Eliquis starter pack directions for new patients

In this article:

• What is the Eliquis starter pack?
• Eliquis starter pack directions
• How to transition to a maintenance dose of Eliquis
• Warnings and precautions about Eliquis
• Frequently asked questions about starting Eliquis

In this article

• What is the Eliquis starter pack?
• Eliquis starter pack directions
• How to transition to a maintenance dose of Eliquis
• Warnings and precautions about Eliquis
• Frequently asked questions about starting Eliquis

If your healthcare provider has told you that you need to begin taking a blood thinner and prescribed you the Eliquis starter pack, you may be understandably confused. Most of the time, when your healthcare provider gives you a new medication, you simply start taking it at the prescribed dose. So why is Eliquis different, and how can you be sure you’re taking it correctly? Here’s what to know about the Eliquis starter pack, including how to use it and what else to keep in mind during the first month of this prescription.

What is the Eliquis starter pack?

Eliquis is a blood thinner, or anticoagulant, that’s prescribed to treat blood clots like deep vein thrombosis (DVT) and pulmonary embolism (PE). It’s also approved for use in lowering the risk of stroke and blood clots in people with atrial fibrillation or who have recently had certain types of surgery. The Eliquis starter pack is a 30-day blister pack of 5 milligram (mg) apixaban tablets with unique instructions for use, particularly in the first seven days. Although the starter pack contains a one-month supply of Eliquis (apixaban), it’s designed to deliver higher doses of the drug for the first seven days and then transition you to a maintenance dose after that. 

“The starter pack is specifically designed for patients beginning treatment for DVT or PE [because] these conditions require a higher initial dose to quickly thin the blood and prevent further clot formation,” says Roshni Patel, MD, internal medicine provider at Executive Medicine of Texas. 

Dr. Patel says that many people are prescribed the Eliquis starter pack while in urgent care centers or emergency departments. Because emergency treatment for a blood clot is a stressful and often scary experience, it can be hard for people to pay close attention to their provider’s instructions on taking Eliquis after they’re discharged to go home. 

The starter pack is designed to make it easy for people to know exactly how much Eliquis to take in the initial days and weeks after a DVT or PE. 

Eliquis starter pack directions 

Your prescription will include two blister pack wallets for your first month’s supply—the first wallet is for days 1 through 14, and the second is for days 15 to 30. Within each wallet, you’ll also find color-coded rows for each day, clearly marking how many tablets to take in the morning and in the evening.

The first time you take Eliquis, you will need to locate the blister pack wallet labeled Wallet 1, which contains medicine for days 1 through 14. On the morning of day 1, take the two tablets included in the orange-colored “AM” row. That evening, you’ll take the two tablets included in the purple-colored “PM” row. You’ll repeat these steps on days 2 through 7 of treatment.

For these first seven days, you will need to take two 5 mg tablets of Eliquis twice per day, or 10 mg in the morning and 10 mg in the evening for a total of 20 mg daily. 

After the first seven days, you will only need to take one 5 mg Eliquis tablet twice per day, or 5 mg in the morning and 5 mg in the evening for a total of 10 mg daily. These tablets can be found in wallet number 1 under days 8 through 14 and will also be color-coded orange and purple. 

Once you reach day 15 of treatment, you should have finished wallet number 1 and can move on to wallet number 2. Your Eliquis starter pack dosing will be the same as it was for days 8 through 14 until you finish the full starter pack on day 30.

How to take Eliquis

You can take Eliquis with or without food. If it causes any nausea or stomach discomfort, a light meal or snack can reduce these symptoms, says Joanna Lewis, Pharm.D., founder of The Pharmacist’s Guide. But you may need to avoid grapefruit, grapefruit juice, and some herbal teas, she adds, since they can interfere with how the drug is metabolized.

RELATED: What foods to avoid while on Eliquis

Try to evenly space your morning and evening doses apart as best as you can (i.e., every 12 hours), but focus more on remembering to take the correct amounts twice daily, every day, especially for the first seven days. According to Dr. Patel, time is of the essence when treating DVT or PE, so it’s important to get this initially higher dose of Eliquis into your system.

If you miss a dose of Eliquis, take it as soon as you remember, unless it’s almost time to take your next scheduled dose. In that case, skip the missed dose and take your normally scheduled dose of Eliquis. Do not take two doses at the same time to make up for a missed dose; this increases your risk for potentially dangerous side effects.

How to transition to a maintenance dose of Eliquis

Most people will need to take Eliquis for more than 30 days to treat a blood clot or reduce their risk for recurrence of DVT or PE. Before you run out of tablets in your Eliquis starter pack, make sure you speak with your healthcare provider about your treatment plan moving forward. They will most likely prescribe you a maintenance dose to prevent any new clots from forming, says Dr. Patel. 

Depending on your overall health, you may need to take this maintenance dose for several months after a DVT or PE. After six months, many people are able to drop down to one 2.5 mg tablet twice per day (for a total of 5 mg daily). Some people stay on a low dose of Eliquis for several more months or years, and some people even continue taking the medication indefinitely, as a life-long prevention strategy for reducing their risk of blood clots and stroke. Any dose changes or treatment decisions should be made by the healthcare provider. 

Warnings and precautions about Eliquis

Eliquis has both benefits and risks. It’s an effective blood clot treatment, but there are things to keep in mind when taking it. 

• Because Eliquis prevents blood clots from forming, it comes with a risk of increased bleeding. Dr. Patel says serious bleeding only happens in a small minority of people (about 3% or less), but it’s still a good idea to know the signs: unusual bruising, prolonged bleeding from cuts, and blood in your urine or stool. Your healthcare provider may recommend you avoid contact sports or other potentially dangerous activities while taking Eliquis. 
• Some bleeding may not be obvious at first, according to Dr. Patel, so if you injure yourself or are in an accident while taking Eliquis, contact your healthcare provider right away or seek urgent medical attention.
• You should use caution when combining Eliquis with certain other medications. Joyce Oen-Hsiao, MD, associate professor of medicine at Yale School of Medicine, says other blood thinners, non-steroidal anti-inflammatory medications (NSAIDs), some antidepressants, and several antibiotics can all interact with Eliquis. Make sure you tell your healthcare provider about any other prescription or OTC medications you take.
• If you are planning to undergo any medical procedures or surgeries, tell your healthcare provider that you are on Eliquis. “Even procedures like a colonoscopy come with increased risk when taking blood thinners,” Dr. Patel says. You may need to reschedule your procedure or surgery, or temporarily stop taking Eliquis beforehand to prevent increased bleeding.

No matter what, you should never stop taking Eliquis without talking to your healthcare provider first because it could increase your risk of blood clots, according to Dr. Patel. 

Frequently asked questions about starting Eliquis

Do I need to take Eliquis with food?

No, you don’t need to take Eliquis with food. You can take Eliquis with or without food.

What happens if I miss a dose of Eliquis?

If you miss a dose of Eliquis, take it as soon as you remember, and then resume your normal dosing schedule. However, if it’s almost time for your next scheduled dose, skip the missed dose and stick to your usual schedule. Do not take two doses at the same time.

Can I split Eliquis tablets?

It’s generally not recommended to split the tablets, but Dr. Lewis says you can crush them and mix them with water, apple juice, or applesauce if you can’t swallow the tablet whole. Just be sure to take it immediately if you do this, rather than letting it sit out, since the liquid can separate from the medication.