Medicine Information

Apixan

Name: Apixan
Brand: Apixan
Rating: 4.5 (117 reviews)

Tablet2.5 mgAnticoagulants (Factor Xa Inhibitors)ATC: B01AF02

Generic Name

Apixaban

Manufacturer

Local Pharmaceutical Co. (Example)

Country

Bangladesh

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Price Details

Current market pricing information

Variant	Unit Price	Strip Price
apixan 25 mg tablet	৳ 10.00	৳ 100.00

Description

Overview of the medicine

Apixaban is an anticoagulant medication used to prevent and treat blood clots (thrombosis). It belongs to a class of drugs called direct Factor Xa inhibitors, which work by blocking a key protein involved in blood clotting.

Uses & Indications

Prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF) who have at least one additional risk factor.

Prophylaxis of deep vein thrombosis (DVT) in patients undergoing hip or knee replacement surgery.

Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE).

Reduction in the risk of recurrent DVT and PE after initial therapy.

Dosage

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.

How to Take

Take orally, with or without food, as directed by your doctor. Swallow the tablet whole. For patients unable to swallow whole tablets, Apixaban tablets may be crushed and suspended in water, 5% dextrose in water (D5W), or apple juice, or mixed with apple puree and administered immediately.

Mechanism of Action

Apixaban is a selective, reversible, direct inhibitor of Factor Xa. By inhibiting Factor Xa, it prevents thrombin generation and thrombus development. It does not require antithrombin III for its antithrombotic activity.

Pharmacokinetics

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.

Side Effects

Contraindications

Active pathological bleeding (e.g., active gastric ulcer, intracranial hemorrhage).
Severe hypersensitivity to apixaban or any component of the formulation.
Significant liver disease associated with coagulopathy and clinically relevant bleeding risk.

Drug Interactions

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.

Storage

Store below 30°C in a dry place, away from direct light and moisture. Keep out of reach of children.

Overdose

Overdose of apixaban increases the risk of bleeding. Management includes discontinuation of apixaban and initiating appropriate supportive care, such as surgical hemostasis or transfusion of blood products (e.g., fresh frozen plasma). For life-threatening bleeding, a specific reversal agent (andexanet alfa) may be considered where available.

Pregnancy & Lactation

Pregnancy Category B. Limited data on use in pregnant women. Not recommended during pregnancy unless the potential benefit outweighs the potential risk to the fetus. It is unknown if apixaban is excreted in human milk, so caution is advised, and a decision should be made whether to discontinue nursing or the drug, considering the importance of the drug to the mother.

Frequently Asked Questions

Common questions about this medicine

Pack Sizes

10 tablets (1x10 blister)30 tablets (3x10 blister)

Shelf Life

Typically 24 to 36 months from the date of manufacture, specific to lot.

Availability

Available in pharmacies worldwide

Approval Status

Approved by regulatory bodies worldwide (e.g., FDA, EMA, DGDA)

Patent Status

Patented, generic versions may be available in some regions

Clinical Trials

Apixaban has been extensively studied in large-scale clinical trials such as ARISTOTLE (for NVAF) and AMPLIFY (for VTE treatment), demonstrating its efficacy and safety compared to standard therapies.

Lab Monitoring

No routine monitoring of coagulation parameters (e.g., INR) is required. Regular assessment of renal function (creatinine clearance) and hepatic function, and complete blood count (CBC) are recommended.

Doctor Notes

Emphasize the importance of consistent dosing and avoiding abrupt discontinuation.
Educate patients on bleeding precautions and symptoms of hemorrhage.
Assess renal and hepatic function periodically, especially in elderly and high-risk patients.
Review concomitant medications for potential drug interactions, particularly other anticoagulants/antiplatelets and strong CYP3A4/P-gp inhibitors/inducers.

Patient Guidelines

Take Apixan exactly as prescribed by your doctor.
Do not stop taking Apixan without consulting your doctor, as this may increase your risk of blood clots.
Inform all healthcare providers (including dentists) that you are taking Apixan before any surgery or procedure.
Report any unusual bleeding or bruising immediately to your doctor.

Missed Dose Advice

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.

Driving Precautions

Apixaban is not known to affect the ability to drive or operate machinery. However, if you experience side effects like dizziness or vision changes, avoid driving or operating machinery.

Lifestyle Advice

Avoid activities that may increase your risk of bleeding or injury.
Be cautious when using sharp objects (e.g., razors, knives) and during sports activities.