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Keep Away Stroke and Heart Problems with Eliquis (apixaban). Including Side Effects & Uses of Eliquis

By Miriatu

EliquisEliquis (apixaban) is a prescription medicine used to reduce the danger of stroke and blood clots in individuals who have atrial fibrillation. Eliquis is associated with a group of drugs called Xa inhibitor anticoagulants, which reduce the chance of a blood clot forming in the body, decrease the risk of forming a blood clot in the legs and lungs of people who have just had a knee replacement or hip surgery. Treat blood clots in the veins of your legs (deep vein thrombosis) or lungs (pulmonary embolism), and reduce the danger of them occurring again. This drug is also given to treat or reduce the danger of developing deep vein thrombosis (DVT; a blood clot that usually develops in the leg) and pulmonary embolism (PE; a blood clot in the lung). Apixaban is a white to faintly-yellow powder. At physiological pH (1.2–6.8), apixaban does not ionize; its aqueous/containing water solubility across the physiological pH range is ~0.04 mg/mL. Eliquis tablets are available for oral administration in capacities of 2.5 mg and 5 mg of apixaban with the following inactive components: microcrystalline cellulose, anhydrous lactose, sodium lauryl sulfate, magnesium stearate and croscarmellose sodium. The film coating embodies hypromellose, titanium dioxide, triacetin, lactose monohydrate and yellow iron oxide (2.5 mg tablets) as well as red iron oxide (5 mg tablets).

b). Possible side effects of Eliquis

            Call your physician or pharmacist as soon as possible if you do not feel well while you are taking Eliquis. All drugs can have side effects. At times they could be serious, most of the time they may not be. You may need medical attention if you witness some of the side effects of Eliquis. It can be difficult to tell whether side effects Eliquis are the result of administering Eliquis, the effects of your condition or side effects of other medicines you may be taking. For this reason it is important to call your doctor of any change in your condition. Do not be alarmed by the list of side effects Eliquis. You may not witness any of these side effects Eliquis. Ask your doctor or pharmacist to answer any questions you may have.

 

The most common side effects Eliquis that occur with Eliquis (apixaban) include:

  • Tiredness
  • Weakness
  • Paleness,
  • Dizziness,
  • Light-headedness,
  • Headache: which can be because of the low iron in the blood
  • Bleeding from any part of your body, no matter how minor, as these may be complicated to control
  • Bruising
  • Nausea (feeling sick),
  • Vomiting
  • Diarrhea or constipation
  • Fever
  • Sore nasal passages and throat
  • Constant need to urinate or pain while urinating
  • Coughing.

Some of the signs of bleeding are:

  • Nosebleeds
  • Bruising more easily
  • Heavy menstrual bleeding
  • Bleeding of your gums as you brush your teeth
  • Excessive bleeding or prolonged bleeding: There is no antidote to reverse this bleeding. It is important to contact your physician immediately if you experience excessive or prolonged bleeding of Eliquis side effects
  • Stomach swelling
  • Yellowing of the skin or whites of the eyes due to liver problems. changes in liver function can only be found when your doctor does tests from time to time to check your progress
  • Oozing from your surgical wound
  • Swelling of the hands, ankles or feet due to water retention
  • Bleeding from your nose
  • If you have blood in your urine or dark brown urine 
  • If you cough up blood
  • If you vomit and it is black
  • If you have blood in your stools or stool blackish projects Eliquis side effects

If you experience any of these serious side effects of Eliquis uses below, call your doctor straight away. If your signs are potentially life threatening or if you think you require a medical urgency, call 9-1-1. The serious side effects Eliquis include :

  • Serious bleeding: Serious bleeding events include coughing up blood or blood in your stomach, intestines, brain, eyes, urine or rectum. Some of these bleeds could be deadly. Symptoms of these include; unexpected bleeding or bleeding that lasts a long while. This includes unusual bleeding from your gums, nose bleeds that happen often, or heavy menstrual bleeding depicts Eliquis side effects
  • Bleeding that is intense or uncontrollable
  • Red, pink, or brown-colored urine
  • Red or black-colored, tarry stools
  • Coughing up blood or blood clots
  • Vomiting blood or vomit that looks like coffee grounds
  • Unexpected pain or swelling
  • Headaches, dizziness, or weakness reveals Eliquis side effects
  • Spinal or epidural blood clots (hematoma). If you administer apixaban and have another drug injected into your spine, or if you have a spinal rupture, you may be at danger of a spinal or epidural blood clot. This can result to permanent paralysis. Signs include: tingling, numbness, or muscle weakness, especially in your feet and legs
  • Loss of control of your bladder or bowels (incontinence)
  • If you have an allergic reaction to Eliquis uses. Signs may include difficulty breathing or wheezing, shortness of breath, swelling of the face, lips, tongue as well as other parts of the body, rash, hives on the skin or itching

If you observed any of these side effects of Eliquis (apixaban), do not hesitate to call your health care specialist for an immediate solution.

c). Patients Counseling information about Eliquis

          Advise patients to read the Food and Drug Administration (FDA) approved patient labeling (Medication Guide). Patients should be advised of the following:

  • Not to discontinue Eliquis without discussing with your physician first.
  • That it might take longer than usual for bleeding to cease, and they may bleed or bruise more easily when treated with Eliquis. Advise patients about how to take note of bleeding or signs of hypovolemia and of the urgent need to report any unusual bleeding to their doctors.
  • To call their doctors and dentists they are taking Eliquis, and/or any other product known to affect bleeding (alongside nonprescription products, such as aspirin or NSAIDs), before any surgery or medical or dental procedure is programmed and before any new drug is taken.
  • If the patient is having neuraxial anesthesia or spinal puncture, inform the patient to be sensitive to signs and symptoms of spinal or epidural hematomas. If any of these symptoms happen, advise the patient to seek emergency medical attention.
  • To call their physician if they are pregnant or plan to become pregnant or are breastfeeding or intend to breastfeed during treatment with Eliquis.
  • How to take Eliquis if they cannot swallow, or need a nasogastric tube

d). Warnings and Precautions of Eliquis

i).Increased risk of thrombotic events after premature discontinuation

Premature discontinuation of any oral anticoagulant, including Eliquis, in the absence of sufficient alternative anticoagulation increases the risk of thrombotic incidence. An increased rate of stroke was noticed during the transition from Eliquis uses to warfarin in clinical tests in atrial fibrillation patients. If Eliquis is discontinued for a purpose other than pathological bleeding or completion of a course of treatment, consider coverage with another anticoagulant.

ii). Bleeding

Eliquis increases the risk of bleeding and can cause serious, potentially frightening, bleeding. Concomitant use of drugs affecting hemostasis elevates the danger of bleeding. This consists of aspirin and other antiplatelet agents, heparin, thrombolytic agents, other anticoagulants, selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, as well as nonsteroidal anti-inflammatory drugs (NSAIDs). Advise patients with signs and symptoms of blood loss and to report them immediately or go to an emergency theatre. Discontinue Eliquis in patients with active pathological hemorrhage. There is no developed way to reverse the anticoagulant effect of apixaban, which can be expected to continue for at least 24 hours after the last dosage of Eliquis, that is, for about two medicines half-lives. A precise antidote for Eliquis is not available. Hemodialysis does not seem to have a substantial impact on apixaban disclosure. Protamine sulfate and vitamin K are not expected to affect the anticoagulant activity of apixaban. There is no experience with anti-fibrinolytic agents (amino caproicacid, tranexamicacid,) in patients receiving apixaban. There is neither scientific consideration for reversal nor experience with systemic hemostatic (desmopressin and aprotinin) in patients receiving apixaban. Use of procoagulant alternating agents such as prothrombin complex concentrate recombinant factor VIIa or activated prothrombin complex concentrates may be considered but has not been assessed in clinical studies. Activated oral charcoal decreases absorption of apixaban, thereby reducing apixaban plasma concentration.

iii). Spinal/Epidural anesthesia or puncture

When neuraxial anesthesia (spinal/epidural anesthesia) or spinal/epidural rupture is employed, patients treated with antithrombotic agents for prevention of thromboembolic complications are in danger of developing an epidural or spinal hematoma which can result in permanent or long-term paralysis. The risk of these incidences may be increased by the postoperative use of indwelling epidural catheters or the concomitant use of medicinal products affecting hemostasis. Indwelling intrathecal catheters or epidural should not be removed earlier than 24 hours after the last administration of Eliquis. The next dosage of Eliquis should not be administered earlier than 5 hours after the removal of the catheter. The risk may also be raised by traumatic or repeated epidural or spinal puncture. If traumatic puncture happens, delay the administration of Eliquis for 48 hours. Following up patients frequently for signs and symptoms of neurological impairment (e.g, weakness or numbness of the legs, bladder or bowel dysfunction). If neurological compromise is observed, urgent diagnosis and treatment is necessary. Prior to neuraxial intervention, the doctor should consider the potential benefit versus the danger in anticoagulated patients or in patients to be anticoagulated for thromboprophylaxis.

iv). Patients with prosthetic heart valves

The efficacy and safety of Eliquis have not been studied in patients alongside prosthetic heart valves. Therefore, the uses of Eliquis are not approved in these patients.

v). Acute PE in hemodynamically unstable patients or patients who require thrombolysis or pulmonary embolectomy

Initiation of Eliquis is not approved as an alternative to unfractionated heparin for the initial treatment of patients with PE who present with hemodynamic instability or who may obtain thrombolysis or pulmonary embolectomy.

e). Uses of Eliquis

i).Reduction of risk of stroke and systemic embolism in non valvular atrial fibrillation

Eliquis (apixaban) is used to reduce the risk of stroke and systemic embolism in patients with non valvular atrial fibrillation.

ii). Prophylaxis of deep vein thrombosis following hip or knee replacement surgery

Eliquis is used for the prophylaxis of DVT, which may result to pulmonary embolism (PE), in patients who have undergone knee replacement or hip surgery.

iii). Treatment of deep vein thrombosis

Eliquis is used for the treatment of grave vein thrombosis DVT.

iv). Treatment of Pulmonary Embolism

Eliquis is used for the treatment of pulmonary embolism PE.

v). Reduction in the risk of recurrence of DVT and PE

Eliquis is indicated to reduce the danger of recurrent DVT and PE following initial therapy.

f). Dosage of Eliquis

i). Recommended dose

Reduction of risk of stroke and systemic embolism in patients with non valvular atrial fibrillation. The approved dose of Eliquis uses for most patients is 5 mg taken orally twice daily. The approved dose of Eliquis is 2.5 mg taking two times in a day in patients with at least three of the following characteristics:

  • Age ≥80 years
  • Body weight ≤60 kg
  • Serum creatinine ≥1.5 mg/dL

ii). Prophylaxis of deep vein thrombosis following hip or knee replacement surgery

The approved dosage of Eliquis is 2.5 mg taken orally two times in a day. The initial dose should be taken 12 to 24 hours after surgery.

  • In patients undergoing hip replacement surgery, the recommended timeframe of treatment is 35 days.
  • In patients undergoing knee replacement surgery, the recommended timeframe of treatment is 12 days.

iii). Treatment of DVT and PE

The approved dose of Eliquis is 10 mg taken orally twice daily for the first 7 days of treatment. After 7 days, the approved dose is 5 mg taken orally twice daily.

iv). Reduction in the risk of recurrence of DVT and PE

The approved dose of Eliquis is 2.5 mg taken orally two times in a day after at least 6 months of therapy for DVT or PE.

g). Dosage forms and strengths of Eliquis

( 2.5 mg, round, yellow, biconvex, film-coated tablets with “893” debossed on one side and “2½” on the other side.

( 5 mg, oval-shaped, pink, biconvex, film-coated tablets with “894” debossed on one side and “5” on the other side.

h). Overdose of Eliquis

          There is no antidote to Eliquis. Overdose of Eliquis elevates the risk of bleeding. In controlled clinical tests, orally administered apixaban in healthy subjects at doses up to 50 mg daily for 3 to 7 days (25 mg twice-daily for 7 days or 50 mg once-daily for 3 days) had no clinically relevant adverse reactions. In healthy subjects, administration of vibrant charcoal 2 and 6 hours after ingestion of a 20-mg dose of apixaban reduced mean apixaban AUC by 50% and 27%, respectively. Mean apparent half-life of apixaban decreased from 13.4 hours when apixaban was taken alone for 5.3 hours and 4.9 hours, respectively, when activated charcoal was taken 2 and 6 hours after apixaban, shows that charcoal blocked the continued absorption of apixaban from the gut. Thus, administration of activated charcoal may be useful in the management of apixaban overdose or accidental ingestion by leading to a more rapid fall in apixaban blood levels.

i). Storage conditions of Eliquis

          Store at 20°C to 25°C (68°F-77°F); excursions allowed between 15°C and 30°C (59°F-86°F). Keep Eliquis tablets in the pack until it is time to administer them. If you take the medicines out of the pack they may not be safer anymore. Keep your tablets in a cool dry place where the temperature stays below 30°C.Do not store Eliquis or any other drug in the bathroom or close to a water sink. Do not allow it on a window sill or in the car. Dampness and heat and can destroy some drugs. Keep it away from the reach of teens. A locked cupboard at least one-and-a-half meters above the ground is a good place to store medicines.

j). Use in specific populations

i). Pregnancy category B

There are no sufficient and well-controlled studies of Eliquis in pregnant women. Treatment is likely to increase the danger of hemorrhage during pregnancy as well as delivery. Eliquis should be applied during pregnancy only if the potential benefit outweighs the potential risk to the mother and fetus. Treatment of pregnant rabbits, rats and mice after implantation until the end of gestation resulted in fetal disclosure to apixaban, but was not associated with increased danger for fetal toxicity or malformations. No fetal or maternal deaths were linked to bleeding. Increased events of maternal bleeding waere noticed in rats, mice and rabbits at maternal exposures that ranges from 19, 4, and 1 times, respectively, the human exposure of unbound medicine, based on area under the plasma-concentration time curve (AUC) comparisons at the maximum recommended human dose (MRHD) of 10 mg (5 mg twice daily).

ii). Labor and delivery

Effectiveness and safety of Eliquis during labor and delivery have not been studied in clinical trials. Consider the dangers of bleeding and of stroke in using Eliquis in this setting. Treatment of pregnant rats from implantation (gestation day 7) to weaning (lactation day 21) with apixaban at a dose of 1000 mg/kg (about 5 times the human exposure based on unbound apixaban) did not result in death of offspring or death of mother rats during labor in connection with uterine bleeding. However, the accelerated incidence of maternal bleeding, primarily during gestation, happened at apixaban doses of ≥25 mg/kg, a dose linking to ≥1.3 times the human disclosure.

iii). Nursing mothers

It is not known whether apixaban or its metabolites are excreted in human milk. Rats excrete apixaban in milk (12% of the maternal dose). Women should be instructed either to discontinue breastfeeding or to discontinue Eliquis treatment, taking into consideration the importance of the medicine to the mother.

iv). Pediatric use

Safety as well as effectiveness in pediatric patients has not been set up.

v). Geriatric use

Of the total subjects in the Aristotle and Averroes clinical studies, >69% were 65 and older, and >31% were 75 years old and beyond. Moreover, in the ADVANCE-1, ADVANCE-2, and ADVANCE-3 clinical studies, 50% of subjects were 65 and older, while 16% were 75 and older. In the AMPLIFY and AMPLIFY-EXT clinical studies, >32% of subjects were 65 and older and >13% were 75 and older. No clinically important differences in effectiveness or safety were observed when comparing subjects in different age groups.

vi). Renal impairment

Reduction of risk of stroke and systemic embolism in patients with non valvular atrial fibrillation. The approved dose is 2.5 mg twice daily in patients with at least two of the following characteristics

  • Age ≥80 years
  • Body weight ≤60 kg
  • Serum creatinine ≥1.5 mg/dL

Clinical safety and efficacy studies with Eliquis did not enroll patients with end-stage renal disease (ESRD) with dialysis. In patients with ESRD kept on intermittent hemodialysis, administration of Eliquis at the normal approved dose. Will result in concentrations of pharmacodynamics and apixaban activity similar to those observed in the Aristotle findings. It is not known if these concentrations will lead to a similar stroke reduction and bleeding danger in patients with ESRD on dialysis as was seen in Aristotle. Prophylaxis of deep vein thrombosis following hip or knee replacement surgery, and therapy of DVT and PE and reduction in the danger of recurrence for DVT and PE. No dose adjustment is approved for patients with renal impairment, including those with ESRD on dialysis. Clinical safety and efficacy studies with Eliquis did not enroll patients with ESRD on dialysis or patients with a CrCl<15 mL/min; as such, dosing recommendations are centered on pharmacokinetics and pharmacodynamics (anti-FXa activity) data in subjects with ESRD maintained on dialysis.

vii). Hepatic impairment

No dose adjustment is required in patients with mild hepatic impairment (Child-Pugh class A). Because patients with moderate hepatic impairment (Child-Pugh class B) may have intrinsic coagulation abnormalities and there is limited clinical experience with uses of Eliquis in these patients, dosing recommendations cannot be offered. The uses of Eliquis are not approved in patients with intense hepatic impairment (Child-Pugh class C). Before you take Eliquis, discuss with your physician if you: have kidney or liver problems; have any other medical condition; have ever had bleeding problems; are pregnant or plan to get pregnant. It is not known if Eliquis will harm your unborn baby; are breastfeeding or plan to breastfeed. It is not known if Eliquis infiltrates into your breast milk. You and your physician should decide if you will take Eliquis or nurse. You should not do both.

A disclaimer: Health line has made every effort to make certain that every information is factually comprehensive, updated and correct. However, this article should not be used as a substitute for the expertise and knowledge of a licensed healthcare specialist. You should always discuss with your physician or other health care expert before taking any medication. The drug information provided herein is susceptible to change and is not meant to cover all directions, possible uses, precautions, warnings, side effects, storage conditions, dosage, adverse effects or allergic reactions. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is effective, safe, or appropriate for all patients or all specific uses.

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