# Apixaban -- leave title blank below
#+TITLE:  
#+AUTHOR:    David Mann
#+EMAIL:     mannd@epstudiossoftware.com
#+DATE:      [2015-03-05 Thu]
#+DESCRIPTION:
#+KEYWORDS:
#+LANGUAGE:  en
#+OPTIONS:   H:3 num:nil toc:nil \n:nil @:t ::t |:t ^:t -:t f:t *:t <:t
#+OPTIONS:   TeX:t LaTeX:t skip:nil d:nil todo:t pri:nil tags:not-in-toc
#+INFOJS_OPT: view:nil toc:nil ltoc:t mouse:underline buttons:0 path:http://orgmode.org/org-info.js
#+EXPORT_SELECT_TAGS: export
#+EXPORT_EXCLUDE_TAGS: noexport
#+LINK_UP:   
#+LINK_HOME: 
#+XSLT:
#+HTML_HEAD: <link rel="stylesheet" type="text/css" href="./org.css"/>
* Dosage and administration
** Nonvalvular atrial fibrillation
- Recommended dose is 5 mg orally twice daily.
- In patients with at least 2 of the following: age ≥80 yrs, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL, recommended dose is 2.5 mg PO BID.
** Prophylaxis of DVT following hip or knee replacement surgery
- Recommended dose is 2.5 mg PO BID.
** Treatment of DVT and PE
- Recommended dose is 10 mg PO BID for 7 days, then 5 mg PO BID.
** Reduction in the risk of recurrent DVT and PE following initial therapy
- Recommended dose is 2.5 mg PO BID.
* Dosage forms and strengths
- Tablets
  - 2.5 mg
  - 5 mg
* Contraindications
- Active pathological bleeding
- Severe hypersensitivity to apixaban
* Warnings and precautions
- Bleeding: serious and potentially fatal bleeding.  Promptly evaluate signs and symptoms of blood loss.
- Prosthetic heart valves: Use is not recommended.
* Adverse reactions
- Most common adverse reactions (>1%) are related to bleeding
* Drug interactions
- For patients receiving apixaban at doses greater than 2.5 mg BID, the dose should be reduced 50% when it is coadministered with strong dual inhibitors of CYP3A4 and P-gp (e.g. ketoconazole, itraconazole, ritonavir, and clarithromycin).  For patients on apixaban 2.5 mg BID avoid coadministration with these drugs.
- Simultaneous use of strong dual inducers of CYP3A4 and P-gp (e.g. rifampin, carbamazepine, phenytoin, and St. John's wort) reduces blood levels of apixaban: avoid concomitant use.
- Simultaneous use with other anti-platelet or anti-coagulant drugs increases risk of bleeding.
* Use in specific populations
- Pregnancy: Not recommended.
- Nursing mothers: Discontinue drug or discontinue nursing.
- Moderate or severe hepatic impairment: Not recommended.
- End stage renal disease on hemodialysis: No change in dosing recommendations, but use caution, as this specific patient population was not included in clinical trials.
