Adults

For NVAF: 5 mg orally twice daily. For specific patients (e.g., ≥80 years old, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL), a dose of 2.5 mg orally twice daily may be considered. For DVT prophylaxis after hip/knee surgery: 2.5 mg orally twice daily for 12 days (hip) or 35 days (knee). For treatment of DVT/PE: Initially 10 mg orally twice daily for 7 days, followed by 5 mg orally twice daily. For reduction in risk of recurrent DVT/PE: 2.5 mg orally twice daily after at least 6 months of treatment for DVT/PE.

Elderly

No specific dose adjustment based on age alone. Consider 2.5 mg BID for NVAF if at least two of the following criteria are met: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL.

Renal_impairment

For NVAF, if serum creatinine ≥1.5 mg/dL and age ≥80 years or body weight ≤60 kg, reduce dose to 2.5 mg twice daily. For other indications, no dose adjustment is generally needed for mild to moderate renal impairment. Use with caution in severe renal impairment and avoid in end-stage renal disease (ESRD) on dialysis for NVAF.

Onset

Anticoagulant effect usually observed within a few hours of the first dose.

Excretion

Approximately 27% of the administered dose is recovered in urine, mainly as unchanged drug. The remaining is eliminated via biliary/fecal route.

Half life

Approximately 12 hours.

Absorption

Rapidly absorbed with peak plasma concentrations occurring 3-4 hours after oral administration. Bioavailability is approximately 50%.

Metabolism

Metabolized primarily via CYP3A4 and P-glycoprotein. Approximately 25% is renally excreted, with the majority (around 75%) eliminated via biliary/fecal excretion.

Other anticoagulants, antiplatelet agents (e.g., aspirin, clopidogrel), NSAIDs

Increased risk of bleeding.

Strong dual inducers of CYP3A4 and P-glycoprotein (e.g., rifampicin, phenytoin, carbamazepine, St. John's Wort)

May decrease apixaban exposure, potentially reducing efficacy. Avoid concomitant use.

Strong dual inhibitors of CYP3A4 and P-glycoprotein (e.g., ketoconazole, itraconazole, clarithromycin, ritonavir)

May increase apixaban exposure, increasing bleeding risk. Reduce apixaban dose to 2.5 mg twice daily for NVAF patients if also taking strong dual inhibitors.