Apiban 2.5

• Reduce risk of stroke and systemic embolism in non-valvular atrial fibrillation
• Prophylaxis of DVT and PE after hip or knee replacement surgery
• Treatment of DVT and PE
• Reduction in risk of recurrent DVT and PE following initial therapy

Apixaban is a selective factor Xa inhibitor that directly, selectively and reversibly inhibits free and clot-bound factor Xa in both intrinsic and extrinsic coagulation pathways. Inhibition of factor Xa prevents the conversion of thrombin and subsequent thrombus formation.

As a result of FXa inhibition, apixaban prolongs clotting tests such as prothrombin time (PT), INR, and activated partial thromboplastin time (aPTT). However, changes observed at therapeutic doses are small and not useful in monitoring the anticoagulation effect.

Standard Dose: 5 mg twice daily

Dose Adjustment (2.5 mg twice daily) - if any 2 of the following:

• Age ≥80 years
• Body weight ≤60 kg
• Serum creatinine ≥1.5 mg/dL

With strong CYP3A4 & P-gp inhibitors (e.g., ketoconazole, itraconazole, ritonavir, clarithromycin): 2.5 mg twice daily

VTE Prophylaxis (Hip/Knee Replacement): 2.5 mg twice daily, first dose 12-24 hr post-op. Hip: 32-38 days, Knee: 10-14 days.

DVT/PE Treatment: 10 mg twice daily for 7 days, then 5 mg twice daily. Recurrence prevention: 2.5 mg twice daily after 6 months.

Hepatic Impairment: Mild: No adjustment; Moderate: Limited data; Severe: Not recommended.

Renal Impairment (Non-valvular AF): Mild-moderate: No adjustment; ESRD on hemodialysis: 5 mg BID (2.5 mg BID if age ≥80 or weight ≤60).

• Epistaxis (nosebleeds)
• Haematoma
• Anaemia
• Haematuria (blood in urine)
• Contusion (bruising)
• Nausea
• GI, rectal or gingival haemorrhage
• Skin rash

Potentially Fatal: Epidural or spinal haematoma, fatal bleeding.

[SAFE IF PRESCRIBED] Apixaban is generally considered safe to use during pregnancy. Animal studies have shown low or no adverse effects. However, treatment may increase risk of hemorrhage during pregnancy and delivery. Use only if potential benefit outweighs the risk.

Serious Precautions:

• Discontinuing apixaban increases risk of thrombotic events - cover with another anticoagulant
• Increased risk of bleeding - be careful while shaving, cutting nails, using sharp objects or contact sports
• Discontinue at least 48 hours before surgery (high risk) or 24 hours (low risk)
• Do not use in severe kidney or liver problems, active bleeding, or with other anticoagulants
• No routine PT-INR monitoring required (advantage over other anticoagulants)
• Caution during pregnancy and lactation
• Do not stop or change dose without consulting your doctor

There is no antidote to apixaban. Overdose increases the risk of bleeding. Activated charcoal may be useful in the management of apixaban overdose.

Store below 30°C in a dry place. Protect from light. Keep out of reach of children.