Eliquis (apixaban) is a blood thinner or anticoagulant medication used to treat and prevent blood clots. It is prescribed in two doses – 5 mg and 2.5 mg. The higher 5 mg dose is usually prescribed initially, but the dose may be reduced to 2.5 mg in certain situations. Knowing when it’s appropriate to go from the 5 mg to the 2.5 mg dose of eliquis requires understanding the uses and dosing recommendations for the medication.
Uses of Eliquis
Eliquis is approved for the following uses:
– To reduce the risk of stroke and blood clots in people with atrial fibrillation. Atrial fibrillation is a heart condition that causes an irregular and often abnormally fast heart rate. This can lead to blood clots forming in the heart that may travel to the brain and cause a stroke.
– To treat blood clots in the veins of the legs (deep vein thrombosis) or lungs (pulmonary embolism) and reduce the risk of them occurring again.
– To prevent blood clots in people who have recently had hip or knee replacement surgery.
The recommended dose of eliquis depends on the condition being treated.
Atrial Fibrillation
The recommended dose of eliquis for people with atrial fibrillation is 5 mg taken twice daily.
Treating Blood Clots
For treating blood clots in the legs or lungs, the recommended dose is 10 mg taken twice daily for 7 days, followed by 5 mg taken twice daily.
Preventing Blood Clots After Surgery
For preventing blood clots after hip or knee replacement surgery, the recommended dose is 2.5 mg taken twice daily for up to 35 days.
When to Reduce the Dose to 2.5 mg
Given the dosing recommendations, there are two main situations when the eliquis dose may be reduced from 5 mg to 2.5 mg twice daily:
1. Transitioning from Treating a Blood Clot to Long-Term Prevention
When eliquis is used to treat an existing blood clot in the leg or lung, the starting dose is 10 mg twice a day for 7 days. After this initial treatment period, the dose is reduced to 5 mg twice a day for continued treatment and prevention of another clot.
In some cases, if the risk of another blood clot is lowered, the doctor may decide to reduce the maintenance dose further to 2.5 mg twice a day. This provides a lower intensity of anticoagulation while still providing some protective benefits against clot recurrence.
Some reasons a doctor may lower the dose for long-term prevention include:
– The blood clot was provoked by a surgery, trauma or other temporary risk factor that has now resolved.
– Testing reveals the blood clot has stabilized and/or started to dissolve with initial treatment.
– The patient has factors putting them at increased bleeding risk on 5 mg twice daily long-term, such as advanced age, low body weight, or impaired kidney function.
2. Preventing Stroke in Atrial Fibrillation When Bleeding Risk Increases
In patients taking eliquis 5 mg twice daily to prevent stroke with atrial fibrillation, the doctor may lower the dose to 2.5 mg twice daily if the patient develops increased bleeding risk.
Some reasons the dose may be lowered in this situation include:
– Starting medications that interact with eliquis to increase bleeding. Examples include antiplatelet agents like aspirin or NSAIDs.
– Development of kidney dysfunction, which can impair elimination of eliquis.
– Significant unexplained drop in hemoglobin and/or hematocrit, which may signal occult bleeding.
– Planning medical procedures with high bleeding risk, such as certain surgeries, biopsies, or spinal/epidural anesthesia. The lower eliquis dose may be used temporarily before and after the procedure when the regular 5 mg dose would need to be held.
– Occurrence of bleeding events or meaningful drop in platelet count on the 5 mg dose.
– Assessment that bleeding risk now outweighs stroke prevention benefit at the 5 mg dose for that patient.
Other Factors in Dose Reduction
Some other considerations when deciding on reducing the eliquis dose from 5 mg to 2.5 mg twice daily:
– Renal function – Kidney impairment can increase eliquis blood levels, increasing bleeding risk. Monitoring renal function and reducing the dose if it declines to eGFR When Not to Reduce the Dose
In general, the 5 mg twice daily dose of eliquis should be maintained when:
– Treating a blood clot in a leg vein or lung artery, during the initial treatment period (first 7 days).
– Preventing post-surgery blood clots following hip or knee replacement, for the recommended treatment duration.
– Preventing stroke in atrial fibrillation, unless bleeding risk factors emerge that outweigh stroke prevention benefit of the 5 mg dose for that patient.
The 5 mg dose should also not be lowered to 2.5 mg in patients with moderate-to-severe kidney dysfunction (eGFR 15-29 ml/min) since anticoagulation intensity is already reduced at 5 mg in this population.
Monitoring on the Reduced Dose
If the eliquis dose is lowered to 2.5 mg twice daily, additional monitoring is recommended. This includes:
– Periodic renal function testing, since the 2.5 mg dose depends on adequate kidney elimination. If eGFR declines to Transitioning Doses
Some key points on transitioning between the 5 mg and 2.5 mg doses of eliquis:
– There is no need to bridge when switching doses. The immediate switch between 5 mg and 2.5 mg taken twice daily is safe.
– When switching from the initial 10 mg twice daily treatment dose down to 5 mg or 2.5 mg twice daily for continued therapy, the lower maintenance dose should start the day after finishing the 10 mg treatment course.
– If switching from 2.5 mg to 5 mg twice daily, the higher dose can be started immediately.
– Renal function should be assessed whenever increasing the dose, to ensure eGFR is adequate (> 30 ml/min) for the 5 mg dose.
Duration of Therapy
How long to continue the 2.5 mg or 5 mg dose of eliquis depends on the clinical indication:
Atrial fibrillation:
– Long-term or lifelong anticoagulation is usually recommended, at either the 5 mg or 2.5 mg twice daily dose based on assessed stroke and bleeding risks.
Treating blood clots:
– After initial treatment period, long-term prevention dose (2.5 or 5 mg twice daily) is continued for at least 3 months. Extended treatment may be appropriate in some situations.
Preventing post-surgery blood clots:
– Typically continue for 14-35 days following hip/knee replacement, depending on surgery type, though some patients may need extended prevention.
Key Takeaways
– The eliquis dose may be reduced from 5 mg to 2.5 mg twice daily when transitioning to long-term treatment after an initial clot, or if bleeding risk increases on the higher dose.
– Do not reduce dose when initially treating clots or preventing post-surgery clots.
– More monitoring is advised when using the 2.5 mg dose long-term.
– Kidney function impacts appropriate dosing. eGFR should be ≥15 ml/min on 2.5 mg dose and ≥30 ml/min on 5 mg.
– Discuss risks vs. benefits of stroke prevention vs. bleeding risks with your doctor to determine appropriate long-term dose.
Conclusion
The decision between long-term treatment with eliquis 5 mg versus 2.5 mg twice daily requires assessing an individual’s stroke risk profile and bleeding risks. Lowering the dose to 2.5 mg may be appropriate when bleeding risk is elevated, such as due to drug interactions, reduced kidney function, older age, low body weight, or previous bleeding events on 5 mg. However, the dose reduction comes with some loss of efficacy for stroke prevention. Careful monitoring and follow-up is recommended when using the 2.5 mg long-term dose. Discuss your specific medical history and circumstances with your healthcare provider to determine when it may be appropriate to reduce your eliquis dose to 2.5 mg twice a day for optimal safety and efficacy.