Apixaban in Pakistan – A Better Option in Renal Failure

Apixaban has recently been marketed by many pharmaceutical companies in Pakistan including Highnoon Laboratories PVT, Pharmevo PVT, and GETZ Pharmaceutical company.

Like Rivaroxaban, it is also available as an oral tablet formulation. It is available in a dosage form of 2.5 mg and 5 mg and the usual dose is one or two tablets twice daily.

For Detail Dosing in different conditions, Read this article: Apixaban – A direct-acting oral anticoagulant.

Mechanism of action of Apixaban:

Apixaban is a direct-acting oral anticoagulant that inhibits both free and clot-bound factor Xa. It inhibits clot activation and propagation by preventing the conversion of prothrombin into thrombin.

Read: Bleeding Disorders

How to administer Apixaban?

It is available as an oral tablet formulation that can be administered without regard to meals. It can also be mixed with water, applesauce, or 5% Dextrose water after crushing it and can be administered via a nasogastric tube in patients who can not swallow the tablets.

The crushed tablet is stable in water for up to four hours.

Apixaban Dose:

The dose ranges from 2.5 mg twice daily to 10 mg twice daily depending on the condition that is treated (see detail dosing here: Apixaban Dose).

  • Apixaban dose in DVT:

    • It is given in a dose of 10 mg orally twice daily for seven days followed by 5 mg twice daily.
  • Apixaban dose in DVT Prophylaxis as in patients who have undergone total knee or hip arthroplasty:

    • 2.5 mg twice daily for 10 to 14 days (maybe extended for up to 35 days).
  • Apixaban dose in Non-valvular atrial fibrillation to prevent stroke and systemic embolization:

    • 5 mg orally twice daily.
    • A dose of 2.5 mg twice daily may be advised in patients who are older than 80 years, weigh less than 60 kgs, and have a creatinine of 1.5 mg or more.

Apixaban vs Rivaroxaban:

A detailed head-to-head comparison of the two drugs can be read here: Apixaban vs rivaroxaban.

The most important difference between the two drugs is the safety of apixaban in patients with kidney disease. Rivaroxaban is not indicated in patients with a CrCl of 30 ml/minute or less. Apixaban, however, is safe in patients with end-stage renal disease including patients on hemodialysis.

Studies have favored apixaban in terms of its safety and efficacy but the differences are minor.

The effects of both drugs can be reversed with andexanate-alfa. Activated charcoal may inhibit the absorption of both drugs and in cases where andexanate alfa is not available, prothrombin concentrate can be administered.

Apixaban in Pakistan (Available Brand Names):

Apiban 2.5 mg and 5 mg (Highnoon Pharmaceuticals)

Abaxil 2.5 mg and 5 mg (Saffron Pharmaceuticals)

Zilero 2.5 mg and 5 mg (Pharmevo Pharmaceuticals)

The cost of each tablet is around PKR: 20 per tablet

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