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Pregnancy: There are limited data from the use of apixaban in pregnant women. Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity. Apixaban is not recommended during pregnancy.
Breastfeeding: It is unknown whether apixaban or its metabolites are excreted in human milk. Available data in animals have shown excretion of apixaban in milk. In rat milk, a high milk to maternal plasma ratio (Cmax about 8, AUC about 30) was found, possibly due to active transport into the milk. A risk to newborns and infants cannot be excluded.
A decision must be made to either discontinue breast-feeding or to discontinue/abstain from apixaban therapy.
Fertility: Studies in animals dosed directly with apixaban have shown no effect on fertility. However, in the female offspring of pregnant rats treated with apixaban, there were decreases in mating and fertility (see Pharmacology: Toxicology: Non-clinical safety under Actions).
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