SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants. Use Caution/Monitor. vortioxetine and apixaban both increase anticoagulation. Stiripentol is a CYP3A4 inhibitor and inducer. nelfinavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Serious - Use Alternative (1)sulindac and apixaban both increase anticoagulation. Serious - Use Alternative (1)ibuprofen and apixaban both increase anticoagulation. Contraindicated. Serious - Use Alternative (1)argatroban and apixaban both increase anticoagulation. Exclusion criteria were identical to ADVANCE-1 and ADVANCE-2. Avoid or Use Alternate Drug. dabrafenib will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Serious - Use Alternative (1)apixaban increases effects of warfarin by anticoagulation. In a single dose escalation study, peak aPTT, INR, and modified PT (higher sensitivity) increased by 1.2-, 1.6-, and 2.9-fold, respectively, from baseline following a 50 mg dose. Monitor for signs/symptoms of blood loss. fedratinib will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Always ask your health care professional for complete information about this product and your specific health needs. Modify Therapy/Monitor Closely. Monitor Closely (1)dronedarone will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. crofelemer increases levels of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling. National Library of Medicine OReilly R, Rytand D. Resistance to warfarin due to unrecognized vitamin K supplementation. Elagolix is a weak-to-moderate CYP3A4 inducer. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants. Douxfils J, Chatelain C, Chatelain B, Dogne JM, Mullier F. Impact of apixaban on routine and specific coagulation assays: a practical laboratory guide. A specific antidote for reversal of anticoagulation by direct and indirect inhibitors of coagulation factor Xa. Monitor Closely (1)nefazodone will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Ask your doctor about the benefits and risks before any spinal procedure. Major bleeding occurred in 0.6% of the apixa-ban arm and 1.8% in the conventional therapy group (RR 0.31 [95% CI 0.170.55], P<0.001 for superiority). Use Caution/Monitor. Monitor Closely (1)encorafenib, apixaban. Avoid or Use Alternate Drug. Modify Therapy/Monitor Closely. tipranavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Your doctor may switch the type of medication you use during pregnancy.It is unknown if this medication passes into breast milk. Avoid or Use Alternate Drug. Modify Therapy/Monitor Closely. Modify Therapy/Monitor Closely. Avoid or Use Alternate Drug. Use Caution/Monitor. Serious - Use Alternative (1)alteplase and apixaban both increase anticoagulation. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate. For patients receiving apixaban 5 or 10 mg BID, decrease apixaban dose by 50% when coadministered with drugs that are both P-gp and strong CYP3A4 inhibitors. Modify Therapy/Monitor Closely. Avoid or Use Alternate Drug. Contraindicated (1)St John's Wort will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Medscape Education, Preventing Pediatric Venous Thromboembolism in Post-Fontan Patients: An Evolving Paradigm, encoded search term (apixaban (Eliquis)) and apixaban (Eliquis). Either increases effects of the other by anticoagulation. Eriksson BI, Quinlan DJ, Weitz JI. rifampin will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Avoid or Use Alternate Drug. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed. Monitor Closely (1)fluvoxamine increases effects of apixaban by anticoagulation. Use Caution/Monitor. Contraindicated (1)mifepristone increases toxicity of apixaban by anticoagulation. affecting hepatic/intestinal enzyme CYP3A4 metabolism. mifepristone increases toxicity of apixaban by anticoagulation. escitalopram increases effects of apixaban by anticoagulation. Use Caution/Monitor. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Consider dose reduction of sensitive P-gp substrates. Serious - Use Alternative (1)eptifibatide and apixaban both increase anticoagulation. Avoid or Use Alternate Drug. Monitor Closely (1)citalopram increases effects of apixaban by anticoagulation. Apixaban, an oral, direct and highly selective factor Xa inhibitor: in vitro, antithrombotic and antihemostatic studies. Use Caution/Monitor. Reduces anticoagulant effect by decreasing apixaban systemic exposure. If you log out, you will be required to enter your username and password the next time you visit. One of the limitations to the use of the TSOACs is the lack of an antidote or reversal agent. Contraindicated (1)phenytoin will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. This drug is available at a higher level co-pay. Since these increases may increase bleeding risk, use apixaban in this situation only if the potential benefit justifies the potential risk. In thromboelastogram studies and rat-tail-transection bleeding assays, PER977 was shown to reverse anticoagulation with each of the new oral agents, including apixaban.46,47. Your doctor may direct you to take a different "blood thinning" or antiplatelet medication to reduce your risk. The primary efficacy outcome occurred in 2.3% of patients in the apixaban group and in 2.7% in the conventional therapy group (RR 0.84 [95% CI 0.601.18], P<0.001 for noninferiority). fenoprofen and apixaban both increase anticoagulation. Apixaban is currently FDA-approved to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, for the prophylaxis of DVT, which may lead to PE, in patients who have undergone TKR or THR, for the treatment of DVT and PE, and for the reduction in the risk of recurrent DVT and PE following initial therapy. Patients were randomized to 5, 10, or 20 mg once daily of apixaban or placebo for 12 weeks within 4 weeks of the start of chemotherapy. SNRIs may further impair platelet activity in patients taking antiplatelet or anticoagulant drugs. Boehringer Ingelheim Pharmaceuticals, Inc. Wong PC, Crain EJ, Xin B, et al. dexamethasone will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. oxaprozin and apixaban both increase anticoagulation. Fexinidazole inhibits CYP3A4. For patients receiving apixaban 5 mg BID, avoid coadministration with combined P-gp and strong CYP3A4 inhibitors. Use an electric razor when shaving and a soft toothbrush when brushing your teeth. sarecycline will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. If taking apixaban dose >2.5 mg BID, decrease dose by 50% if coadministered with strong dual inhibitors of CYP3A4 and P-gp; if currently taking apixaban 2.5 mg PO BID, avoid coadministration with strong dual inhibitors of CYP3A4 and P-gp. Tecovirimat is a weak CYP3A4 inducer. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding. Use Caution/Monitor. Use Caution/Monitor. Avoid or Use Alternate Drug. Please confirm that you would like to log out of Medscape. May increase risk of bleeding. If not feasible, avoid use of abametapir. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or Use Alternate Drug. Modify Therapy/Monitor Closely. Monitor Closely (1)berotralstat will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Serious - Use Alternative (1)cilostazol and apixaban both increase anticoagulation. Serious - Use Alternative (1)anagrelide and apixaban both increase anticoagulation. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants. Contraindicated. Use Caution/Monitor. anagrelide and apixaban both increase anticoagulation. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications. Apixaban has a half-life of approximately 12 hours following oral administration with renal excretion accounting for approximately 27% of total clearance and biliary and direct intestinal excretion contributing to the remainder of the elimination in feces. Some conditions may become worse when this drug is suddenly stopped. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Apixaban or enoxaparin for thromboprophylaxis after knee replacement. Avoid or Use Alternate Drug. Use Caution/Monitor.elagolix will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor Closely (1)fish oil triglycerides will increase the level or effect of apixaban by anticoagulation. Avoid or Use Alternate Drug. vorapaxar increases toxicity of apixaban by anticoagulation. Depending upon the method utilized, the antithrombin assay may be affected by apixaban (FXa based assays should be avoided). SNRIs may further impair platelet activity in patients taking antiplatelet or anticoagulant drugs. Mild-to-moderate: No dosage adjustment required, Serum creatinine 1.5 mg/dL: Decrease dose to 2.5 mg BID if patient has 1 additional characteristic of age 80 years or weight 60 kg, ESRD maintained on hemodialysis: 5 mg BID; decrease dose to 2.5 mg BID if 1 additional characteristic of age 80 years or weight 60 kg is present, Deep Vein Thrombosis: No dose adjustment recommended; not studied in ESRD on dialysis or patients with a CrCl <15 mL/min; dosing recommendations based on pharmacokinetic and pharmacodynamic (anti-FXa activity) data in study subjects with ESRD maintained on dialysis, Indicated to reduce the risk of recurrent DVT and PE following initial 6 months treatment for DVT and/or PE, If taking >2.5 PO BID, decrease dose by 50%, If taking 2.5 mg BID, avoid coadministration with strong dual inhibitors. Use Caution/Monitor. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Individual characteristics leading to one or all of this triad include advanced age, prolonged immobility, previous VTE, pregnancy or the postpartum state, cancer, hospitalization, surgery, trauma, and thrombophilia.5. Avoid or Use Alternate Drug. Contraindicated. Avoid or Use Alternate Drug. Use Caution/Monitor. Long-term concomitant treatment with edoxaban and other anticoagulants is not recommended. Avoid or Use Alternate Drug. edoxaban, apixaban. Use Caution/Monitor. FXa chromogenic assays illustrated high sensitivity and a linear correlation depending upon the reagent and or the methodology utilized, thus serve as the assay of choice to measure for the presence of apixaban.27 Additional details regarding the effects of apixaban on coagulation assays are delineated in Table 3. Use Caution/Monitor. Avoid or Use Alternate Drug. Based on the mechanism of action, Factor X is likely to be counteracted by direct and indirect Factor Xa inhibitors. The predictable pharmacokinetics, limited medication interactions, lack of required laboratory monitoring, and potentially improved cost-effectiveness48 render apixaban an attractive alternative to other anticoagulants such as warfarin. Your doctor may need to check you for hidden bleeding that could be serious.During pregnancy, this medication should be used only when clearly needed. A Phase II pilot study evaluated the use of apixaban for primary VTE prophylaxis in patients with advanced malignancy receiving either first-line or second-line chemotherapy. Avoid concurrent use of rivaroxaban with other anticoagulants due to increased bleeding risk other than during therapeutic transition periods where patients should be observed closely. If you cannot swallow the tablet whole, you may crush the tablet and mix with water, apple juice, or applesauce and take it right away.The dosage is based on your medical condition, age, weight, kidney function, response to treatment, and other medications you may be taking. tecovirimat will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor Closely (1)aspirin and apixaban both increase anticoagulation. Contraindicated (1)vorapaxar increases toxicity of apixaban by anticoagulation. itraconazole will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered. Avoid or Use Alternate Drug. However, if your doctor has directed you to take low-dose aspirin to prevent heart attack or stroke (usually 81-162 milligrams a day), you should continue taking the aspirin unless your doctor instructs you otherwise. heparin and apixaban both increase anticoagulation. Modify Therapy/Monitor Closely. ivosidenib will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect. Evaluate for loss of therapeutic effect if medication must be coadministered. celecoxib and apixaban both increase anticoagulation. Use Caution/Monitor. A: Generally acceptable. Most Modify Therapy/Monitor Closely. rivaroxaban and apixaban both increase anticoagulation. In patients with cancer, there is no published data regarding the efficacy and safety of the TSOACs in the management of acute VTE. Avoid or Use Alternate Drug. CYP3A4 substrates may require dosage adjustment. The risk of bleeding may be higher if you have a deformed spine, or have had spinal procedures/surgery before (such as epidural catheter placement, difficult epidural/spinal puncture), or are taking other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, "blood thinners" such as warfarin/enoxaparin, nonsteroidal anti-inflammatory drugs-NSAIDs such as ibuprofen). Avoid or Use Alternate Drug. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Minor (1)clarithromycin will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Consult your doctor for more details. Monitor Closely (1)ibrutinib will increase the level or effect of apixaban by anticoagulation. Contraindicated. Monitor Closely (1)sarecycline will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Contraindicated. Avoid or Use Alternate Drug. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate. By clicking send, you acknowledge that you have permission to email the recipient with this information. Either increases effects of the other by anticoagulation. provider for the most current information. Either increases effects of the other by anticoagulation. nintedanib increases effects of apixaban by anticoagulation. Monitor Closely (1)lopinavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively termed venous thromboembolism (VTE), results in significant morbidity and mortality. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. Monitor Closely (1)tecovirimat will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. efavirenz will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Agnelli G, Buller HR, Cohen A, et al.AMPLIFY Investigators Oral apixaban for the treatment of acute venous thromboembolism. A meta-analysis of three randomized trials of apixaban therapy compared with enoxaparin involving 7,337 individuals, of whom 4,057 were treated with apixaban 2.5 mg once daily and 3,280 with subcutaneous enoxaparin (40 mg once daily or 30 mg twice daily) confirmed that apixaban was associated with a lower major bleeding rate than enoxaparin in the setting of post-TKR (odds ratio [OR] 0.55 [95% CI 0.320.96], P=0.034).22. Serious - Use Alternative (1)oxaprozin and apixaban both increase anticoagulation. This effect was not observed with istradefylline 20 mg/day. Order your refills early to avoid running out of pills.Use this medication regularly to get the most benefit from it. In this article, we will review the pharmacology, clinical trial data leading to FDA approved indications, and practical aspects related to the use of apixaban in the prevention and treatment of VTE. Avoid or Use Alternate Drug. Reduces anticoagulant effect by decreasing apixaban systemic exposure. Serious - Use Alternative (1)etodolac and apixaban both increase anticoagulation. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Both were designed as noninferiority trials. Lassen MR, Raskob GE, Gallus A, Pineo G, Chen D, Portman RJ. Contraindicated (1)defibrotide increases effects of apixaban by pharmacodynamic synergism. Serious - Use Alternative (1)primidone will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. prasugrel and apixaban both increase anticoagulation. Serious - Use Alternative (1)levoketoconazole will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Although warfarin has been utilized for over 60 years, it has several limitations, including a slow onset of action, a narrow therapeutic window requiring routine international normalized ratio (INR) monitoring, lack of predictable anticoagulant effect by drug dose, and multiple factors that influence absorption such as drugdrug interactions, altered metabolism due to genetic variations, altered vitamin K balance, impaired liver function, and hypermetabolic states such as fever or hyperthyroidism.610 In the last 5 years, four new target-specific oral anticoagulants (TSOACs), dabigatran, rivaroxaban, apixaban, and edoxaban, have been approved for various indications.1114 The advantages of these TSOACs are the lack of need for routine laboratory monitoring, a rapid onset of action with a predictable anticoagulant effect, once or twice daily fixed dosing, and low potential for food and drug interactions. This information does not assure that this product is safe, effective, or appropriate for you. STORAGE: Store at room temperature away from light and moisture. Reduces anticoagulant effect by decreasing apixaban systemic exposure. Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents. Reduces anticoagulant effect by decreasing apixaban systemic exposure. tolmetin and apixaban both increase anticoagulation. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. Serious - Use Alternative (1)abametapir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Lassen MR, Raskob GE, Gallus A, Pineo G, Chen D, Hornick P, ADVANCE-2 Investigators Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2); a randomized double-blind trial. Serious - Use Alternative (1)reteplase and apixaban both increase anticoagulation. Serious - Use Alternative (1)heparin and apixaban both increase anticoagulation. Major bleeding in patients with atrial fibrillation receiving apixaban or warfarin. Contraindicated. Avoid or Use Alternate Drug. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants. This document does not contain all possible drug interactions. Avoid or Use Alternate Drug. Avoid combined use once INR is established in the desired therapeutic range. Avoid or Use Alternate Drug. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. This review will focus on the pharmacology, clinical trial data, and laboratory assessment of apixaban. fluoxetine increases effects of apixaban by anticoagulation. Limit alcoholic beverages. Finally, in low-risk patients such as bileaflet aortic valve replacement (AVR) without major risk factors for stroke, CHADS2 score of 02 and no prior stroke or transient ischemic attack, or VTE >12 months prior, the risk of ATE is <4% annually and VTE is <2% per month, thus these patients do not require bridging anticoagulation. Historically, parenteral anticoagulants have been utilized to include unfractionated heparin (UFH), low molecular weight heparin (LMWH), and the indirect anti-factor Xa inhibitor fondaparinux. primidone will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, kidney disease, bleeding problems (such as bleeding of the stomach/intestines, bleeding in the brain), blood disorders (such as anemia, hemophilia, thrombocytopenia), recent major injury/surgery, stroke, a certain clotting disorder (antiphospholipid syndrome), frequent falls/injuries.Before having surgery or any medical/dental procedures (especially spinal puncture or spinal/epidural anesthesia), tell your doctor or dentist that you are taking this medication and about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). fexinidazole will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid coadministration with chronic use of higher dose aspirin. Use Caution/Monitor. lopinavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Promptly evaluate any signs or symptoms of blood loss if treated concomitantly with low-dose aspiriin. Serious - Use Alternative (1)idelalisib will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Factor Xa inhibitor that inhibits platelet activation by selectively and reversibly blocking the active site of factor Xa without requiring a cofactor (eg, antithrombin III) for activity, Inhibits free and clot-bound factor Xa, and prothrombinase activity; no direct effect on platelet aggregation, but indirectly inhibits platelet aggregation induced by thrombin, Blood coagulation cascade is dependent on the activation of factor X to factor Xa via the intrinsic and extrinsic pathways, which play a central role in the blood coagulation cascade, Bioavailability: Displays prolonged absorption Peak Plasma Concentration: 3-4 hr, Metabolized with minor contributions from CYP1A2, 2C8, 2C9, 2C19 and 2J2, Major sites of biotransformation: O-demethylation and hydroxylation at the 3-oxopirperidinyl moiety, Metabolites: No active circulating metabolites Substrate of P-gp and BCRP, Half-life: 5-6 hr (dominant); 12 hr (apparent half-life with repeated dosing), Excretion: 25% in urine and feces as metabolites; renal excretion accounts for 27% of total clearance; biliary and direct intestinal excretion contributes to elimination in feces. Use Caution/Monitor. Patients were ineligible if they had a contraindication to continued anticoagulant therapy or if they required ongoing anticoagulant therapy, dual antiplatelet therapy, or aspirin at a dose higher than 165 mg daily, hemoglobin level less than 9 mg/dL, platelet count less than 100,000/mm3, serum creatinine level greater than 2.5 mg/dL or a calculated CrCl of less than 25 mL/min, alanine aminotransferase or aspartate amin-otransferase level more than two times the upper limit of the normal range, or total bilirubin level more than 1.5 times the upper limit of the normal range. Serious - Use Alternative (1)celecoxib and apixaban both increase anticoagulation. Monitor Closely (1)verapamil will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Venous thromboembolism in very elderly patients: findings from a prospective registry (RIETE). Modify Therapy/Monitor Closely. A randomized phase II trial of apixaban for the prevention of thromboembolism in patients with metastatic cancer. Avoid or Use Alternate Drug. Si P, Samama C, Godier A, et al. Economic burden of venous thromboembolism in hospitalized patients. tucatinib will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Modify Therapy/Monitor Closely. Kyrle PA, Rosendaal FR, Eichinger S. Risk assessment for recurrent venous thrombosis. Patients with renal impairment receiving apixaban with drugs that are combined P-gp and weak or moderate CYP3A4 inhibitors may have significant increases in exposure compared with patients with normal renal function and no inhibitor use, since both pathways of apixaban elimination are affected.