Modify Therapy/Monitor Closely. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants. If not feasible, avoid use of abametapir. Avoid or Use Alternate Drug. 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. Modify Therapy/Monitor Closely. Use Caution/Monitor. Your list will be saved and can be edited at any time. Avoid or Use Alternate Drug. Contraindicated (1)fondaparinux and apixaban both increase anticoagulation. Either increases toxicity of the other by Other (see comment). provider for the most current information. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. enzalutamide will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. ritonavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. omacetaxine increases toxicity of apixaban by anticoagulation. commonly, these are "non-preferred" brand drugs or specialty Limit alcoholic beverages. Serious - Use Alternative (1)nelfinavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Lonafarnib is a weak P-gp inhibitor. For patients receiving apixaban 5 mg BID, avoid coadministration with combined P-gp and strong CYP3A4 inhibitors. Therapeutics and Clinical Risk Management, http://creativecommons.org/licenses/by-nc/3.0/, http://www.surgeongeneral.gov/library/calls/index.html, http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/009218s107lbl.pdf, http://www.accessdata.fda.gov/drugsatfda_docs/label/2015/022512s024lbl.pdf, http://www.accessdata.fda.gov/drugsatfda_docs/label/2015/022406s012lbl.pdf, http://www.accessdata.fda.gov/drugsatfda_docs/label/2015/206316lbl.pdf, http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/201370s000lbl.pdf, 813 hours (prolonged in renal impairment), None required. rucaparib will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. carbamazepine will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated (1)mifepristone increases toxicity of apixaban by anticoagulation. Both drugs have the potential to cause bleeding. Learn more Table 5 addresses risk stratification and recommendations regarding perioperative bridging anticoagulation. Thus, the ADVANCE-2 trial established noninferiority of apixaban in the setting of VTE prophylaxis for TKR. Reduce P-gp substrate dose if needed.Serious - Use Alternative (1)lonafarnib will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. The https:// ensures that you are connecting to the flurbiprofen and apixaban both decrease anticoagulation. Modify Therapy/Monitor Closely. Major bleeding occurred in 0, 0, and 2 of the patients receiving apixaban 5, 10, and 20 mg, respectively, and there were no fatal bleeds. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. View the formulary and any restrictions for each plan. If you log out, you will be required to enter your username and password the next time you visit. 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. 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. Use Caution/Monitor. 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. Coadministration may increase risk for adverse effects of CYP3A4 substrates. Modify Therapy/Monitor Closely. Serious - Use Alternative (1)abametapir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. 8600 Rockville Pike Either increases toxicity of the other by anticoagulation. This can lead to blood clots forming, which can travel to other parts of your body (such as the lungs or legs) or increase your risk for stroke. The need for simultaneous use of low-dose aspirin (<100 mg/day) with anticoagulants are common for patients with cardiovascular disease, but may result in increased bleeding; monitor closely. Long-term concomitant treatment with edoxaban and other anticoagulants is not recommended. Avoid or Use Alternate Drug. Contraindicated (1)vorapaxar increases toxicity of apixaban by anticoagulation. Venous thromboembolism (VTE) results in significant morbidity and mortality. Adjust dose of drugs that are CYP3A4 substrates as necessary. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors. Thus, the ADVANCE-3 trial proved efficacy and safety of apixaban in the prevention of VTE after THR. If you fall or injure yourself, especially if you hit your head, contact your doctor right away. SIDE EFFECTS: See also Warning section.Nausea, easy bruising, or minor bleeding (such as nosebleed, bleeding from cuts) may occur. Avoid or Use Alternate Drug. Comment: Imatinib may cause thrombocytopenia; bleeding risk increased when imatinib is coadministered with anticoagulants, NSAIDs, platelet inhibitors, and thrombolytic agents; patients requiring anticoagulation while on imatinib should receive LMWH or unfractionated heparin instead of warfarin because of multiple interaction mechanisms of imatinib with warfarin. Avoid or Use Alternate Drug. Serious - Use Alternative (1)apixaban increases effects of warfarin by anticoagulation. Monitor Closely (1)eliglustat increases levels of apixaban by P-glycoprotein (MDR1) efflux transporter. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Modify Therapy/Monitor Closely. Avoid or Use Alternate Drug. citalopram increases effects of apixaban by anticoagulation. Serious - Use Alternative (1)piroxicam and apixaban both increase anticoagulation. Similarly, for nursing mothers it is unknown whether apixaban or its metabolites are excreted in human milk, thus discontinuation of apixaban is recommended in this population.13, Regarding the use of apixaban in the elderly, in the ARISTOTLE and AVERROES trials, which established the safety and efficacy of apixaban for the prevention of stroke or systemic embolism in patients with nonvalvular atrial fibrillation, >69% of subjects were 65 and older, and >31% were 75 and older.33,34 In the ADVANCE-1, ADVANCE-2, and ADVANCE-3 studies, 50% of subjects were 65 and older and 16% were 75 and older.19,20,23 In the AMPLIFY and AMPLIFY-EXT studies, >32% of patients were 65 and older and >13% were 75 and older.24,25 It is known that major and fatal bleeding is twice as high in patients 80 years of age and older on anticoagulation.35 At present there are no specific randomized controlled trials (RCTs) evaluating the use of TSOACs in the elderly compared to conventional anticoagulation. Eriksson BI, Quinlan DJ, Weitz JI. Otherwise, call a poison control center right away. Serious - Use Alternative (1)lasmiditan increases effects of apixaban by P-glycoprotein (MDR1) efflux transporter. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid. Contraindicated. protein C concentrate and apixaban both increase anticoagulation. Reduces anticoagulant effect by decreasing apixaban systemic exposure. Avoid or Use Alternate Drug. Use Caution/Monitor. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Monitor or titrate P-gp substrate dose if coadministered. 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). 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. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed. Reversal of apixaban anticoagulation by 4-factor prothrombin complex concentrates in healthy subjects [abstract]. Modify Therapy/Monitor Closely. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. Some conditions may become worse when this drug is suddenly stopped. caplacizumab, apixaban. Decrease dose to 2.5 mg PO BID in patients with any 2 of the following characteristics: Moderate: Patients may have intrinsic coagulation abnormalities; data are limited and no recommendations are available, Apixaban affects INR, so measurements during coadministration with warfarin may not determine appropriate warfarin dose, If continuous anticoagulation is necessary, discontinue apixaban and begin both a parenteral anticoagulant and warfarin at the time the next dose of apixaban would have been taken, Discontinue parenteral anticoagulant when INR reaches an acceptable level, Discontinue at least 48 hr before elective surgery or invasive procedures with a moderate or high risk of unacceptable or clinically significant bleeding, Discontinue at least 24 hr before elective surgery or invasive procedures with low risk of unacceptable bleeding or where bleeding would be noncritical in location and easily controlled, Premature discontinuation of any oral anticoagulant, including, apixaban, increases risk of thrombotic events; consider using another anticoagulant if anticoagulation with apixaban is discontinued for a reason other than pathological bleeding or completion of a course of therapy, An increased rate of stroke was observed following discontinuation of apixaban in clinical trials in patients with nonvalvular atrial fibrillation, If anticoagulation with apixaban must be discontinued for a reason other than pathological bleeding, coverage with another anticoagulant should be strongly considered (see Dosing Considerations), Increased risk of epidural or spinal hematoma when used with neuraxial anesthesia (epidural/spinal anesthesia) or spinal puncture (can result in long-term or permanent paralysis), Risk increased with indwelling epidural catheters for administration of analgesia or by the concomitant use of drugs affecting hemostasis (eg, NSAIDs, platelet aggregation inhibitors, other anticoagulants), Risk also increased by traumatic or repeated epidural or spinal puncture; if this occurs, delay apixaban administration for 48 hr, Monitor patients for signs and symptoms of neurologic impairment; if neurologic compromise is noted, urgent treatment is necessary, Indwelling epidural or intrathecal catheters should not be removed earlier than 24 hr after the last administration of apixaban; the next apixaban dose should not be administered earlier than 5 hr after the removal of the catheter, Consider the potential benefit versus risk before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis, Anticoagulant effect is expected to persist for about 24 hr after the last dose (~2 half-lives), Coagulation factor Xa recombinant, inactivated-zhzo is commercially available for reversal of the anticoagulant effect of apixaban when reversal of anticoagulation is needed because of life-threatening or uncontrolled bleeding, Because of high plasma protein binding, apixaban is not expected to be dialyzable, Protamine sulfate and vitamin K would not be expected to affect the anticoagulant activity of apixaban, There is no experience with antifibrinolytic agents (tranexamic acid, aminocaproic acid) in individuals receiving apixaban, There is neither scientific rationale for reversal nor experience with systemic hemostatics (desmopressin and aprotinin) in individuals receiving apixaban, Use of procoagulant reversal agents (eg, prothrombin complex concentrate, activated prothrombin complex concentrate, or recombinant factor VIIa) may be considered but has not been evaluated in clinical studies, Activated oral charcoal reduces absorption of apixaban, thereby lowering plasma concentration, Treatment of pregnant rats, rabbits, and mice after implantation until the end of gestation resulted in fetal exposure to apixaban, but was not associated with increased risk for fetal malformations or toxicity, All patients receiving anticoagulants, including pregnant women, are at risk for bleeding; use during labor or delivery in women who are receiving neuraxial anesthesia may result in epidural or spinal hematomas; consider use of a shorter acting anticoagulant as delivery approaches, Consider the risks of bleeding and of stroke in this setting, Females of reproductive potential requiring anticoagulation should discuss pregnancy planning with their physician, The risk of clinically significant uterine bleeding, potentially requiring gynecological surgical interventions, identified with oral anticoagulants should be assessed in females of reproductive potential and those with abnormal uterine bleeding, If not taken at the scheduled time, the dose should be taken as soon as possible on the same day and twice daily administration should be resumed, Do not double the dose to make up for a missed dose, 5 mg and 2.5 mg tablets may be crushed and suspended in water, 5% dextrose in water (D5W), or apple juice, or mixed with applesauce and promptly administered orally, Alternatively, tablets may be crushed and suspended in 60 mL of water or D5W and promptly delivered through a nasogastric tube, Crushed tablets are stable in water, D5W, apple juice, and applesauce for up to 4 hr. Avoid or Use Alternate Drug. Do not store in the bathroom. The study medications were administered for 12 months. Apixaban may be resumed 24 hours postoperatively in patients who undergo a low bleeding risk surgery and 4872 hours following surgery in those patients undergoing a high bleeding risk surgery, keeping in mind the quick onset of anticoagulant effect.31, There is an absence of data regarding the use of apixaban in patients with chronic kidney disease, cancer, extreme body weight, pregnant women, and the elderly. One of the limitations to the use of the TSOACs is the lack of an antidote or reversal agent. Compare formulary status to other drugs in the same class. Modify Therapy/Monitor Closely. Apixaban was initiated 1224 hours following wound closure and enoxaparin 12 hours prior to surgery. fish oil triglycerides will increase the level or effect of apixaban by anticoagulation. Elagolix is a weak-to-moderate CYP3A4 inducer. CYP3A4 substrates may require dosage adjustment.stiripentol will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. restrictions. Monitor Closely (1)imatinib, apixaban. Reduces anticoagulant effect by decreasing apixaban systemic exposure. Monitor Closely (1)melatonin increases effects of apixaban by anticoagulation. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered. Avoid or Use Alternate Drug. Serious - Use Alternative (1)cilostazol and apixaban both increase anticoagulation. Economic burden of venous thromboembolism in hospitalized patients. 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. Use Caution/Monitor. Avoid or Use Alternate Drug. antithrombin alfa and apixaban both increase anticoagulation. May increase risk of bleeding. cilostazol and apixaban both increase anticoagulation. Use of PER977 to reverse the anticoagulant effect of edoxaban. Use Caution/Monitor. pharmacodynamic antagonism. The primary efficacy outcome was the composite of symptomatic recurrent VTE or death from any cause; however, symptomatic recurrent VTE or death related to VTE was a prespecified secondary efficacy outcome. 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. 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. nabumetone and apixaban both increase anticoagulation. In the ADVANCE-2 trial, patients were randomized to receive apixaban 2.5 mg twice daily (n=1,528) or subcutaneous enoxaparin 40 mg once daily (n=1,529).20 Apixaban was initiated 1224 hours following wound closure and enoxaparin was initiated 12 hours prior to surgery. abciximab and apixaban both increase anticoagulation. Monitor Closely (2)stiripentol, apixaban. Use Caution/Monitor. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Monitor Closely (1)acalabrutinib increases effects of apixaban by anticoagulation. itraconazole will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Consider increasing CYP3A substrate dose if needed. Intracranial hemorrhage and novel anticoagulants for atrial fibrillation: what have we learned? If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications. lopinavir will increase the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Consider dose reduction of sensitive P-gp substrates. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Contraindicated. Serious - Use Alternative (1)antithrombin alfa and apixaban both increase anticoagulation. SSRIs may inhibit platelet aggregation, thus increase bleeding risk when coadministered with anticoagulants. lonafarnib will increase the level or effect of apixaban by P-glycoprotein (MDR1) efflux transporter. Most Si P, Samama C, Godier A, et al. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. Serious - Use Alternative (1)tenecteplase and apixaban both increase anticoagulation. Recommendations of the Working Group on perioperative haemostasis and the French Study Group on thrombosis and haemostasis. Use Caution/Monitor. Monitor Closely (1)fluvoxamine increases effects of apixaban by anticoagulation. Avoid activities such as contact sports. Use Caution/Monitor. Oral anticoagulant therapies: balancing the risks. etodolac and apixaban both increase anticoagulation. FOIA Currently, no evidence-based guidelines exist for the management of apixaban in the perioperative setting. There was no effect on the ecarin clotting time, thrombin time, and reptilase time. Serious - Use Alternative (1)caplacizumab, apixaban. Serious - Use Alternative (1)argatroban and apixaban both increase anticoagulation. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs. Contraindicated. Avoid or Use Alternate Drug. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Use Caution/Monitor. affecting hepatic/intestinal enzyme CYP3A4 metabolism. venlafaxine and apixaban both increase anticoagulation. Avoid or Use Alternate Drug. tolmetin and apixaban both increase anticoagulation. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding. Before STORAGE: Store at room temperature away from light and moisture. Contraindicated. Medscape Education, Preventing Pediatric Venous Thromboembolism in Post-Fontan Patients: An Evolving Paradigm, encoded search term (apixaban (Eliquis)) and apixaban (Eliquis).