Eliquis – composition, action, dosage, side effects of the anticoagulant drug

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Eliquis is a drug that contains the active ingredient – apixaban. Eliquis belongs to the group of medicines called anticoagulants. It works by preventing blood clots from forming in the blood and by blocking one of the main clotting factors, factor Xa. Read what else does Eliquis work, what its dosage looks like and what side effects it can cause.

Eliquis – composition and operation

Eliquis contains the active substance apixaban and belongs to the group called anticoagulants. This medicine helps to prevent blood clots from forming by blocking factor Xa, which is an important clotting factor.

Eliquis is used in adults in the following cases:

1. to prevent blood clots from forming (deep vein thrombosis) after hip or knee replacement surgery. After hip or knee surgery, you may be at increased risk of developing a blood clot in the veins of your legs. This can lead to swelling of the legs with or without pain. If a blood clot travels from the leg to the lungs it can block blood flow through the lungs, causing breathlessness with or without a feeling of chest pain. This condition (pulmonary embolism) can be life-threatening and requires immediate medical attention.
2. to prevent a blood clot from forming in the heart in patients with an irregular heart beat (atrial fibrillation) and at least one additional risk factor. Blood clots can break off and travel to the brain, leading to a stroke or to other organs, obstructing the blood supply to these organs (also known as systemic embolism). Stroke can be life threatening and requires immediate medical attention.
3. to treat blood clots in the veins of the legs (deep vein thrombosis) and in the blood vessels of the lungs (pulmonary embolism) and to prevent blood clots from re-occurring in the blood vessels of the legs and / or lungs.

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Eliquis – method of taking and dosage

Eliquis comes in the form of tablets. Swallow the tablet with a drink of water. Eliquis can be taken with or without food. For best results, it is recommended that you take the tablets at the same time each day.

If you have problems swallowing the tablets whole, talk to your doctor about other ways to take Eliquis. The tablet can be crushed immediately before taking and mixed with water or 5% aqueous dextrose solution, juice or apple sauce.

Instructions for crushing tablets:

1. crush the tablet with a pestle in a mortar,
2. carefully transfer the powder into a suitable container and then mix it with a little e.g. 30 ml (2 tablespoons), water or any other liquid mentioned above to make a mixture,
3. swallow the mixture
4. rinse the pestle and mortar used to crush the tablets and the container with a little water or other liquid (e.g. 30 ml) and swallow the rinsing liquid.

If necessary, the doctor may give the patient a crushed tablet of Eliquis mixed with 60 ml of water or 5% aqueous dextrose solution through a nasogastric tube.

1. Why does the body need water?

Eliquis should be taken as prescribed in the specific indications.

1. To prevent blood clots from forming after hip or knee replacement surgery

The recommended dose is one tablet of Eliquis 2,5 mg twice a day. For example, one tablet in the morning and one in the evening. The first tablet should be taken 12 to 24 hours after the operation. If you have had major hip surgery you will usually take the tablets for 32 to 38 days.

If you have had major knee surgery, you will usually take the tablets for 10 to 14 days.

1. To prevent a blood clot from forming in the heart if you have an irregular heart beat (atrial fibrillation) and at least one additional risk factor

The recommended dose is one tablet of Eliquis 5 mg twice a day.

The recommended dose is one tablet of Eliquis 2,5 mg twice a day if:

1. the patient has severe renal impairment,
2. two or more of the following conditions are true:

1. the patient’s blood test results suggest decreased renal function (serum creatinine value is 1,5 mg / dl (133 micromol / l) or more),
2. the patient is 80 years of age or older,
3. the patient’s body weight is 60 kg or less.

The recommended dose is one tablet twice a day, for example one tablet in the morning and one in the evening. Your doctor will decide for how long the treatment should be continued.

1. Treatment of blood clots in the veins of the legs and blood clots in the blood vessels of the lungs

The recommended dose is two tablets of Eliquis 5 mg twice a day for the first 7 days, for example two tablets in the morning and two in the evening. After 7 days, the recommended dose is one tablet of Eliquis 5 mg twice a day, for example one tablet in the morning and one in the evening.

1. To prevent blood clots from re-occurring after completing 6 months of treatment

The recommended dose is one tablet of Eliquis 2,5 mg twice a day, for example one tablet in the morning and one in the evening. Your doctor will decide for how long the treatment should be continued.

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Eliquis – precautions

Although Eliquis is judged to be safe, there are a number of circumstances in which its use is discouraged. These include, first of all, situations where:

1. the patient is allergic to apixaban or any of the other substances in the composition of the drug,
2. the patient is bleeding excessively,
3. the patient is exposed to excessive internal hemorrhage in the near future,
4. the patient suffers from liver diseases associated with the risk of excessive bleeding (e.g. hepatic coagulopathy),
5. the patient is taking drugs that reduce blood clotting (e.g. warfarin, rivaroxaban, dabigatran, heparin).

In addition, during treatment with Eliquis, special care is recommended if the patient:

1. suffers from high blood pressure,
2. is over 75 years of age,
3. weighs less than 60 kg,
4. has kidney problems,
5. has or has had liver disease,
6. has a prosthetic heart valve,
7. getting ready to undergo surgery.

If you use more Eliquis than you should

If you have taken more than the prescribed dose of Eliquis, tell your doctor immediately, as there may be an increased risk of bleeding. If bleeding occurs, surgery or blood transfusion may be necessary.

If you forget to use Eliquis:

1. take the tablet as soon as the patient remembers it and:

1. take the next Eliquis tablet at the usual time
2. then take your medicine as before.

Eliquis treatment is also not recommended for people under 18 years of age.

However, Eliquis does not affect awareness, concentration and therefore the ability to drive or use machines.

If you stop taking Eliquis

Do not stop taking Eliquis without consulting your doctor, as the risk of a blood clot may be higher if you stop taking Eliquis prematurely. If you have any further questions about the use of this medicine, ask your doctor, pharmacist or nurse.

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Eliquis – side effects

As with any medication, the use of Eliquis may cause unwanted side effects. The side effects of Eliguis vary depending on the medical condition under which the preparation is used.

The following side effects may happen if you take Eliquis to prevent blood clots from forming after hip or knee surgery.

Common side effects (may affect up to 1 in 10 people):

1. anemia, which may make you tired or look pale
2. bleeding including: blood in the urine (which makes the urine pink or red), bruising and swelling, vaginal bleeding
3. nausea (feeling sick).

Uncommon side effects (may affect up to 1 in 100 people):

1. reduced number of platelets (which can affect blood clotting)
2. bleeding including: bleeding after surgery including bruising and swelling, leakage of blood or other fluid from the wound / postoperative incision (discharge from the wound), bleeding in the stomach, intestines or blood in stools, blood in the urine, nosebleed
3. low blood pressure which can lead to dizziness or a fast heartbeat.

Blood test results may show:

1. liver dysfunction
2. increase in some liver enzymes
3. increased levels of bilirubin, a product made up of damaged red ones
4. blood cells which can cause yellow skin and eyes.

The following side effects may occur when taking Eliquis to prevent a blood clot from forming in the heart in patients with an irregular heart beat and at least one additional risk factor.

Common side effects (may affect up to 1 in 10 people):

1. bleeding including: eye, stomach, intestine or dark / black blood in stools, blood in urine from laboratory tests, nose, gums, bruising and swelling

Uncommon side effects (may affect up to 1 in 100 people):

1. bleeding, including: into the brain or spine, in the mouth or hemoptysis, in the abdomen, from the rectum or from the vagina – bright / red blood in the stools, bleeding that occurs after any surgery including bruising and swelling, leakage of blood or fluid from the surgical wound / tissue incision site (discharge from the wound) or at the injection site, itching
2. allergic (hypersensitivity) reactions which may cause: swelling of the face, lips, mouth, tongue and / or throat and difficulty breathing.

If you notice any of these symptoms, please contact your doctor immediately.

The following side effects can happen if you take Eliquis to treat or prevent blood clots from re-occurring in the veins of the legs and blood clots in the blood vessels of the lungs

Common side effects (may affect up to 1 in 10 people):

1. bleeding including: nose bleeds, gums, blood in the urine (which makes the urine pink or red), bruising and swelling, in the stomach, intestine, rectum.

Uncommon side effects (may affect up to 1 in 100 people):

1. bleeding including: in the eyes and blue eyes, in the mouth or coughing up blood, dark / black blood in the stools, in the womb or from the vagina
2. test results showing blood in your stools or urine
3. a bruising and swelling of the wound or injection site
4. itch.

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Eliquis – pregnancy and breastfeeding

The health effects of taking Eliquis in pregnant women and new mothers who are breastfeeding are not fully known. For this reason, it is recommended that you inform your doctor about the planned pregnancy or the upcoming date of delivery if you wish to be treated with this drug.. However, it is usually advised not to take Eliquis during pregnancy and breastfeeding, due to insufficient research on this medicine.

Eliquis – drug interactions

Tell your doctor about all the medications you are taking or have recently taken, and about any medications you plan to use. Some medicines may increase the effect of Eliquis and some may reduce the effect of Eliquis.

Your doctor will decide whether you should receive Eliquis while taking other medicines and how carefully you should be monitored.

The following medicines may increase the effect of Eliquis and increase the risk of unwanted bleeding:

1. certain drugs used to treat fungal infections (e.g. ketoconazole and others),
2. some antiviral medicines used to treat HIV / AIDS (e.g. ritonavir)
3. other drugs used to reduce blood clotting (e.g. enoxaparin and others),
4. anti-inflammatory or analgesic drugs (e.g. acetylsalicylic acid or naproxen). Especially if you are over the age of 75 and are taking acetylsalicylic acid, you may be at an increased risk of unwanted bleeding.
5. medicines for high blood pressure or heart problems (e.g.
6. diltiazem).

The following medicines may reduce the ability of Eliquis to prevent blood clots from forming:

1. medicines to prevent epilepsy or seizures (e.g. phenytoin and others)
2. St. John’s wort (a herbal supplement for depression)
3. medicines to treat tuberculosis or other infections (e.g. rifampicin).