Apixaban

1. About apixaban

Apixaban is a type of medicine known as an anticoagulant - or blood thinner. It makes your blood flow through your veins more easily. This means your blood will be less likely to make a dangerous blood clot.

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

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 an abnormal heartbeat, known as atrial fibrillation
  • have recently had surgery to replace a hip or knee joint

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

2. Key facts

  • It's usual to take apixaban twice a day.
  • You can take apixaban with or without food.
  • The most common side effect of apixaban is bleeding more easily than normal - such as having nosebleeds, heavier periods, bleeding gums and bruising. It tends to happen in the first few weeks of treatment or if you're unwell.
  • Always carry your anticoagulant alert card with you. Show it to your doctor or dentist before you have surgery or dental treatment. It's important they know you're taking apixaban, as it may put you at risk of bleeding. Your doctor or dentist might advise you to stop taking apixaban for a short time beforehand.
  • Apixaban is also called by the brand name Eliquis.

3. Who can and can't take apixaban

Apixaban can be taken by adults aged 18 and over.

Apixaban isn't suitable for some people. Tell your doctor if you:

  • have had an allergic reaction to apixaban or any other medicines in the past
  • are trying to get pregnant or are already pregnant - apixaban can be harmful to your baby
  • have liver problems
  • have had a recent spinal injury or surgery
  • are taking any other medicines that affect blood clotting, such as warfarin
  • have any injuries that are currently bleeding a lot (such as a wound or a stomach ulcer)
  • are taking the herbal remedy St John's wort (often taken for depression)

4. How and when to take it

It's very important to take apixaban as your doctor has told you.

It's usual to take it twice a day. Try to take it at the same time every day.

If you have trouble swallowing pills, speak to your doctor or pharmacist. You can crush apixaban tablets and mix them with water, apple juice or apple puree. Swallow this mixture straight away.

How much will I take?

Your dose of apixaban depends on why you're taking it.

  • For people with a heart problem called atrial fibrillation - the usual dose is one 5mg tablet twice a day. However, 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 a higher risk of bleeding.

  • For people who've recently had a blood clot - if you've had a blood clot within the last 6 months, the usual dose is two 5mg tablets, twice a day, for the first 7 days. After that, you'll take one 5mg tablet twice a day.

  • For people taking it to reduce the risk of a future blood clot - if you had a blood clot more than 6 months ago, the usual dose is one 2.5mg tablet twice a day.

  • For people who've had a hip or knee replacement - the usual dose is one 2.5mg tablet twice a day. You'll usually take your first dose 12 to 24 hours after surgery.

If you're unsure what dose you need to take, check with your doctor or pharmacist.

What if I forget to take it?

Take your medicine as soon as you remember, unless it's nearly time for your next dose. Do not take a double dose to make up for a missed one. Take your next dose at the usual time, and then carry on as normal.

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.

What if I take too much?

Ask your doctor or pharmacist for advice straight away as overdose puts you at risk of bleeding.

How long will I take it for?

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

If you've had knee replacement surgery, you'll usually take the tablets for 10 to 14 days.

If you've had a hip replacement, you'll usually take the tablets for 32 to 38 days.

If you've had a blood clot (DVT or pulmonary embolism), you'll normally take apixaban for at least 3 months. Depending on what caused the blood clot, you might need to take it for longer.

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

Anticoagulant alert card

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.

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.

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.

5. 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 won't clot as easily.

Less serious bleeding

It's usual to bleed more easily than normal while you're taking apixaban. The kind of bleeding you might have includes:

  • 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 isn't dangerous and should stop by itself. If it happens, keep taking the apixaban, but tell your doctor if the bleeding bothers you or doesn't stop.

Things you can do to help yourself

  • Cuts - press on the cut for 10 minutes with a clean cloth.
  • Nosebleeds - read about how to stop a nosebleed or watch this video on stopping nosebleeds.
  • Bleeding gums - use 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 damp 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 a head 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 - don't wear dentures or retainers that don't 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

Serious bleeding

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

Contact your doctor or anticoagulant clinic, or go to A&E straight away if:

  • 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 that keep growing in size
  • you get nosebleeds that last longer than 10 minutes
  • 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 won't stop or slow down
  • your periods are heavier and last longer than normal
  • you have any other vaginal bleeding, including postmenopausal bleeding

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

6. Other side effects

There are no other common side effects. In rare cases, however, apixaban can cause a serious allergic reaction.

Contact a doctor straight away if:

  • you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
  • you're wheezing
  • you get tightness in the chest or throat
  • you have trouble breathing or talking
  • your mouth, face, lips, tongue or throat start swelling

These are warning signs of a serious allergic reaction. A serious allergic reaction is an emergency.

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

Information:

You can report any suspected side effect to the UK safety scheme.

7. Pregnancy and breastfeeding

Apixaban isn't normally recommended during pregnancy or while breastfeeding.

Tell your doctor if you're:

  • trying to get pregnant
  • pregnant
  • breastfeeding

8. Cautions with other medicines

Some medicines and supplements can interfere with apixaban. This can lead to serious side effects.

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

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

Taking apixaban with everyday painkillers

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 to. 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.

Important

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.

9. Common questions

How does apixaban work?

Apixaban is a type of medicine known as an anticoagulant. It makes your blood clot more slowly.

Blood clotting (thickening) is a complicated process involving substances called clotting factors.

Clotting factors are made by the liver and help stop bleeding. They work with blood cells called platelets that trigger the clotting process to make sure your blood clots properly.

Apixaban works by stopping a clotting factor called factor Xa from working. This thins your blood so it takes longer to clot.

How long does it take to work?

Apixaban works within a few hours of taking it.

Is it safe to take it for a long time?

Apixaban is safe to take for a long time. There don't seem to be any lasting harmful effects from taking it for many months or even years.

What will happen if I stop taking it?

Do not stop taking apixaban without talking to your doctor.

If you stop taking apixaban, the rate at which your blood clots will return to what it was before you started taking it - usually within a day or two of stopping. This means that you may be at increased risk of serious problems like stroke, heart attack, DVT or pulmonary embolism.

Are there any other similar medicines?

There are several other anticoagulants available as tablets or capsules. They include rivaroxaban, dabigatran, edoxaban and warfarin.

There are also anticoagulants that you take by injecting them. These include heparin, enoxaparin, dalteparin and tinzaparin.

Not all medicines that prevent blood clots are suitable for everyone. Talk to your doctor or pharmacist to find out why you've been recommended a particular medicine.

Can I drink alcohol with it?

You can drink alcohol while taking apixaban, so long as you stick to the national guidelines of no more than 14 units a week for men and women. One unit of alcohol is roughly equal to a third of a pint of beer or a small glass (125ml) of wine.

Drinking heavily - especially binge drinking lots of alcohol in one go - is dangerous while taking apixaban. The alcohol can increase apixaban's effect and make you more likely to get bleeding.

Is there any food or drink I need to avoid?

There are no foods or drinks you need to avoid while taking apixaban.

Will I need to stop apixaban before surgery?

Because of the risk of bleeding, your dose of apixaban may need to be lowered or stopped a few days before you have an operation.

Tell the surgeon that you're taking apixaban and show them your anticoagulant alert card. You should also tell anyone else involved with your care, such as your anticoagulant specialist, so they can make arrangements.

Will I need to stop apixaban before dental treatment?

You can still go to your dentist as usual. But tell your dentist that you're taking apixaban - and show them your anticoagulant alert card - before you have any treatment. This is especially important if you need to have a tooth out.

Your dentist may suggest that you stop your apixaban for 2 to 3 days before you have your tooth out. However, some people don't need to change their apixaban dose and there should be no risk of complications afterwards.

Can it cause hair loss?

Some people report hair loss when taking certain anticoagulants.

Apixaban doesn't seem to affect the hair, or cause hair loss. However, if you have any concerns about your hair while taking this medicine, or you notice any changes, speak to your doctor or pharmacist.

Can I have vaccinations?

You can have vaccinations while taking apixaban.

Before you have them, be sure to show your anticoagulant alert card to the nurse or doctor. It's important to tell them that you are taking apixaban, in case there is any bleeding at the site of the injection.

Will it affect my contraception or fertility?

Apixaban doesn't affect any type of contraception, including the contraceptive pill and the morning after pill. It doesn't have any effect on male or female fertility.

Do I need to avoid all sports?

You can continue to take part in non contact sports, such as running, athletics, cycling, tennis and badminton. However, be sure to use the right protective clothing or equipment, like wearing a helmet when riding your bike.

Avoid all contact sports, particularly martial arts and kickboxing. This is because these types of sports can lead to an injury, which would further increase the risk of bleeding.

Can I drive or ride a bike?

Most people can drive or ride a bike while taking apixaban.

However, if taking apixaban makes you fee dizzy or light headed, then don't drive or cycle until this feeling goes away.

Can I have a tattoo or piercing?

Having a body piercing or tattoo isn't recommended while you're taking apixaban. This is because of the increased risk of bleeding and infection.

If you still want to go ahead, talk to your doctor about your specific risks in case you need antibiotics.

And let the tattooist or piercer know beforehand that you're taking a blood thinning medicine.

Can lifestyle changes help?

You can reduce your risk of having a blood clot by making changes to your lifestyle, such as:

Page last reviewed: 07/02/2018
Next review due: 07/02/2021