Experiences with

Apixaban

Apixaban is a type of medicine known as an anticoagulant.

It makes your blood flow through your veins more easily, which means your blood is less likely to make blood clots.

It's used to treat people who have had a health problem caused by a blood clot, such as:

• a blood clot in the leg (deep vein thrombosis, or DVT)
• a blood clot in the lungs (pulmonary embolism)

It's also used to prevent blood clots if you're at high risk of having them in the future.

People who are at high risk include those who:

• have previously had a stroke or transient ischaemic attack (TIA)
• have an irregular heartbeat (atrial fibrillation)
• have heart failure
• have recently had surgery to replace a hip or knee joint

Apixaban is only available on prescription. It comes as tablets.

Who can take apixaban

Most adults aged 18 and over can take apixaban.

Apixaban is not suitable for some people. To make sure it's safe for you, tell your doctor if you:

• have ever had an allergic reaction to apixaban or any other medicine
• are trying to get pregnant or are already pregnant – apixaban can be harmful to your baby
• have liver or kidney problems
• have had a recent spinal injury or surgery
• have any injuries that are currently bleeding a lot, such as a wound
• have a stomach ulcer
• have antiphospholipid syndrome, a condition that affects the immune system and makes you more likely to get blood clots
• have ever had surgery to replace a heart valve

Dosage and strength

Apixaban comes as 2.5mg and 5mg tablets.

Your dose of apixaban depends on why you're taking it. If you're unsure what dose you need to take, check with your doctor or pharmacist.

The usual dose in adults if you:

• have a heart condition called atrial fibrillation is one 5mg tablet, taken twice a day. Your doctor may prescribe a lower dose of one 2.5mg tablet twice a day if you're over 80 years old, weigh less than 60kg (9st 6lb), or have kidney disease and are at higher risk of bleeding
• have recently had a blood clot (within the last 6 months) is two 5mg tablets taken twice a day, for the first 7 days. After that, you'll take one 5mg tablet twice a day
• need to reduce the risk of a future blood clot is one 2.5mg tablet taken twice a day
• have had a hip or knee replacement is one 2.5mg tablet, taken twice a day. You'll usually take your first dose 12 to 24 hours after surgery

You'll usually take apixaban tablets twice a day. Try to take it at the same time every day.

Swallow the tablet with a drink of water. Apixaban can be taken with or without food.

You can crush apixaban tablets and mix them with water, apple juice or apple purée. Swallow this mixture straight away.

How long to take it for

How long you need to take apixaban will depend on why you're taking it. If you have had:

• knee replacement surgery, you'll usually take it for 10 to 14 days
• a hip replacement, you'll usually take it for 32 to 38 days
• a blood clot (DVT or pulmonary embolism), you'll usually take it for at least 3 months

Depending on what caused the blood clot, you might need to take it for longer.

If you have a heart problem like atrial fibrillation, you might need to take apixaban long term or even for the rest of your life.

Do not stop taking apixaban without talking to your doctor.

If you stop taking apixaban, your risk of blood clots will return to what it was before. This can start happening again within a day or two of stopping. This means that you may be at increased risk of serious problems like stroke, heart attack, deep vein thrombosis or pulmonary embolism.

If you forget to take it

Take your medicine as soon as you remember, unless it's nearly time for your next dose. In this case, skip the missed dose and take your next dose at the usual time.

Do not take 2 doses to make up for a missed one.

It's very important that you remember to take apixaban every day. If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much

Taking too much apixaban puts you at risk of bleeding.

• you take more than your prescribed dose of apixaban

Go to 111.nhs.uk or call 111

If you go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the apixaban packet, or leaflet inside it, plus any remaining medicine with you.

Your doctor or pharmacist will give you an anticoagulant alert card.

Carry this with you all the time. It tells healthcare professionals that you're taking an anticoagulant. This can be useful for them to know in case of a medical emergency.

If you need any medical or dental treatment, show your anticoagulant alert card to the nurse, doctor or dentist. This includes before you have vaccinations and routine sessions with the dental hygienist.

Your doctor may advise you to stop taking apixaban or reduce your dose for a short time.

Changes to your medicine

Switching from apixaban to warfarin

If you need to switch from apixaban to warfarin, you may need to take both medicines together for a few days.

Your doctor, or anticoagulant clinic, will do a blood test called the international normalised ratio (INR) to check how quickly your blood's clotting.

This is to help decide exactly when you should stop taking apixaban.

Switching from warfarin to apixaban

If you need to switch from warfarin to apixaban, your doctor will advise you when to stop taking warfarin. This will probably be a few days before you start apixaban.

Your doctor, or anticoagulant clinic, will do a blood test called the international normalised ratio (INR) to check how quickly your blood's clotting.

This is to help decide exactly when you should start taking apixaban.

Bleeding and what to do about it

While apixaban has enormous benefits, the downside is that it can make you bleed more than normal.

This is because while you're taking apixaban your blood will not clot as easily.

It's usual to bleed more easily than normal while you're taking apixaban.

The kind of bleeding you might have includes:

• periods that are heavier and last longer than usual
• bleeding for a little longer than usual if you cut yourself
• occasional nosebleeds (that last for less than 10 minutes)
• bleeding from your gums when you brush your teeth
• bruises that come up more easily and take longer to fade than usual

This type of bleeding is not dangerous and should stop by itself.

If it happens, keep taking the apixaban, but tell your doctor if the bleeding bothers you or does not stop.

Things you can do to help yourself:

• Cuts – press on the cut for 10 minutes with a clean cloth.
• Nosebleeds – sit or stand upright (do not lie down), pinch your nose just above your nostrils for 10 to 15 minutes, lean forward and breathe through your mouth, and place an icepack (or a bag of frozen peas wrapped in a teatowel) at the top of your nose.
• Bleeding gums – try using a soft toothbrush and waxed dental floss to clean your teeth.
• Bruises – these are harmless, but can be unsightly. It might help to make them fade more quickly if you put an ice pack wrapped in a towel over the bruise for 10 minutes at a time several times a day.

What you can do to prevent bleeding

While you're taking apixaban, be careful when you do activities that might cause an injury or a cut or bruising.

It can help to:

• stop playing contact sports or other activities than can cause an injury, such as football, rugby, hockey and horse riding
• wear gloves when you use sharp objects like scissors, knives and gardening tools
• stop wet shaving or removing hair with wax – use an electric razor or hair-removing cream instead
• take dentures (false teeth) or retainers out for a few hours a day, if you wear them, to give your gums a rest – do not wear dentures or retainers that do not fit properly
• tell your doctor, dentist or nurse that you take apixaban before you have any medical or dental procedures or surgery – this includes vaccinations and routine appointments with the dental hygienist

Other common side effects

These common side effects of apixaban happen in more than 1 in 100 people. There are things you can do to help cope with them:

If this advice does not help and any of these side effects bother you or do not go away, tell your doctor or pharmacist.

Serious bleeding

Occasionally, you can have heavy bleeding from taking apixaban. This can be dangerous and needs urgent medical attention.

• you have red pee or black poo
• you get bruises that happen for no reason, or bruises that are larger than you'd expect or keep growing in size

Go to 111.nhs.uk or call 111

• you get nosebleeds that last longer than 10 minutes, despite trying to stop it
• you have blood in your vomit or you're coughing up blood
• you get severe headaches
• you have any bleeding from a cut or injury that will not stop or slow down

These are symptoms of serious bleeding. If you get serious bleeding, stop taking apixaban.

Very rarely, apixaban can lead to bleeding in the brain.

you get any of these symptoms:

• sudden severe headache unlike anything you've experienced before
• fits or seizures
• sudden loss of vision or blurred vision
• a feeling of numbness or tingling in your arms or legs

You may also feel very tired, weak or sick.

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to apixaban.

These are not all the side effects of apixaban. For a full list, see the leaflet inside your medicine packet.

Apixaban and pregnancy

Apixaban should not be taken during pregnancy.

If you take apixaban and are planning a pregnancy or you become pregnant while taking it, speak to your doctor or specialist. You will need to be changed to a different medicine.

Apixaban is not usually recommended while breastfeeding.

Speak to your doctor about other medicines you can use while breastfeeding.

Apixaban and fertility

There's no evidence to suggest that taking apixaban reduces fertility in either men or women.

Speak to a pharmacist or your doctor if you're trying to get pregnant.

Cautions with other medicines

Some medicines can affect apixaban. This can lead to serious side effects.

Tell your doctor if you are taking any of these medicines before starting apixaban:

• any other anticoagulant, such as warfarin or enoxaparin
• medicines to treat fungal or bacterial infections, such as ketoconazole, erythromycin, clarithromycin or rifampicin
• medicines to treat an abnormal heartbeat, such as dronedarone, quinidine or verapamil
• medicines to prevent organ rejection after a transplant, such as ciclosporin
• medicines to treat epilepsy, such as carbamazepine, phenytoin or phenobarbital
• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin

You can take paracetamol while you're taking apixaban.

Do not take aspirin or ibuprofen while you're taking apixaban unless a doctor has said it's OK. They increase the chance of bleeding.

Mixing apixaban with herbal remedies and supplements

Do not take St John's wort, the herbal remedy for depression, while you're taking apixaban. It can increase your risk of side effects.

There's not enough information to say that other herbal remedies and supplements are safe to take with apixaban.

They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Related links

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