Eliquis
Section: Cardiovascular System
Sub Section: Thromboembolic disorders
Drug Class: Antithrombotics

Apixaban
Price:
2.5mg yellow f-c tab marked 893 and 2½, 10=£9.50; 20=£19.00; 60=£57.00.
5mg pink oval f-c tab marked 894 and 5, 28=£26.60; 56=£53.20.
Indications:
Prevention of VTE following elective hip or knee replacement surgery. Prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF) and ?1 risk factor (eg, prior stroke or TIA, age ?75 years, hypertension, diabetes, heart failure). Treatment of DVT and pulmonary embolism (PE) and prevention of recurrent DVT and PE.
Adults:
Prevention post-surgery: 2.5mg twice daily starting 12—24 hrs after surgery for 32—38 days following hip surgery or 10—14 days following knee surgery.
Prevention in AF: 5mg twice daily. Reduce to 2.5mg twice daily if two or more of the following: age ?80 years; body wt ?60kg; or serum creatinine ?133 micromole/L.
Treatment of DVT and PE: 10mg twice daily for 7 days, then 5mg twice daily.
Prevention of recurrent DVT and PE: 2.5mg twice daily following 6 months of treatment.
Children:
Under 18 years, not recommended.
General warnings for Apixaban
Contraindications:
Active clinically significant bleeding, condition at significant risk of major bleeding. Severe renal impairment (CrCl <15ml/min), dialysis, severe hepatic impairment, prosthetic heart valves. Haemodynamically unstable pulmonary embolism (PE), PE requiring thrombolysis or pulmonary embolectomy. Antiphospholipid syndrome. Lactation.
Warnings:
Increased bleeding risk. Spinal or epidural anaesthesia, spinal puncture. Surgery or invasive procedures, cardioversion. Active cancer. Severe renal impairment (CrCl 15—29ml/min). Mild or moderate hepatic impairment, raised liver enzymes (ALT/AST >2 x ULN) or total bilirubin ?1.5 x ULN. Monitor for bleeding. Measure ALT before starting. Pregnancy.
Interactions:
Other anticoagulants, NSAIDs, SSRIs, SNRIs, antiplatelets, thrombolytics, dextran, sulfinpyrazone, vit K antagonists, strong CYP3A4/P-gp inhibitors (eg, azole antifungals, HIV protease inhibitors) and inducers (eg, rifampicin, phenytoin, carbamazepine, phenobarbital, St John’s wort).
Adverse Effects:
Bleeding (incl haematoma, epistaxis, GI, vaginal, urethral and eye haemorrhage), anaemia, thrombocytopenia, hypotension, nausea, contusion, rash, raised LFT

G Mohan