Has your doctor prescribed a special medication to prevent blood clots for someone in your family, or perhaps you? It could be a drug called Apixaban. This is a very important drug that reduces the risk of stroke, which can often be caused by certain changes in the heart rhythm (Atrial Fibrillation), prevents the formation of blood clots in the body, and dissolves blood clots that have formed. But there are a few things we need to be very careful about when using this medication. So, today we will talk about what you need to know about this Apixaban.
Simply put, what is Apixaban?
Apixaban is a blood thinner. It is often found in our country under the brand name Eliquis. Its main function is to prevent the formation of unwanted blood clots in our blood vessels.
Think of our blood vessels as pipes that carry water. Just as a clog in these pipes can obstruct the flow of water, a blood clot can obstruct the flow of blood. If this blood clot gets stuck in a vein leading to the brain, it can cause a stroke. If it gets stuck in a vein leading to the lungs, it can also be very serious. So what Apixaban does is reduce the risk of developing dangerous blood clots like these.
Things you need to tell your doctor before starting this medication
Before your doctor prescribes Apixaban, they will need to know your complete medical history. Therefore, be sure to tell your doctor if you have any of the following conditions:
- Bleeding problems: If you have frequent nosebleeds, bleeding gums, or if even a small cut takes a long time to stop bleeding.
- Antiphospholipid Syndrome (APS): This is a condition that increases the risk of blood clots.
- If you are about to undergo surgery, an epidural, or a spinal tap: It is essential to be aware of this medication as the risk of bleeding is higher during these procedures.
- Kidney disease: If your kidneys are not functioning properly, your medication dosage may need to be adjusted.
- Liver disease: If you have any liver disease.
- If you have a prosthetic heart valve.
- If you have had an allergic reaction to apixaban or any other medicine, food, or dye.
- If you are pregnant or expecting a child.
- If you are a mother who is breastfeeding.
Based on this information, the doctor will decide whether this medication is right for you and, if so, what dosage to give.
How exactly should I use this medicine?
This is very simple, but very important.
1. Take as prescribed by your doctor: Take the dose and time your doctor tells you to take. Usually, they tell you to take it twice a day.
2. Take it at the same time every day: Try to take your medicine at the same time every day, as much as possible. If you set a time like 8am and 8pm, you won't forget.
3. Before or after meals: This medicine can be taken before or after meals. However, if you experience stomach upset, it is best to take it with food.
4. Don't skip medication: This is the most important thing. If you miss a dose of medication, your risk of blood clots can suddenly increase.
Do not stop taking this medication suddenly for any reason without your doctor's advice. Doing so greatly increases the risk of having a stroke or developing a dangerous blood clot.
If given to young children:
If this medicine is given to young children, the doctor will determine the dosage based on the child's weight. As the child grows and gains weight, the dosage may need to be changed. Therefore, it is important to stay in constant contact with the doctor.
What to do if you take too much medicine?
If you think you have taken too much medicine, immediately call the National Poisons Information Centre at the Colombo National Hospital . Or go to the Emergency Treatment Unit (ETU) of the nearest hospital.
What to do if you miss a dose of medication?
If you forget to take a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take your next dose at the scheduled time. Never take two doses at once, that is, a double dose.
If a child vomits within 30 minutes of taking the medicine, give the same dose again. If the child vomits after 30 minutes, do not give another dose. Give the normal dose at the next scheduled time. If the child continues to vomit, call the doctor.
What other medications may interact with Apixaban?
This is a very important part. Apixaban is a drug that can interact with other medications. Therefore, you should tell your doctor about all other medications you are taking (including vitamins, herbal remedies).
The table below lists some of the main medications that may interact with Apixaban.
| Type of medicine | Description and examples |
|---|---|
| Medicines that should never be taken | Medications like Defibrotide, Factor X, and Mifepristone. Your doctor will be aware of these. |
| Painkillers | Aspirin and NSAIDs (e.g., Ibuprofen, Naproxen, Diclofenac). These increase the risk of bleeding. |
| Other blood thinners | You should be very careful when using it together with other blood thinners such as Clopidogrel, Warfarin, Heparin, and Enoxaparin. |
| Medication for depression | Medications called SSRIs (e.g. Sertraline, Fluoxetine) and SNRIs (e.g. Venlafaxine, Duloxetine). |
| Other medications | Medications such as antifungals (e.g. Ketoconazole), epilepsy medications (e.g. Carbamazepine, Phenytoin), Rifampin, and Ritonavir can also affect this. |
This list is not complete, so if you are starting a new medication, ask your doctor if it is okay to take it with Apixaban.
Things you should be careful about when taking medication
You will need to make some small changes to your lifestyle while taking Apixaban. These are for your safety.
- Stay away from things that can cause injuries: Since it thins the blood, even a small cut can cause a lot of bleeding. Therefore, be as careful as possible about sports that involve loud noises and activities that may cause falls.
- Be careful when using sharp tools: Be very careful when cutting vegetables and shaving. Use an electric razor if possible.
- Be careful when brushing your teeth: Don't brush your teeth vigorously. Use a soft toothbrush. Be careful not to injure your gums when flossing.
- Inform before any surgery: Even before doing something minor like a tooth extraction, you should tell the doctor that you are taking Apixaban.
- Wear a medical ID: Carrying a medical ID bracelet or card that says you are taking Apixaban can be very important in an emergency.
What are the possible side effects of the medication?
As with any medication, Apixaban has the potential to cause side effects. Some of these are serious, some are not so serious. The important thing is to be aware of these symptoms and take immediate action if you notice any serious symptoms.
| Type of side effect | Features to watch out for |
|---|---|
| Symptoms that should be reported to your doctor immediately | |
| Symptoms of bleeding |
|
| Bleeding in the brain | Severe headache, stiff neck, confusion, vision changes, numbness or weakness in the face, arm, or leg, difficulty speaking. |
| Allergic reactions | Skin rash, itching, swelling of the face, lips or tongue, difficulty breathing. |
| For women | Excessive bleeding during menstruation. |
| Usually not serious (but tell your doctor if it persists) | |
| Other | Headache, vomiting. |
How should you store the medicine?
- Keep out of reach of children and pets.
- Store at room temperature (between 20-25 degrees Celsius). Protect from excessive heat and moisture.
- Do not use expired medicine.
When disposing of expired or no longer needed medications, check the instructions on the medication package to see if they are safe to throw away. If you are unsure, ask your doctor. If you are throwing them away, take the pills out of the container, mix them with something like used tea leaves or coffee grounds, put them in a bag, seal it, and throw them away.
Take-Home Message
- Never stop taking Apixaban without your doctor's advice. Doing so greatly increases your risk of stroke or blood clots.
- Take the prescribed dose at the same time every day. Do not skip a dose.
- Inform your doctor about all other medications you are taking (including painkillers and vitamins).
- If you notice any unusual bleeding (black stools, heavy bruising, bleeding that won't stop), seek medical advice immediately.
- Avoid activities that could cause injury as much as possible.
- It is essential to inform the relevant doctor that you are taking Apixaban before any surgery or dental extraction.
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