Home Drug Guide Apixaban

Drug Guide

Generic Name

Apixaban

Brand Names Eliquis, Eliquis Sprinkle

Classification

Therapeutic: Anticoagulant

Pharmacological: Factor Xa inhibitor

FDA Approved Indications

  • Prevention of stroke and systemic embolism in non-valvular atrial fibrillation
  • Treatment and prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE)

Mechanism of Action

Apixaban selectively inhibits factor Xa, reducing thrombin generation and thrombus development.

Dosage and Administration

Adult: 10 mg twice daily for 7 days, then 5 mg twice daily; dosage may vary based on condition.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; dose adjustments based on renal function.

Renal Impairment: Adjust dose or avoid in severe impairment; specific guidelines based on renal function.

Hepatic Impairment: Use with caution; contraindicated in significant hepatic disease causing coagulopathy.

Pharmacokinetics

Absorption: Rapid, with peak plasma concentration in 3-4 hours.

Distribution: Moderate binding to plasma proteins.

Metabolism: Primarily via CYP3A4 and CYP3A5 enzymes.

Excretion: Removes through renal (~27%) and fecal (~73%) routes.

Half Life: Approximate 12 hours.

Contraindications

  • Active major bleeding
  • Hypersensitivity to apixaban

Precautions

  • Risk of bleeding; use with caution in patients with bleeding disorders, recent surgery, or spinal/epidural anesthesia.

Adverse Reactions - Common

  • Bleeding (Common)
  • Nausea (Uncommon)

Adverse Reactions - Serious

  • Major bleeding including intracranial and GI hemorrhage (Rare)
  • Thrombocytopenia (Rare)

Drug-Drug Interactions

  • Strong inhibitors of CYP3A4 and P-gp (e.g., ketoconazole, ritonavir) increase bleeding risk.
  • Strong inducers (e.g., rifampin) decrease efficacy.

Drug-Food Interactions

N/A

Drug-Herb Interactions

  • St. John's Wort may decrease efficacy.

Nursing Implications

Assessment: Monitor for signs of bleeding, check renal function periodically.

Diagnoses:

  • Bleeding risk

Implementation: Administer with or without food; avoid abrupt discontinuation—consult prescriber.

Evaluation: Assess for signs of bleeding regularly; evaluate renal function periodically.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Inform healthcare providers about all other medications.
  • Seek immediate medical attention for signs of bleeding or bruising.

Special Considerations

Black Box Warnings:

  • Premature discontinuation increases risk of thrombotic events.

Genetic Factors: N/A

Lab Test Interference: May minimally affect prothrombin time, but not reliable for monitoring.

Overdose Management

Signs/Symptoms: Excessive bleeding, hypotension.

Treatment: Discontinue apixaban; consider use of activated charcoal if ingestion was recent; specific reversal agents like andexanet alfa can be used in severe cases.

Storage and Handling

Storage: Store at room temperature, away from moisture and heat.

Stability: Stable as per manufacturer specifications.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.