Hematology and Oncology Book

Tranfusion

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Apixaban

Aka: Apixaban, Eliquis
  1. Mechanism
    1. Oral direct Xa inhibitor
    2. Factor Xa is the first step in the Common Clotting Cascade
  2. Indications : Nonvalvular Atrial Fibrillation (stroke prevention with CHADS Score 2 or more)
    1. Alternative to Warfarin (where Pradaxa Dyspepsia not tolerated)
    2. Poor INR control on Warfarin
    3. Barriers to INR monitoring
    4. Warfarin Drug Interactions
  3. Contraindications
    1. Acute bleeding
      1. Initial studies suggest less bleeding risk than Warfarin
    2. Mechanical Heart Valves or valvular Atrial Fibrillation
      1. Use Warfarin instead
    3. Moderate to severe hepatic Impairment
    4. Pregnancy or Lactation
  4. Precautions
    1. No antidote for bleeding
      1. Consider Prothrombin Complex Concentrate, activated PCC or recombinant factor VIIa
    2. Increased stroke risk if stopped abruptly without other Anticoagulation in nonvalvular Atrial Fibrillation
  5. Pharmacokinetics
    1. Half-life: 8-15 hours (12 hour mean)
    2. Oral bioavailability: 58%
    3. Onset: 3-4 hours
  6. Dosing: Atrial Fibrillation
    1. Standard dose
      1. Apixaban (Eliquis) 5 mg twice daily
    2. Half-dose indications (2.5 mg twice daily)
      1. See Renal Dosing below
  7. Dosing: Venous Thromboembolism
    1. Venous Thromboembolism Treatment
      1. Initial: 10 mg orally twice daily for 7 days
      2. Maintenance: 5 mg orally twice daily
      3. Prevention of recurrence: 2.5 mg orally twice daily
    2. Venous Thromboembolism Prophylaxis after Surgery
      1. Hip Replacement: 2.5 mg orally twice daily for 35 days
      2. Knee Replacement: 2.5 mg orally twice daily for 12 days
  8. Dosing: Renal Dosing Indications
    1. Renal Dosing (2.5 mg orally twice daily) is indicated if at least 2 of the following criteria are present
      1. Serum Creatinine >=1.5 mg/dl or higher
      2. Age >=80 years old
      3. Weight <=60 kg (or <132 lb)
    2. References
      1. https://packageinserts.bms.com/pi/pi_eliquis.pdf
  9. Drug Interactions
    1. Strong cytochrome P450 3A4 inducers
      1. Rifampin (also induces P-Glycoprotein)
      2. Phenytoin
      3. Carbamazepine
      4. Phenobarbital
    2. P-Glycoprotein Inhibitors
      1. Ketoconazole
      2. Itraconazole
      3. Voriconazole
      4. Ritonavir
      5. Conivaptan
    3. Other Anticoagulants and antiplatelet agents
      1. Aspirin and other antiplatelet agents (e.g. Clopidogrel)
      2. NSAIDs
  10. References
    1. (2014) Presc Lett 21(11): 61
    2. Granger (2011) N Engl J Med 365(11): 981-92 [PubMed]
    3. Connolly (2011) N Engl J Med 364(9): 806-17 [PubMed]
    4. Wilbur (2017) Am Fam Physician 95(5): 295-302 [PubMed]
Medication Costs
eliquis (on 3/22/2017 at Medicaid.Gov Pharmacy Drug pricing)
ELIQUIS 2.5 MG TABLET $6.21 each
ELIQUIS 5 MG TABLET $6.21 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

apixaban (C1831808)

Definition (NCI) An orally active inhibitor of coagulation factor Xa with anticoagulant activity. Apixaban directly inhibits factor Xa, thereby interfering with the conversion of prothrombin to thrombin and preventing formation of cross-linked fibrin clots.
Definition (PDQ) An orally active inhibitor of coagulation factor Xa with anticoagulant activity. Apixaban directly inhibits factor Xa, thereby interfering with the conversion of prothrombin to thrombin and preventing formation of cross-linked fibrin clots. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=484444&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=484444&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C61308" NCI Thesaurus)
Concepts Pharmacologic Substance (T121)
MSH C522181
SnomedCT 698090000
LNC LP157546-5, MTHU045309
English 1H-Pyrazolo(3,4-c)pyridine-3-carboxamide, 4,5,6,7-tetrahydro-1-(4-methoxyphenyl)-7-oxo-6-(4-(2-oxo-1-piperidinyl)phenyl)-, apixaban, APIXABAN, Apixaban, Apixaban (substance), apixaban (medication), anticoagulants apixaban
Spanish apixabán, apixabán (sustancia)
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Eliquis (C3530466)

Concepts Pharmacologic Substance (T121)
English Eliquis
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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