Adults

For treatment of DVT/PE: 10 mg orally twice daily for 7 days, followed by 5 mg orally twice daily. For other indications, dosages vary (e.g., 5 mg BID for NVAF). Always follow physician's instructions.

Elderly

No specific dose adjustment for age alone. Dose adjustments for renal impairment may be necessary.

Renal_impairment

For NVAF: If serum creatinine ≥ 1.5 mg/dL, age ≥ 80 years, or body weight ≤ 60 kg, then 2.5 mg BID. For DVT/PE treatment, no dose adjustment is generally required for mild to moderate renal impairment during the initial 7 days of 10mg BID, then 5mg BID for ongoing treatment based on individual risk/benefit. Severe renal impairment requires careful consideration and dose reduction (e.g., 2.5 mg BID).

Onset

Onset of anticoagulant effect within a few hours (typically 3-4 hours after first dose).

Excretion

Approximately 27% excreted renally as unchanged drug. Biliary-fecal excretion accounts for a significant portion.

Half life

Approximately 12 hours.

Absorption

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

Metabolism

Metabolized primarily via CYP3A4/5, with minor contributions from CYP1A2, CYP2C8, CYP2C9, CYP2C19, and CYP2J2. O-demethylation and hydroxylation are the main biotransformation pathways.

Strong dual inducers of CYP3A4 and P-gp (e.g., rifampin, carbamazepine, phenytoin, St. John's wort)

Decrease apixaban exposure and may increase risk of thrombotic events. Avoid co-administration.

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

Increase apixaban exposure and bleeding risk. Dose reduction of apixaban may be necessary.

Other anticoagulants (e.g., heparin, warfarin, dabigatran, rivaroxaban) and antiplatelet agents (e.g., aspirin, clopidogrel)

Concomitant use increases bleeding risk. Co-administration generally not recommended unless benefits outweigh risks.