Is it better to take 2.5 or 5 mg of Eliquis?

In this article:

• Eliquis dosing options

In this article

• Eliquis dosing options

Eliquis (apixaban) is a brand-name prescription drug approved by the U.S. Food and Drug Administration (FDA) to prevent or treat blood clots and strokes. The blood-thinning medication—which falls under the class of anticoagulants called factor Xa inhibitors—works by blocking the blood-clotting factor Xa, making your blood less likely to form clots.

Eliquis is available as tablets in two dosages: 2.5 and 5 milligrams (mg) twice daily. The dosage you’re prescribed heavily depends on what you’re being treated for and your overall health. 

Eliquis dosing options

There are two separate Eliquis dosing options: 2.5 mg and 5 mg BID (twice daily). The chosen dosage depends on several factors. “The dosing of Eliquis is determined by the condition being treated,” says Kenneth Perry, MD, a board-certified emergency medicine physician in Charleston, South Carolina. “These medications (a family of medications called ‘DOACS’ or direct oral anticoagulants) are used for patients who need to take a blood thinner. Diseases such as atrial fibrillation (an irregular heartbeat) or DVT (deep vein thrombosis or a blood clot in a vein) require a patient to be on a blood thinner.”

Other factors that may be considered for Eliquis dosage include:

• Age
• Body weight
• Other medications being taken (for risk of potential drug interactions)
• Kidney function 

Eliquis 2.5 mg

Eliquis 2.5 mg taken twice daily is the lower dosage of the drug that is prescribed for the following medical conditions or situations:

• Prevention of deep vein thrombosis (DVT) post-hip replacement surgery (first dose given 12 to 24 hours after procedure) for 35 days
• Prevention of DVT post-knee replacement surgery (first dose given 12 to 24 hours after procedure) for 12 days
• Lowering the risk of the recurrence of DVT or pulmonary embolism 

According to Elizabeth Rubin Ribak, MD, a board-certified emergency medicine physician and clinical advisor at Embers Recovery in Phoenix, Arizona, a 2.5-mg dose is also prescribed if the person has two or more of the following criteria:

• Is an older adult aged 80 or up
• Has a body weight of less than or equal to 60 kilograms (kg) or about 132 pounds
• Has a serum creatinine level of more than 1.5 mg/ dL 
• Has kidney impairment
• Needs a milder anticoagulant
• Needs long-term prevention after initial treatment of blood-clotting disorder
• Has an increased bleeding risk
• Is at least six months post-treatment of deep vein thrombosis (DVT) or pulmonary embolism

Joyce Oen-Hsiao, MD, FACC, a board-certified cardiologist and associate professor of medicine (cardiovascular medicine) at Yale School of Medicine in New Haven, Connecticut, says that if a person has chronic kidney disease (CKD), the lower dose of 2.5 mg may be more suitable than the higher dose of apixaban. “If a patient is put on 2.5 mg dosing when they do not have the above requirements, then they risk not being anti-coagulated enough, and they might form a clot even while taking the medication.”

Like any medication, there’s a risk of side effects. The most common side effects of this blood-thinning medication are:

• Nausea
• Anemia
• Bleeding (from nosebleeds or minor cuts and scrapes)
• Easy bruising

More serious symptoms include the following:

• Severe headaches
• Dizziness
• Joint pain
• Muscle weakness
• Fainting
• Red or black tarry stool
• Severe, unusual, or uncontrollable bleeding
• Severe allergic reactions (anaphylaxis)

If you experience any of these severe side effects from taking Eliquis, please seek immediate medical attention by visiting your nearest emergency room or dialing your local emergency number. 

Eliquis 5 mg

“Most adults are prescribed 5 mg twice daily for conditions like atrial fibrillation to prevent stroke or for the treatment of deep vein thrombosis and pulmonary embolism,” Dr. Ribak explains. This is typically the standard dosage unless certain groups meet two or more of the above criteria, in which case 2.5 mg may be a safer option. 

For most conditions requiring Eliquis treatment, the initial starting dose is 10 mg twice daily for the first week, Dr. Perry explains. “ The dose can then be cut in half in patients with DVT/PE for 6 months. For patients with atrial fibrillation, the dosing is 5 mg twice a day, but this can be reduced to 2.5 mg in certain patients for chronic management.”

Dr. Ribak says the potential side effects are identical for both Eliquis dosages, though 5 mg carries a slightly higher risk of major bleeding. Minor and common side effects should resolve within a few days to a couple of weeks after starting treatment—but if they persist or worsen over time, please reach out to your healthcare provider. 

The cost of Eliquis 5 mg varies depending on insurance coverage and your preferred pharmacy, but the average retail price is $811 for 60, 5 mg tablets. 

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Bottom line

When it comes to comparing Eliquis 2.5 vs. 5 mg for lowering the risk of stroke and blood clots, neither dose is “better” than the other. However, what you’re prescribed depends on what conditions you’re being treated for, your age, body weight, and other medications you’re taking. 

In some cases, Eliquis dosages may be adjusted. “We can adjust between 2.5 mg and 5 mg at any time based on the patient’s kidney function, age, risk of bleeding, and their overall response to treatment,” Dr. Ribak says. “Importantly, these changes should only be made by a medical professional or under medical supervision.”

If you have any questions or concerns about Eliquis dosing, please contact your pharmacist or healthcare provider directly.