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Apixaban

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WARNING

If you are taking apixaban to help prevent strokes or serious blood clots and have atrial fibrillation (a condition in which the heart beats erratically, increasing the risk of clots forming in the body and potentially causing strokes), you are at an increased risk of having a stroke after stopping this medication. Without first consulting your physician, do not discontinue taking apixaban. Even if you feel good, keep taking apixaban. To avoid missing any apixaban doses, make careful to replenish your prescription before you run out of medicine. To assist prevent a blood clot from developing and leading to a stroke, your doctor may prescribe another anticoagulant (‘blood thinner’) if you need to stop taking apixaban.

You run the chance of developing a blood clot in or around your spine during an epidural, spinal anaesthetic, or spinal puncture while taking apixaban, which might leave you paralysed. Inform your doctor if you have a residual epidural catheter, have undergone spinal surgery, have undergone repeated epidural or spinal punctures, or have any of these conditions. If you are taking any of the following, let your physician and pharmacist know: anagrelide (Agrylin); aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, etc.), indomethacin (Indocin, Tivorbex), ketoprofen, and naproxen (Aleve, Anaprox, etc.); cilostazol (Pletal); clopidogrel (Plavix); dipyridamole (Persantine); eptifibatide (Coumadin, Jantoven). Call your doctor right away if you suffer any of the following symptoms: muscle weakness (particularly in your legs and feet), numbness or tingling (especially in your legs), or inability to control your bowels or bladder.

Whenever you refill your prescription for apixaban, your doctor or pharmacist will provide you the manufacturer’s patient information leaflet (Medication Guide). If you have any questions, carefully read the material and contact your doctor or pharmacist. The Medication Guide is also available on the manufacturer’s website or the Food and Drug Administration (FDA) website.

You should discuss the dangers of taking apixaban with your doctor.

Why is this medication prescribed?

Apixaban is used to treat people with atrial fibrillation (a condition in which the heart beats erratically, raising the risk of blood clots forming in the body and potentially causing strokes) who are not suffering from heart valve disease prevent strokes or blood clots. In patients undergoing hip or knee replacement surgery, apixaban is also used to prevent deep vein thrombosis (DVT), a blood clot that typically forms in the leg, and pulmonary embolism (PE), a blood clot that forms in the lung. After the initial course of treatment is finished, apixaban may be continued to prevent DVT and PE from occurring again. Factor Xa inhibitors are a group of medicines that includes apixaban. It functions by preventing the action of a certain natural chemical that promotes the formation of blood clots.

How should this medicine be used?

Apixaban is available as an oral tablet. It is often taken twice daily, with or without food. The first dosage of apixaban should be administered at least 12 to 24 hours after surgery if it is being used to prevent DVT and PE following hip or knee replacement. After a hip or knee replacement, apixaban is typically given for 35 days and for 12 days, respectively. Take apixaban every day at roughly the same time. Ask your doctor or pharmacist to explain any instructions on your prescription label that you are unsure about following. Administer apixaban exactly as prescribed. Never take it in larger or less amounts or more frequently than directed by your doctor.

The tablets can be crushed and mixed with water, apple juice, or applesauce if you are unable to swallow them whole. As soon as the mixture is ready, swallow it. You can also administer apixaban through several types of feeding tubes. Ask your doctor if you should use your feeding tube to administer this medication. Carefully adhere to your doctor’s instructions.

Even if you feel good, keep taking apixaban. Without first consulting your physician, do not discontinue taking apixaban. Your chance of developing a blood clot may increase if you stop taking apixaban.

Other uses for this medicine

Ask your doctor or pharmacist for more details if you believe this drug should be used for something else.

What special precautions should I follow?

Before taking apixaban,

  • If you have an allergy to apixaban, any other medications, or any of the ingredients in apixaban tablets, let your doctor and pharmacist know right once. For a list of the ingredients, consult the Medication Guide or speak with your pharmacist.
  • You should be honest with your doctor and pharmacist about any other prescription and over-the-counter drugs, vitamins, and dietary supplements you are now taking or intend to take. Any of the following should be mentioned: rifampin (Rifadin, Rimactane, in Rifadin, in Rifater); ritonavir (Norvir, in Kaletra); carbamazepine (Carbatrol, Epitol, Equetro, Tegretol, Teril); clarithromycin (Biaxin, in Prevpac); itraconazole (Onmel, Sporanox); ketoconazole (Nizoral); phenytoin; Serotonin and norepinephrine reuptake inhibitors (SNRIs) include duloxetine (Cymbalta), desvenlafaxine (Khedezla, Pristiq), milnacipran (Fetzima, Savella), and venlafaxine. Selective serotonin reuptake inhibitors (SSRIs) include citalopram (Celexa), fluoxetine (Prozac, Sarafem (Effexor). Your physician might need to adjust the dosage of your drugs or keep a close eye on you for side effects. Tell your doctor about all of the medications you are taking, including any not on this list, as many other drugs may also interact with apixaban.
  • Please let your doctor know if you are taking any herbal supplements, especially St. John’s wort.
  • You should be aware that apixaban might interfere with specific drugs that are prescribed to you in the event of a stroke or other medical emergency. You or a family member should disclose that you are taking apixaban to the physician or emergency department staff who treat you in the event of an emergency.
  • If you have an artificial heart valve or severe, uncontrollable bleeding anyplace in your body, let your doctor know. Most likely, your doctor will advise against taking apixaban.
  • Inform your doctor if you have or have ever had any clotting issues, kidney or liver problems, antiphospholipid syndrome (APS), or any other bleeding issues.
  • If you are breastfeeding a child or intend to become pregnant, let your doctor know. Call your doctor if you become pregnant while taking apixaban.
  • Inform your doctor or dentist that you are taking apixaban if you are having surgery, including dental surgery. You could be instructed by your doctor to cease taking apixaban prior to the operation or treatment. Your doctor could recommend a different drug if you need to stop taking apixaban because you need to have surgery in order to prevent blood clots during this period. After your procedure, your doctor will advise you when to resume taking apixaban. Pay close attention to these guidelines.
  • If you fall or hurt yourself, especially if you hit your head, call your doctor right away. Your physician might need to examine you.

What special dietary instructions should I follow?

Keep eating normally unless your doctor instructs you otherwise.

What should I do if I forget a dose?

If you miss a dosage, take it as soon as you recall. If the next dose is soon due, skip the missed one and carry on with your regular dosing plan. To make up for a missing dose, do not take a second one.

What side effects can this medication cause?

Some adverse effects can be very harmful. Call your doctor right away if you encounter any of these symptoms, or seek emergency care:

  • Bluish gums
  • Nosebleeds
  • Intense uterine bleeding
  • Urine that is brown, pink, or red
  • Tarry, red or black stools
  • Spitting up or coughing up blood or what seems to be coffee grounds
  • Inflammation or joint pain
  • Headache
  • Rash
  • Stiffness or pain in the chest
  • Facial or tongue swelling
  • Difficulty breathing
  • Wheezing
  • Feeling lightheaded or weak

Apixaban stops blood from clotting normally, so if you are cut or injured, it could take longer than usual for the bleeding to cease. You can bruise or bleed more easily when using this drug. If you experience unusual, severe, or uncontrollable bleeding or bruising, call your doctor straight once.

Other adverse effects of apixaban could exist. If you have any strange side effects while taking this medicine, call your doctor right away.

You or your doctor can report a significant side effect to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting programme by phone (1-800-332-1088) or online.

What should I know about storage and disposal of this medication?

Keep this medication tightly closed in the original container and out of the reach of children. Store it away from light, excessive heat, and moisture at room temperature (not in the bathroom).

Unused prescriptions must be disposed of carefully to prevent pets, kids, and other people from ingesting them. You should not, however, dispose of this medication in the toilet. Instead, utilising a medicine take-back programme is the easiest approach to get rid of your medication. To find out about take-back programmes in your area, speak with your pharmacist or the garbage/recycling department in your city. If you do not have access to a take-back programme, see the FDA’s Safe Disposal of Medicines website at http://goo.gl/c4Rm4p for additional information.

As many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and are simple for young children to open, it is crucial to keep all medications out of sight and out of reach of children. Always lock safety caps and promptly stash medication up and away from young children where it is out of their sight and reach to prevent poisoning. http://www.upandaway.org

In case of emergency/overdose

Call the poison control hotline at 1-800-222-1222 in the event of an overdose. Additionally, information can be found online at https://www.poisonhelp.org/help. Call 911 right once if the person has collapsed, experienced a seizure, is having difficulty breathing, or cannot be roused.

Overdose signs could include the following:

  • Uncommon bruising or bleeding
  • Urine that is pink, brown, or red
  • Tarry, red or black stools
  • Spitting up or coughing up blood or what seems to be coffee grounds

What other information should I know?

Keep all of your doctor’s appointments.

No one else should take your medication. Any queries you may have regarding medication refills should be directed to your pharmacist.

You should keep a written record of every medication you take, including any over-the-counter (OTC) items, prescription drugs, and dietary supplements like vitamins and minerals. This list should be brought with you whenever you see a doctor or are admitted to the hospital. You should always have this information with you in case of emergencies.

Brand names

  • Eliquis®
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