Apixaban Dosage

Medically reviewed by Drugs.com. Last updated on Aug 15, 2024.

Applies to the following strengths: 2.5 mg; 5 mg

Usual Adult Dose for:

Deep Vein Thrombosis - Prophylaxis
Deep Vein Thrombosis Prophylaxis after Hip Replacement Surgery
Deep Vein Thrombosis Prophylaxis after Knee Replacement Surgery
Prevention of Thromboembolism in Atrial Fibrillation
Thromboembolic Stroke Prophylaxis
Deep Vein Thrombosis
Pulmonary Embolism

Usual Adult Dose for Deep Vein Thrombosis - Prophylaxis

DEEP VEIN THROMBOSIS (DVT) PROPHYLAXIS FOLLOWING HIP OR KNEE REPLACEMENT SURGERY:
2.5 mg orally twice a day

Duration of therapy:

Hip replacement: 35 days
Knee replacement: 12 days

Comments: The initial dose should be taken 12 to 24 hours after surgery.

Use: Prophylaxis of DVT, which may lead to pulmonary embolism (PE), in patients who have undergone hip or knee replacement surgery.

RECURRENT DVT AND PE RISK REDUCTION:
2.5 mg orally twice a day

Use: Reduction in the risk of recurrence of DVT and PE after at least 6 months of treatment for DVT or PE.

Usual Adult Dose for Deep Vein Thrombosis Prophylaxis after Hip Replacement Surgery

DEEP VEIN THROMBOSIS (DVT) PROPHYLAXIS FOLLOWING HIP OR KNEE REPLACEMENT SURGERY:
2.5 mg orally twice a day

Duration of therapy:

Hip replacement: 35 days
Knee replacement: 12 days

Usual Adult Dose for Deep Vein Thrombosis Prophylaxis after Knee Replacement Surgery

DEEP VEIN THROMBOSIS (DVT) PROPHYLAXIS FOLLOWING HIP OR KNEE REPLACEMENT SURGERY:
2.5 mg orally twice a day

Duration of therapy:

Hip replacement: 35 days
Knee replacement: 12 days

Usual Adult Dose for Prevention of Thromboembolism in Atrial Fibrillation

5 mg orally 2 times a day

Use: Reduction of risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation.

Usual Adult Dose for Thromboembolic Stroke Prophylaxis

5 mg orally 2 times a day

Use: Reduction of risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation.

Usual Adult Dose for Deep Vein Thrombosis

Initial dose: 10 mg orally 2 times a day for 7 days
Maintenance dose: 5 mg orally 2 times a day

Use: Treatment of deep vein thrombosis and pulmonary embolism.

Usual Adult Dose for Pulmonary Embolism

Initial dose: 10 mg orally 2 times a day for 7 days
Maintenance dose: 5 mg orally 2 times a day

Use: Treatment of deep vein thrombosis and pulmonary embolism.

Renal Dose Adjustments

Stroke and systemic embolism risk reduction in patients with nonvalvular atrial fibrillation:

Reduce dose to 2.5 mg orally 2 times a day for patients with any 2 of the following:
Age 80 years or older
Body weight 60 kg or less
Serum creatinine 1.5 mg/dL or higher

Deep vein thrombosis prophylaxis after hip or knee replacement: No adjustment required.
Deep vein thrombosis (DVT) and pulmonary embolism (PE) treatment: No adjustment required.
Recurrent DVT and PE risk reduction: No adjustment required.

Liver Dose Adjustments

Mild liver impairment (Child-Pugh A): No adjustment recommended

Moderate liver impairment (Child-Pugh B): These patients may have intrinsic coagulation abnormalities and there is limited experience with apixaban in these patients; therefore, data is not available.

Severe liver impairment (Child-Pugh C): Not recommended

Dose Adjustments

Coadministration with strong dual CYP450 3A4 and P-gp inhibitors:

Patients receiving over 2.5 mg orally 2 times a day: Reduce dose by 50%
Patients receiving 2.5 mg orally 2 times a day: Avoid coadministration

Nonvalvular atrial fibrillation patients:

Reduce dose to 2.5 mg orally 2 times a day for patients with any 2 of the following:
Age 80 years or older
Body weight 60 kg or less
Serum creatinine 1.5 mg/dL or higher

Precautions

The US FDA requires a Risk Evaluation and Mitigation Strategy (REMS) for apixaban. It includes a communication plan. For additional information: www.fda.gov/REMS

US BOXED WARNINGS:
PREMATURE DISCONTINUATION INCREASES THE RISK OF THROMBOTIC EVENTS:

Premature discontinuation of any anticoagulant increases the risk of thrombotic events.
To reduce this risk, consider coverage with another anticoagulant if apixaban is discontinued for a reason other than pathological bleeding or completion of therapy.

SPINAL/EPIDURAL HEMATOMA:

Epidural or spinal hematomas may occur in patients treated with apixaban who are receiving neuraxial anesthesia or undergoing spinal puncture.
These hematomas may result in long term or permanent paralysis.
Consider these risks when scheduling patients for spinal procedures.

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Hemodialysis:
Nonvalvular atrial fibrillation patients with end stage renal disease: 5 mg orally 2 times a day
Reduce dose to 2.5 mg orally 2 times a day if patient is 80 years or older OR body weight is 60 kg or less.

Deep vein thrombosis prophylaxis after hip or knee replacement: No adjustment required.
Deep vein thrombosis (DVT) and pulmonary embolism (PE) treatment: No adjustment required.
Recurrent DVT and PE risk reduction: No adjustment required.

Other Comments

Administration advice:

May take with or without food.
Missed dose: Take as soon as possible on the same day then resume twice daily administration. Do not double up to make up for a missed dose.
Stop medication 48 hours prior to surgery or invasive procedures with moderate to high risk of unacceptable or clinically significant bleeding.
Stop medication 24 hours prior to surgery or invasive procedures with low bleeding risk or where bleeding would be in a non-critical location and easily controlled.
Bridging anticoagulation is generally not required.
Restart after surgery/procedure as soon as adequate hemostasis has been established.
Patients unable to swallow whole tablets: The manufacturer product information should be consulted.