## 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.