Eliquis (Apixaban 2.5mg) Tablets

Eliquis general information

What is Eliquis used for?

When you cut yourself or are injured, at first, you will bleed from the wound, but then bleeding stops as a blood clot or thrombus forms and plugs the wound.  Blood clot formation is a normal response to blood vessel injury that is designed to stop excessive bleeding, a process known as haemostasis.  However, if a blood clot forms inside an intact blood vessel, which is known as thrombosis, there is a risk that it clot can break off and travel through the circulation.  This can become a serious problem if the thrombus becomes lodged in the heart, brain or lungs, and this is known as a thromboembolism.  Eliquis tablets 2.5mg are used to treat and prevent thrombosis in conditions where there is a risk of thromboembolism, that could be life-threatening.

Thrombosis risk factors and danger signs

Some conditions are known to increase your risk of thrombosis.  These include heart conditions such as atrial fibrillation (irregular heartbeat) and congestive heart failure (the heart cannot pump efficiently), where blood flow is disturbed or slows down, allowing the blood to pool and increasing risk of blood clot formation.  Other conditions include hypertension (high blood pressure), diabetes mellitus, and having had a stroke or a transient ischaemic attack (mini-stroke).  Also, increasing age over 75 years, using oral contraceptives and smoking all increase the risk of thrombosis. 

When blood clots form in the veins, it is called venous thrombosis or deep vein thrombosis (DVT) because they usually occur in the deep veins of the leg or pelvis.  Risk factors for DVT include anything that prevents blood circulating efficiently like extended periods of immobility, such as sitting on a plane or following surgery.  These clots can break loose and can become lodged in the lungs, causing a pulmonary embolism (PE) or in the brain, causing a stroke.  Signs of a DVT are pain, swelling, change of colour, and warmth in the affected area, such a blood clot in the leg. 

Venous thromboembolism (VTE) is the type of thrombosis that can happen following hip or knee replacement surgery, when there is an increased risk of blots clots due to immobility. 

A clot can form in an artery due to a condition called atherosclerosis, where cholesterol deposited in the artery wall (known as plaque) breaks up and triggers thrombosis.  The thrombus can travel to the coronary arteries and block the blood supply to the heart tissue causing myocardial infarction (heart attack), or it can travel to the brain and cause a stroke.

Eliquis tablets 2.5mg are used to treat and prevent DVT and PE, also to prevent VTE following hip or knee replacement surgery, and to prevent stroke caused by thromboembolism in patients with atrial fibrillation.

Coagulation and thrombosis

Coagulation is the process that changes free-flowing blood to a solid that then develops into a clot.  It involves several components, including blood platelets and proteins in the blood called coagulation factors.  The coagulation cascade is the interaction of a series of coagulation factors, which are mostly enzymes, to generate a plug formed by fibrin, a fibrous protein.  This fibrin plug combines with a clump of aggregated platelets and becomes a blood clot or thrombus. 

The coagulation cascade is the activation of one coagulation factor by another.  It can be activated by injury or trauma to a blood vessel that becomes exposed (known as the extrinsic pathway), or by internal damage to a blood vessel wall (intrinsic pathway).  The coagulation cascade is completed by the formation of fibrin.

How does Eliquis work?

Eliquis tablets 2.5mg contain apixaban, an anticoagulant that is used to treat and prevent thrombosis.  Apixaban in Eliquis tablets 2.5mg works by blocking the coagulation cascade and acts as a reversible, direct, and highly selective inhibitor of the factor Xa, the clotting factor that links the intrinsic and extrinsic coagulation pathways. 

Factor Xa is a serine protease, which is an enzyme that converts prothrombin to its active form thrombin.  This is the final coagulation factor in the cascade that results in the generation of fibrin needed for blood clot formation.  Activation of Factor Xa is the common link in the coagulation cascade between the intrinsic and the extrinsic pathways.  Therefore, inhibition of Factor Xa is an ideal and effective target for preventing thrombosis. 

Several of the coagulation factors need Vitamin K as a cofactor in their production and these are the target of other anticoagulants like warfarin, which can take time to become effective and may require dose adjustment, as everyone responds differently.  Apixaban in Eliquis tablets 20mg is fast-acting with maximum effect within 3 to 4 hours.  It also has good bioavailability when taken orally, which means that a high proportion of the medication is absorbed and reaches the target site without being metabolised in the liver.  Also, it does not need vitamin K, and is it effective at a fixed dose. 

Apixaban in Eliquis tablets 2.5mg has no direct effects on platelet aggregation, which is another component of the blood clotting process, but indirectly inhibits platelet aggregation, which is induced by thrombin produced during the coagulation cascade.  By inhibiting Factor Xa, apixaban prevents thrombin generation, which blocks the formation of a blood clot, and this is achieved at doses that that do not interfere with haemostasis, which is the normal control of bleeding.

What does Eliquis contain?

Eliquis tablets 2.5mg contain the active ingredient apixaban 2.5mg, an inhibitor of coagulation Factor Xa, used to treat and prevent the formation of blood clots (thrombosis).  They also contain microcrystalline cellulose, croscarmellose sodium, lactose, sodium lauryl sulfate, magnesium stearate, lactose monohydrate hypromellose titanium dioxide, glycerol triacetate, yellow iron oxide.

What are the side effects of Eliquis?

Most medications have some side effects, but they are not experienced by everyone.  Some side effects are commonly experienced when taking Eliquis tablets 2.5mg, but others are not so common, and you should discuss any problems or concerns with your primary care physician. 

Common side effects when taking Eliquis include anaemia, haemorrhage (bleeding from the eyes, gums, rectum, and intestines) and haematoma (blood blisters), contusion (bruising), epistaxis (nosebleeds), haematuria (blood in the urine), nausea, hypotension (low blood pressure). 

When should Eliquis not be used?

Have a talk with your primary healthcare physician before taking Eliquis tablets 2.5mg so that you have a full understanding of what this medicine is for and how to use it.  There are some reasons for not taking a medication; these are called contraindications, and for Eliquis you should consider the following before taking Eliquis:

• Have you ever had an unusual reaction or an allergy when taking Eliquis?
• Are you pregnant or breastfeeding?
• Do you have any problems with your kidneys or your liver?
• Do you have any liver disease associated with increased blood coagulation?
• Do you have any blood disorders that affect normal blood clotting?
• Do you have any condition that can increase the risk of excessive bleeding such as a gastrointestinal ulcer, a malignant tumour, a lung condition called bronchiectasis, a history of bleeding from the lungs, or severe uncontrolled high blood pressure?
• Do you have a prosthetic heart valve?

What medications interact with Eliquis?

Some medicines interact with Eliquis and may affect the way it works, or are affected by Eliquis or increase side effects; you should discuss possible interactions with your primary care physician.  These may include ritonavir for HIV, the antifungal ketoconazole), other anticoagulants like heparin or warfarin, inhibitors of platelet aggregation like clopidogrel, heparin or warfarin, inhibitors of platelet aggregation like clopidogrel and NSAIDs like aspirin, the anti-infective rifampicin, the anticonvulsives carbamazepine and phenytoin, the sedative phenobarbital the herbal remedy St. John’s Wort. 

If other medications may interact with Eliquis, your doctor will discuss these with you. 

How should Eliquis be taken and for how long?

You should take your Eliquis tablets 2.5mg swallowed whole with a glass of water, with food, or crushed into food if swallowing is difficult.  The dose you take, how often (once or twice daily) and for how long depends on what you are being treated for and your doctor’s recommendation.  You should continue to take your Eliquis tablets 2.5mg for as long as recommended by your doctor, which may be for several days or weeks.

Missed dose of Eliquis

If you miss a dose of Eliquis tablets 2.5mg take it as soon as you remember, unless it is time to take the next dose, then skip the missed dose.  Do not take a double dose.

How should Eliquis be stored?

You should store your Eliquis tablets 2.5mg below 25°C in a cool, dry place.