Apixaban: Price, Dosage & Where to Buy

Apixaban is an anticoagulant medicine belonging to the factor Xa inhibitor class. It requires a prescription in the United Kingdom.

Apixaban is most commonly prescribed to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, to prevent deep vein thrombosis after hip or knee replacement surgery, and to treat deep vein thrombosis and pulmonary embolism. Generic apixaban has been available since July 2020.

Apixaban is prescribed to reduce the risk of stroke and systemic embolism in adults with nonvalvular atrial fibrillation. It is also used for the prophylaxis of deep vein thrombosis, which may lead to pulmonary embolism, in adults who have undergone hip or knee replacement surgery.

Apixaban treats deep vein thrombosis and pulmonary embolism in adults, and reduces the risk of recurrent deep vein thrombosis and pulmonary embolism following initial therapy. In paediatric patients from birth and older, apixaban is indicated for the treatment of venous thromboembolism and reduction in the risk of recurrent venous thromboembolism after at least 5 days of initial anticoagulant treatment.

Apixaban works by inhibiting factor Xa, a key protein in the blood clotting cascade. When blood clots form inappropriately inside blood vessels, they can block circulation and cause serious complications such as stroke or pulmonary embolism. Factor Xa plays a central role in converting prothrombin to thrombin, which in turn converts fibrinogen to fibrin, the building block of blood clots.

By selectively blocking factor Xa, apixaban reduces the blood's ability to form clots, thereby lowering the risk of stroke in patients with atrial fibrillation and preventing or treating venous thromboembolism. This targeted action helps maintain blood flow whilst reducing the likelihood of dangerous clot formation.

The label lists 2.5 mg and 5 mg film-coated tablets, as well as 0.15 mg capsules and 0.5 mg tablets for suspension for paediatric use. For reducing the risk of stroke in nonvalvular atrial fibrillation, the usual dose is 5 mg twice daily. The label lists 2.5 mg twice daily for patients with at least two of the following: age 80 years or older, body weight 60 kg or less, or serum creatinine 1.5 mg/dL or greater.

For prophylaxis of deep vein thrombosis after hip or knee replacement, the usual dose is 2.5 mg twice daily, starting 12 to 24 hours after surgery. The label lists treatment for 35 days after hip replacement and 12 days after knee replacement. For treating deep vein thrombosis and pulmonary embolism, the usual starting dose is 10 mg twice daily for 7 days, followed by 5 mg twice daily.

For reducing recurrent thrombosis risk after at least 6 months of treatment, the usual dose is 2.5 mg twice daily. Paediatric dosing is weight-based and differs for initial and maintenance periods.

The label states that if a dose of apixaban is not taken at the scheduled time, the dose should be taken as soon as possible on the same day. Twice-daily administration should then be resumed as usual.

The dose should not be doubled to make up for a missed dose. Because apixaban is given twice daily to maintain stable anticoagulation, taking the missed dose promptly on the same day helps to minimise any gap in anticoagulant effect, whilst doubling up risks excessive anticoagulation and bleeding.

The limited available data on apixaban use in pregnant women are insufficient to inform drug-associated risks of major birth defects, miscarriage, or adverse developmental outcomes. Treatment may increase the risk of bleeding during pregnancy and delivery. Pregnancy confers an increased risk of thromboembolism that is higher for women with underlying thromboembolic disease and certain high-risk pregnancy conditions.

Use of anticoagulants, including apixaban, may increase the risk of bleeding in the foetus and neonate. All patients receiving anticoagulants, including pregnant women, are at risk for bleeding. Apixaban use during labour or delivery in women receiving neuraxial anaesthesia may result in epidural or spinal haematomas.

Breastfeeding is not recommended during treatment with apixaban. Women of reproductive potential requiring anticoagulation should discuss pregnancy planning with their doctor or specialist.

The label lists storage at 20°C to 25°C, with excursions permitted between 15°C and 30°C, which corresponds to controlled room temperature. Apixaban tablets and capsules should be kept in their original packaging to maintain quality until the expiry date. As with all medicines, apixaban should be stored out of the sight and reach of children.