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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 (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.
  • 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 is not 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)
  • have antiphospholipid syndrome, a condition that affects the immune system and makes you more likely to get blood clots

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.

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

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 purée. Swallow this mixture straight away.

How much to 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. But 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 have recently had a blood clot - if you have 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 have 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 have had knee replacement surgery, you'll usually take the tablets for 10 to 14 days.

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

If you have 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 will not 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:

  • periods that are heavier and last longer than normal
  • 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 - find out what to do about a nosebleed or watch this video on stopping nosebleeds.
  • Bleeding gums - if your gums are bleeding, 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 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 - 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

Serious bleeding

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

Urgent advice: 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 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 will not stop or slow down

These are symptoms of serious bleeding.

If you experience serious bleeding, stop taking apixaban.

6. Other side effects

Like all medicines, apixaban can cause side effects, although not everyone gets them.

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

This can cause a very severe headache, fits (seizures), changes to your eyesight, numbness or tingling in your arms or legs, and make you feel very tired, weak or sick.

If you suddenly get any of these symptoms, contact your doctor immediately. This is an emergency.

Common side effects

These common side effects happen in more than 1 in 100 people.

They're usually mild and do not last long, but talk to your doctor or pharmacist if these side effects bother you or do not go away:

  • tiredness and lack of energy, shortness of breath, noticeable heartbeats (heart palpitations) and pale skin - these can be signs of anaemia
  • feeling dizzy or lightheaded
  • a mild rash
  • feeling sick (nausea)

Serious allergic reaction

In rare cases, apixaban can cause a serious allergic reaction (anaphylaxis).

Immediate action required: Call 999 or go to A&E 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

You could be having a serious allergic reaction and may need immediate treatment in hospital.

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. How to cope with side effects

What to do about:

  • signs of anaemia - talk to your doctor, who may arrange a blood test.
  • feeling dizzy or lightheaded - if apixaban makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so you do not faint, then sit until you feel better. If the dizziness does not go away or keeps happening, speak to your doctor. They may arrange a blood test to see if you have anaemia.
  • a mild rash - it may help to take an antihistamine, which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you. If the rash does not go away within a few days, speak to your doctor.
  • feeling sick (nausea) - stick to simple meals and do not eat rich or spicy food. It might help to take your apixaban after you have eaten.

8. Pregnancy and breastfeeding

Apixaban is not normally recommended during pregnancy or while breastfeeding.

Non-urgent advice: Tell your doctor if you're:

  • trying to get pregnant
  • pregnant
  • breastfeeding

9. 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 an abnormal heartbeat, 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.

10. 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 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 do not 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, deep vein thrombosis 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 have been recommended a particular medicine.

Can I drink alcohol with it?

You can drink alcohol while taking apixaban as long as you stick to the advice not to drink more than 14 alcohol units a week.

A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.

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 bleed.

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.

Most people do not need to change their apixaban dose, but your dentist may contact your doctor for advice before starting the dental treatment.

Can it cause hair loss?

Some people report hair loss when taking certain anticoagulants.

Apixaban does not seem to affect the hair or cause hair loss.

But 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're taking apixaban in case there's any bleeding at the site of the injection.

Will it affect my contraception?

Apixaban does not affect any type of contraception, including the combined pill and emergency contraception.

Will it affect my fertility?

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

But speak to a pharmacist or your doctor before taking it if you're trying to get pregnant.

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.

But 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.

But if taking apixaban makes you feel dizzy or lightheaded, do not drive or cycle until this feeling goes away.

Can I have a tattoo or piercing?

Having a body piercing or tattoo is not 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: