interactions
- Strong dual CYP3A4/P-gp inhibitors (ketoconazole, ritonavir) increase levels
- Strong inducers (rifampin, carbamazepine, phenytoin) lower levels — avoid
- NSAIDs, antiplatelets and SSRIs increase bleeding risk
Adverse Effects
- Bleeding (GI, intracranial)
- Anemia
- Nausea
Monitoring Parameters
- Renal function and CBC at least yearly (more often in CKD)
- Age, weight and creatinine criteria for dose
- Bleeding signs
Pregnancy & Lactation
- Limited data; avoid in pregnancy (LMWH preferred)
- Avoid during breastfeeding