<p><strong>Recommended Dose</strong>: The recommended dose of Apixaban for most patients is 5 mg taken orally twice daily.<br />
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<strong>Dosage Adjustments</strong>: The recommended dose of Apixaban is 2.5 mg twice daily in patients with any 2 of the following characteristics: age &ge;80 years, body weight &le;60 kg, serum creatinine &ge;1.5mg/dl.<br />
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<strong>CYP3A4 and P-gp inhibitors</strong>: When Apixaban is coadministered with drugs that are strong dual inhibitors of cytochrome P450 3A4 (CYP3A4) and P-glycoprotein (P-gp) (e.g. ketoconazole, itraconazole, ritonavir, clarithromycin) the recommended dose is 2.5 mg twice daily.<br />
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<strong>Missed Dose</strong>: If a dose of Apixaban is 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. The dose should not be doubled to make up for a missed dose.<br />
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<strong>Discontinuation for Surgery and Other Interventions</strong>: Apixaban should be discontinued at least 48 hours prior to elective surgery or invasive procedures with a moderate or high risk of unacceptable or clinically significant bleeding. Apixaban should be discontinued at least 24 hours prior to elective surgery or invasive procedures with a low risk of bleeding or where the bleeding would be non-critical in location and easily controlled.<br />
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<strong>Switching from or to Apixaban</strong>: Switching from warfarin to Apixaban: Warfarin should be discontinued and Apixaban started when the international normalized ratio (INR) is below 2.0.<br />
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<strong>Switching from Apixaban to warfarin</strong>: Apixaban affects INR, so that INR measurements during co-administration with warfarin may not be useful for determining the appropriate dose of warfarin. 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, discontinuing the parenteral anticoagulant when INR reaches an acceptable range.<br />
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<strong>Switching between Apixaban and anticoagulants other than warfarin</strong>: Discontinue one being taken and begin the other at the next scheduled dose.</p>