Apixan Dosage/Direction for Use

Prevention of Venous Thromboembolic Events (VTE) in Elective Hip or Knee Replacement Surgery: The recommended dose is 2.5 mg orally twice daily. The initial dose should be taken 12 to 24 hours after surgery.
In patients undergoing hip replacement surgery, the recommended duration of treatment is 32-38 days.
In patients undergoing knee replacement surgery, the recommended duration of treatment is 10-14 days.
Prevention of Stroke and Systemic Embolism in NVAF: The recommended dose is 5 mg orally twice daily.
In patients with at least 2 of the following characteristics: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL (133 micromole/L), the recommended dose is 2.5 mg orally twice daily.
Treatment of DVT and PE: The recommended dose is 10 mg taken orally twice daily for 7 days, followed by 5 mg taken orally twice daily.
Prevention of Recurrent DVT and PE: The recommended dose is 2.5 mg taken orally twice daily after at least 6 months of treatment for DVT or PE.
Missed Dose: If a dose of apixaban tablets is not taken at the scheduled time, the dose should be taken as soon as possible on the same day and twice-daily administration should be resumed. The dose should not be doubled to make up for a missed dose.
Switching: Switching from warfarin or other VKA therapy to apixaban: Warfarin or other VKA therapy should be discontinued and apixaban started when the international normalized ratio (INR) is below 2.0.
Switching from apixaban to warfarin or other VKA therapy: Administration of apixaban should be continued for at least 48 hours after beginning warfarin or other VKA therapy. After 48 hours of co-administration of apixaban with warfarin or other VKA therapy (at usual starting doses), an INR should be obtained and then retested just prior to any next scheduled dose of apixaban. Co-administration of apixaban and warfarin or other VKA therapy should be continued until the INR is ≥2.0.
Switching from apixaban to other non-warfarin anti-coagulants (oral or parenteral): Discontinue apixaban and begin taking the other non-warfarin anticoagulant at the usual time of the next scheduled dose of apixaban.
Switching from other non-warfarin anti-coagulants (oral or parenteral) to apixaban: Discontinue the other non-warfarin anticoagulant and begin taking apixaban at the usual time of the next scheduled dose of the other non-warfarin anticoagulant.
Renal Impairment: For the prevention of VTE in elective hip or knee replacement surgery, for the treatment of DVT, treatment of PE and prevention of recurrent DVT and PE, no dose adjustment is necessary.
For the prevention of stroke and systemic embolism in patients with NVAF: Serum creatinine <1.5mg/dl, no dose adjustment is necessary unless age ≥80 years and body weight ≤60 kg, then a dose reduction is needed.*
Serum creatinine ≥1.5 mg/dL (133 micromole/L) and associated with either age ≥80 years or body weight ≤60 kg, a dose reduction is necessary.*
*(See Prevention of Stroke and Systemic Embolism in NVAF as previously mentioned.)
In patients with creatinine clearance <15 mL/min, or in patients undergoing dialysis, there is no clinical experience therefore apixaban is not recommended.
Geriatrics patients ≥65 years of age with creatinine clearance <25 mL/min, apixaban is not recommended due to increased risk of bleeding.
Hepatic Impairment: It is not recommended in patients with severe hepatic impairment. No dose adjustment is required in patients with mild or moderate hepatic impairment.
Body Weight: No dose adjustment required, unless weighing ≤60 kg with criteria for dose reduction (age ≥80 years and/or having serum creatinine concentration ≥1.5 mg/dL) are met. (See Renal Impairment as previously mentioned.)
Gender/race/ethnicity: No dose adjustment required.
Elderly: NVAF: no dose adjustment required, unless criteria for dose reduction are met. (See Prevention of Stroke and Systemic Embolism in NVAF as previously mentioned.)
Pediatrics: The safety and efficacy of apixaban in children and adolescents below age 18 have not been established. No data are available.
Mode of Administration: Apixaban should be swallowed with water, with or without food.
For patients who are unable to swallow whole tablets, apixaban 2.5 or 5.0 mg tablets may be crushed and suspended in 60 ml of water, or 5% dextrose in water (D5W), or apple juice or mixed with apple puree and immediately administered orally.
Nasogastric tube administration, apixaban tablets may be crushed and suspended in 60 mL of water or D5W and immediately delivered.
Crushed apixaban tablets are stable in water, D5W, or apple juice or mixed with apple puree for up to 4 hours.