Apixaban Prescribing Guidelines

Standard Dosing by Indication

The American College of Cardiology recommends a standard dose of 5 mg orally twice daily for most patients with atrial fibrillation, with a reduced dose of 2.5 mg orally twice daily for patients with at least two of the following characteristics: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL 1, 2, 3
For venous thromboembolism treatment, the initial therapy is 10 mg orally twice daily for the first 7 days, followed by 5 mg orally twice daily for continuation therapy 1, 4
The European Heart Journal recommends a dose of 2.5 mg orally twice daily for VTE prophylaxis after orthopedic surgery 2

The American College of Cardiology recommends standard dosing for patients with CrCl >50 mL/min, and use of standard 5 mg twice daily unless the patient also meets two dose-reduction criteria for patients with CrCl 15-50 mL/min 3
Apixaban has 27% renal excretion, making it more favorable in renal impairment compared to dabigatran or edoxaban 3

For cardioversion in atrial fibrillation, a single loading dose of 10 mg (or 5 mg if dose-reduced) may be administered, followed by standard dosing as 5 mg or 2.5 mg twice daily based on dose-reduction criteria 2
The American College of Cardiology recommends avoiding concurrent use with combined P-glycoprotein and strong CYP3A4 inhibitors, and reducing the dose to 2.5 mg twice daily if such combinations are necessary 3

The American College of Cardiology recommends using apixaban with caution in patients with hepatic impairment, with transaminases >2× upper limit of normal or total bilirubin >1.5× upper limit of normal 5