Eliquis, also known by its generic name apixaban, is an anticoagulant medication (blood thinner) used to prevent the formation of blood clots. It falls under the class of drugs called direct oral anticoagulants (DOACs) and works by inhibiting Factor Xa, an essential element in the blood clotting process.

By blocking Factor Xa, Eliquis prevents the formation of blood clots. This action is essential for reducing the risk of stroke in individuals with atrial fibrillation and preventing or treating deep vein thrombosis (DVT) and pulmonary embolism (PE).

However, patients often question whether they can cut Eliquis in half to adjust doses or save on medication costs. This article explores the implications, risks, and safe practices associated with splitting Eliquis tablets.

Key Findings:

  • Eliquis (apixaban) is available in 2.5 mg and 5 mg tablets. The 2.5 mg tablets are yellow, round, and biconvex, while the 5 mg tablets are pink, oval, and biconvex.
  • Splitting Eliquis tablets is generally not recommended due to potential dose variability, which can compromise safety and efficacy.
  • Eliquis tablets do not have score lines, indicating they should not be split.
  • Alternatives to splitting Eliquis include using lower-dose tablets, generic versions, patient assistance programs, alternative anticoagulants, reviewing insurance coverage, and pharmacy discount programs.

Eliquis DosageEliquis Dosage Forms and Strengths

Eliquis comes in the following dosage forms and strengths:

  • 2.5 mg Tablets: Small, yellow, round, biconvex, film-coated tablets with “893” on one side and “2.5” on the other.
  • 5 mg Tablets: Pink, oval, biconvex, film-coated tablets with “894” on one side and “5” on the other.

These tablets are formulated to be taken orally, with or without food.

Eliquis Dosing Guidelines for Various Conditions

Eliquis is prescribed for the prevention and treatment of several thromboembolic conditions. These include:

  1. Reduce the likelihood of stroke and the occurrence of systemic embolism (blockage of a blood vessel due to an embolus) in patients with nonvalvular atrial fibrillation.
  2. Prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE), in patients who have undergone hip or knee replacement surgery.
  3. Treatment of deep vein thrombosis (DVT).
  4. Treatment of pulmonary embolism (PE).
  5. Reducing the likelihood of DVT and PE recurrence.

It is important to understand its indications and appropriate dosages to ensure its effectiveness and safety.

Eliquis Dosage for Deep Vein Thrombosis (DVT)

For the treatment of DVT, the recommended dosage of Eliquis is:

  • Initial Phase: 10 mg taken orally twice daily for the first 7 days.
  • Maintenance Phase: After 7 days, the dose is reduced to 5 mg taken orally twice daily.

To reduce the risk of recurrent DVT, after the initial 6 months of treatment, the dose may be further reduced to 2.5 mg taken orally twice daily.

Eliquis Dosage for Atrial Fibrillation

For patients with nonvalvular atrial fibrillation (AF), the recommended dosage of Eliquis is:

  • Standard Dose: 5 mg taken orally twice daily.
  • Dose Adjustment: The dose is reduced to 2.5 mg in patients with at least two of the following characteristics:
  • age ? 80 years
  • body weight ? 60 kg
  • serum creatinine ? 1.5 mg/dL

Eliquis Dosage for Pulmonary Embolism (PE)

For the treatment of PE, the recommended dosage of Eliquis is:

  • Initial Phase: 10 mg taken orally twice daily for the first 7 days.
  • Maintenance Phase: After 7 days, the dose is reduced to 5 mg taken orally twice daily.

After the initial 6 months of treatment, the dosage may be further adjusted to 2.5 mg taken orally twice daily.

Eliquis Dosage for Prophylaxis of Deep Vein Thrombosis (DVT)

For the prevention of DVT following hip or knee replacement surgery, the recommended dosage of Eliquis is:

  • Dosage: 2.5 mg taken orally twice daily.
  • Initial Dose: The first dose should be taken 12 to 24 hours after the surgery.
  • Duration of Treatment: For hip replacement surgery, the treatment duration is typically 35 days. For knee replacement surgery, the treatment duration is typically 12 days.

Following the prescribed dosage regimen will ensure the effectiveness and minimize the risk of Eliquis’ adverse effects.

Can You Cut Eliquis in Half?

Eliquis’ prescribing information does not include specific instructions about splitting or cutting tablets. However, general guidance on pill splitting advises against cutting anticoagulants or blood thinner tablets.

A 1999 study published in Thrombosis and Haemostasis emphasized that cutting oral anticoagulant tablets into quarters can result in significant dose variability, compromising both the safety and efficacy of the medication. This variability can lead to either sub-therapeutic dosing or an increased risk of bleeding, making precise dosing critical for anticoagulants.

A helpful tip is to check the tablet for a score line, an indented line down the center. If present on one or both sides, it indicates that the tablet can be safely split along that line. If there’s no score line, consult a healthcare provider or pharmacist.

Risks and Concerns Related to Splitting Tablets

Risks and Concerns Related to Splitting Tablets

A systematic review of cutting tablets revealed several concerns and considerations. Key concerns include:

1. Difficulty Breaking Tablets

Patients may struggle to split tablets, particularly older adults with diminished manual dexterity or visual/cognitive impairments. This difficulty is noted in 38 articles and pertains to both hand-splitting and using a tablet splitter. Smaller, harder, and asymmetrically shaped tablets are harder to split, while score lines can make splitting easier. Note that Eliquis 5 mg is oval-shaped and doesn’t have a score line, including that of the 2.5 mg tablets that are in round shapes.

2. Loss of Mass

Splitting tablets can lead to pulverization and a meaningful loss of mass, potentially resulting in incorrect dosages and health risks for those exposed to the residue. Losses of up to 14% have been observed for tablets split into quarters, and about 2.6% for round tablets.

3. Chemical Instability

Split tablets may degrade chemically or physically due to increased friability and reactions with air, water, or light once their coatings are breached. This degradation can result in lower effective doses and more adverse effects.

A study on 11 cardiovascular medications found significant degradation in three drugs–digoxin, spironolactone, and amlodipine. More evidence is needed on the chemical stability of split medications, though known degradations suggest caution. Splitting only one tablet at a time can mitigate this concern.

4. Weight/Dose Variability

Uneven splitting can lead to significant dose variability, which is particularly problematic for drugs with a narrow therapeutic index, which refers to a small range between the minimum effective dose and the dose at which a drug becomes toxic.

Eliquis does not typically fall into the category of drugs with a narrow therapeutic index. In contrast, traditional anticoagulants such as warfarin do have a narrow therapeutic index, requiring regular blood monitoring and dose adjustments. Precise dosing is critical for these medications, as even small deviations can lead to underdosing (ineffectiveness) or overdosing (toxicity).

5. Confusion/Non-Compliance

Directions to split tablets may confuse patients or lead to non-compliance. A study involving 2,019 patients reported that 7% found tablet splitting affected their medication adherence.

Overall, splitting tablets, especially oral anticoagulants, poses several concerns. While some of these issues can be mitigated with the use of tablet splitters and proper guidance, caution is advised, particularly for medications with narrow therapeutic indices or complex release mechanisms.

Eliquis vs Warfarin

Struggling to choose between Eliquis and Warfarin for blood clot prevention? Dive into our in-depth analysis to learn the key differences and make an informed decision

Reasons Patients Consider Splitting Eliquis

Patients might consider splitting Eliquis for various reasons, though it is essential to note that splitting the tablet is generally not recommended without medical advice. Some potential reasons include:

  • Cost Savings: Splitting higher-dose tablets to achieve the same overall dosage can sometimes be more cost-effective, especially if the higher-dose tablets are priced similarly to the lower-dose ones.
  • Dose Adjustment: Some patients might split tablets to achieve a dose that is not commercially available, especially if their healthcare provider recommends a gradual increase or decrease in dosage.
  • Ease of Administration: For some patients, particularly those with swallowing difficulties, splitting a tablet might make it easier to take the medication.
  • Prescription Mistake: In cases where the wrong dosage is prescribed, patients might split the tablets as a temporary measure until they can get the correct prescription.

However, Eliquis tablets are designed to be taken whole, and splitting them can lead to uneven dosing and potentially increase the risk of adverse effects.

Alternatives to Splitting Eliquis

If splitting Eliquis tablets is not an option, patients and healthcare providers can consider several alternatives to address issues such as cost, dosage adjustments, or ease of administration. Here are some options:

  • Lower-Dose Tablets: Instead of splitting higher-dose tablets, patients can be prescribed lower-dose tablets that match the required dosage. For example, if a patient needs a 2.5 mg dose, they can use the 2.5 mg tablets directly instead of splitting a 5 mg tablet.
  • Generic Versions: The Food and Drug Administration (FDA) has authorized a generic version of Eliquis, known as apixaban. Generic drugs are regarded as equally safe and effective as their brand-name counterparts. Patients should check with their pharmacist or healthcare provider about the availability of generic options.
  • Patient Assistance Programs: Many pharmaceutical companies offer patient assistance programs that provide medications at a reduced cost or even for free to eligible patients. Patients can inquire about such programs for Eliquis.
  • Alternative Anticoagulants: Depending on the patient’s medical condition and specific needs, healthcare providers might consider alternative anticoagulant medications that are more cost-effective or easier to administer. These alternatives might include warfarin, dabigatran (Pradaxa), rivaroxaban (Xarelto), or edoxaban (Savaysa). The choice of anticoagulant should be made based on a thorough evaluation of the patient’s medical history and risk factors.
  • Insurance Coverage: Patients should review their insurance coverage and explore options for better coverage of Eliquis or alternative medications. Sometimes, switching to a different insurance plan or pharmacy benefit manager can result in lower out-of-pocket costs.
  • Pharmacy Discount Programs: Some pharmacies offer discount programs or membership plans that can reduce the cost of medications. Patients should ask their pharmacist about available discount programs for Eliquis.

It’s important for patients to discuss these alternatives with their healthcare provider to determine the best and safest option for their specific situation.

Takeaway

Cutting Eliquis tablets is generally not recommended. Eliquis is an anticoagulant, and altering the dosage by cutting the tablet can lead to an incorrect dose, potentially increasing the risk of bleeding or reducing its effectiveness.

However, if there are specific concerns or instructions from a healthcare provider, it is best to consult them directly for personalized medical advice. They can provide guidance on the proper use of the medication and any adjustments needed.

Frequently Asked Questions

How much does Eliquis cost?

The cost of Eliquis varies depending on several factors, including whether you have insurance and the specifics of your prescription coverage. The list price for a month’s supply of Eliquis (both 2.5 mg and 5 mg tablets) is approximately $594.

If you want to save on Eliquis, consider purchasing from a Canadian online pharmacy. Eliquis is available on Pharma Giant for only $157 for a month’s supply. Additionally, you can enjoy extra discounts and offers when ordering larger quantities. To save even more, use the coupon code FIRST10 for a 10% discount on your first order. Pharma Giant promises expedited delivery, with medications typically arriving within 3-5 business days.

How does Eliquis work?

Eliquis is an anticoagulant that works by inhibiting Factor Xa, an essential enzyme in the blood clotting process. By blocking Factor Xa, Eliquis reduces thrombin production, preventing blood clots from forming.

What is the recommended Eliquis dosage for the elderly?

There are no specific dosing guidelines for Eliquis specifically for elderly patients. The dosage can vary based on the patient’s health conditions and factors such as kidney function, body weight, and the presence of other medical conditions. For a more personalized and accurate dosage recommendation, it is important to consult your healthcare provider.

Can you take Eliquis once a day?

Eliquis is typically prescribed to be taken twice daily. It’s essential to follow your doctor’s instructions regarding how often to take Eliquis.

Will Eliquis dissolve a blood clot?

Eliquis does not dissolve existing blood clots. Instead, it prevents the formation of new clots and stops existing clots from growing larger.

How long can you safely take Eliquis?

The duration of Eliquis treatment depends on the individual’s medical condition and the recommendations of their healthcare provider. Some people may need to take Eliquis for a few months, while others may require long-term or even lifelong therapy. Regular check-ups with your doctor are necessary to determine the appropriate length of treatment.

What is the lowest dose of Eliquis?

The lowest dose of Eliquis is 2.5 mg, which is typically taken twice daily.

How many hours apart should you take Eliquis?

Eliquis should be taken approximately 12 hours apart to maintain a consistent level in your bloodstream. For instance, if you take your first dose at 8 AM, you should take the second dose at 8 PM.

What is the general guideline for Xarelto to Eliquis dose conversion?

Switching from Xarelto (rivaroxaban) to Eliquis should be done under the guidance of a healthcare provider. Generally, the last dose of Xarelto is taken, and the first dose of Eliquis is started at the next scheduled dose. However, specific conversion protocols should be followed based on individual patient needs and clinical judgment.

Is missing a dose of Eliquis dangerous?

Missing a dose of Eliquis can increase the risk of blood clots. If you miss a dose, take it as soon as you remember on the same day. Do not take two doses at the same time to make up for the missed dose. Continue with your regular dosing schedule.

What is the recommended Eliquis dosage in patients with renal failure?

In patients with mild-to-moderate renal impairment, no dosage adjustment is required. Typically, for patients with severe renal impairment, the dose is reduced to 2.5 mg twice daily.

Sources

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Saran, A. K., Holden, N. A., & Garrison, S. R. (2022). Concerns regarding tablet splitting: a systematic review. BJGP open, 6(3), BJGPO.2022.0001. https://doi.org/10.3399/BJGPO.2022.0001

Margiocco, M. L., Warren, J., Borgarelli, M., & Kukanich, B. (2009). Analysis of weight uniformity, content uniformity and 30-day stability in halves and quarters of routinely prescribed cardiovascular medications. Journal of veterinary cardiology : the official journal of the European Society of Veterinary Cardiology, 11(1), 31–39. https://doi.org/10.1016/j.jvc.2009.04.003

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Perry, T. (2020, March 1). Pill splitting. Therapeutics Letter – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK598480/

Gee, M., Hasson, N. K., Hahn, T., & Ryono, R. (2002). Effects of a Tablet-Splitting program in patients taking HMG-COA reductase inhibitors: analysis of clinical effects, patient satisfaction, compliance, and cost avoidance. Journal of Managed Care Pharmacy, 8(6), 453–458. https://doi.org/10.18553/jmcp.2002.8.6.453

Office of the Commissioner. (2019). FDA approves first generics of Eliquis. U.S. Food And Drug Administration. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-approves-first-generics-eliquis

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