Apixaban

Adults: Recommended Dose Most patients take Apixaban 5 mg orally, twice daily. Dosage Adjustments The dose of Apixaban is 2.5 mg twice daily for patients who have any 2 of these characteristics: age 80 years or above, body weight 60 kg or less, serum creatinine 1.5 mg/dl or above. CYP3A4 and P-gp inhibitors When Apixaban is given together with drugs that are strong dual inhibitors of cytochrome P450 3A4 (CYP3A4) and P-glycoprotein (P-gp), for example ketoconazole, itraconazole, ritonavir and clarithromycin, the recommended dose is 2.5 mg twice daily. Missed Dose If a dose of Apixaban isn't taken at the scheduled time, it should be taken as soon as possible on the same day, and then twice-daily dosing should be resumed. The dose should not be doubled to make up for a missed one. Discontinuation for Surgery and Other Interventions Apixaban should be discontinued at least 48 hours before elective surgery or invasive procedures that carry a moderate or high risk of unacceptable or clinically significant bleeding. For elective surgery or invasive procedures with a low risk of bleeding, or where the bleeding would be non-critical in location and easily controlled, it should be discontinued at least 24 hours before. Switching from or to Apixaban Switching from warfarin to Apixaban Warfarin should be discontinued, and Apixaban started once the international normalized ratio (INR) is below 2.0. Switching from Apixaban to warfarin Apixaban affects INR, so INR measurements while the two are given together may not be useful for working out the right dose of warfarin. If continuous anticoagulation is necessary, discontinue Apixaban and begin both a parenteral anticoagulant and warfarin at the time the next dose of Apixaban would have been taken. The parenteral anticoagulant is then discontinued when the INR reaches an acceptable range. Switching between Apixaban and anticoagulants other than warfarin Discontinue the one being taken and begin the other at the next scheduled dose.