Generic Name

Apixaban

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Classification

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

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.