Apixaban

About Apixaban

Apixaban blocks factor Xa, a clotting enzyme. In adults it is approved to lower the risk of stroke and clots in nonvalvular atrial fibrillation, to prevent deep vein thrombosis after hip or knee replacement, and to treat deep vein thrombosis and pulmonary embolism and lower the risk of their return. Since April 2025 it is also approved from birth to treat clots in the veins and lower the risk of a return, after at least 5 days of initial anticoagulant treatment, with doses by weight. In atrial fibrillation most adults take 5 mg twice a day, or 2.5 mg twice a day if at least two apply: age 80 or older, weight 60 kg or less, serum creatinine of 1.5 mg/dL or more. A clot is treated with 10 mg twice a day for 7 days, then 5 mg twice a day, and 2.5 mg twice a day after at least 6 months lowers the chance of a return. After joint replacement it is 2.5 mg twice a day for 35 days after a hip or 12 after a knee.

The boxed warning has two parts: stopping it early raises the risk of clots, so if it is stopped for a reason other than abnormal bleeding or the end of a planned course, the prescriber considers another anticoagulant; and after spinal or epidural anesthesia or a spinal puncture, bleeding around the spinal cord can cause long-term or permanent paralysis. It can cause serious, potentially fatal bleeding and is not taken with active abnormal bleeding or after a severe allergic reaction to it. It is not recommended with prosthetic heart valves, triple-positive antiphospholipid syndrome or severe liver impairment, nor in place of heparin to start treating a pulmonary embolism with unstable blood pressure. Side effects in adults are mostly bleeding; in children, headache, vomiting and heavy menstrual bleeding were most common.

Before planned surgery it is stopped at least 48 hours ahead when the bleeding risk is moderate or high, or 24 hours when it is low, as the prescriber directs. For children under 35 kg the 2025 approval added Eliquis Sprinkle 0.15 mg capsules, opened and mixed into water or infant formula, and 0.5 mg tablets for oral suspension in packets. It is not recommended in pregnancy or while breastfeeding; it may raise the risk of bleeding during pregnancy and delivery. A June 2026 label revision removed the text on the reversal drug andexanet alfa after Andexxa was withdrawn from the market.

Taking Apixaban

How to take it

Twice a day at about the same times, with or without food. Tablets can be crushed and mixed with water, apple juice or applesauce and taken promptly. A child’s Sprinkle capsules are opened into water or infant formula, never swallowed, and liquid mixtures are given within 2 hours.

If you miss a dose

Take it as soon as possible on the same day, then go back to your usual twice-daily times. Do not take a double dose to make up for a missed one.

Storage

At room temperature, 68°F to 77°F (20°C to 25°C), in the container it came in, tightly closed, away from light, heat and moisture (not in a bathroom), out of reach of children. Do not flush it; use a medicine take-back program.

Interactions to know about

Aspirin, clopidogrel, other anticoagulants, regular NSAIDs and SSRI or SNRI antidepressants raise bleeding risk. Ketoconazole, itraconazole and ritonavir raise its levels, so the dose is halved, or the combination avoided at 2.5 mg twice a day; rifampin, carbamazepine, phenytoin and St. John’s wort lower them and are avoided.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Apixaban differs from pharmacy to pharmacy

With no generic on sale, every apixaban fill is Eliquis and is priced as a brand, though quotes can still differ between pharmacies. A new clot can be treated from the 30-day starter pack of 74 tablets of 5 mg, and a later change of dose is a new fill. The children’s forms are sold only as Eliquis and Eliquis Sprinkle.

Ways to pay less for Apixaban without insurance

• Ask each pharmacy whether it can supply an FDA-approved generic yet.
• Ask the maker whether its savings or patient assistance program applies to someone paying cash; many copay cards require commercial insurance.
• Once your dose is settled, ask for a ninety-day supply, and refill before you run out, since stopping early raises the risk of clots.
• Ask the prescriber whether a generic anticoagulant such as warfarin, which needs regular INR blood tests, would suit you.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Apixaban

1. 1.Is my dose the standard one or the reduced one, and why?
2. 2.Which pain relievers, supplements or antidepressants raise my bleeding risk with it?
3. 3.What should I do if I miss a dose or am about to run out?
4. 4.How long before my surgery or dental work should it be stopped, and who decides?

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