Eliquis dose reduction: When and why it’s recommended

In this article:

• Why an Eliquis dose reduction may be recommended
• When a reduced dose may be recommended
• For AFib
• When taken with certain medications
• For DVT or PE
• What is a reduced dose of Eliquis?
• Risks of incorrect Eliquis dosing

In this article

• Why an Eliquis dose reduction may be recommended
• When a reduced dose may be recommended
• For AFib
• When taken with certain medications
• For DVT or PE
• What is a reduced dose of Eliquis?
• Risks of incorrect Eliquis dosing

Eliquis is the brand name for apixaban, a type of direct-acting oral anticoagulant (DOAC) that’s prescribed to treat and prevent the incidence of blood clots. Eliquis is a type of factor Xa inhibitor and is approved by the Food and Drug Administration to reduce the risk of systemic embolism and support stroke prevention in adults with atrial fibrillation (AFib). It’s also indicated to treat and reduce deep vein thrombosis (DVT) or pulmonary embolism (PE) and prevent DVT and PE after hip or knee replacement surgery.

Sometimes your dose of apixaban (Eliquis) needs to be decreased from the standard recommended dose of Eliquis, which ranges from 2.5 mg to 10 mg twice daily. Here, we’ll go over everything you need to know about Eliquis dose reduction, including when it might be recommended, by how much your dose may be reduced, and the criteria healthcare providers use when they recommend an Eliquis dose reduction.

Why an Eliquis dose reduction may be recommended

A dose reduction for Eliquis is usually only recommended in certain limited circumstances and among people with certain risk factors. Most commonly, Eliquis reduction is recommended when a patient’s kidneys are having trouble processing the medication. These patients also often have other health vulnerabilities, too. 

“Patients who are elderly or have advanced kidney disease or low body weight may need a lower dose,” explains Aeshita Dwivedi, MD, cardiologist at Northwell’s Lenox Hill Hospital. In some cases, other considerations may be taken into account. “If you are at higher risk for bleeding from gastrointestinal bleeding or high fall risk, it may warrant a reduced dose on a case-by-case basis,” Dr. Dwivedi shares.

According to Mohamed Dahodwala, MD, cardiologist at Saint Anthony Hospital in Chicago, sometimes doses of Eliquis may be reduced to prevent long-term effects of the medication. He says that some studies have shown benefits, such as a lower risk of bleeding, with smaller doses long-term.

For instance, a study from the University of Michigan found that reduced-dose apixaban (Eliquis) or Xarelto (rivaroxaban)—another oral anticoagulant—could potentially reduce a person’s risk of major bleeding events or hospital visits. This was studied in patients who were treated for a blood clot and were taking blood thinners to prevent them from returning. However, reducing doses of blood thinners for long-term benefits is not an official recommendation, and the researchers note that these clinical outcomes need to be confirmed with more robust, randomized clinical trials.

Eliquis dose reduction criteria: When a reduced dose may be recommended

There are certain criteria used by healthcare providers when considering Eliquis dose adjustment. Here’s what to know.

People taking Eliquis for nonvalvular atrial fibrillation (AFib)

Sometimes Eliquis reduction is recommended for atrial fibrillation patients who are taking Eliquis to reduce the risk of stroke and embolism. In these cases, “there are specific criteria why someone would need a reduced dose of Eliquis,” explains Joyce Oen-Hsiao, MD, associate professor of medicine at Yale School of Medicine.

According to Dr. Oen-Hsiao, patients must have at least two out of the following criteria to warrant a dose reduction:

• Are 80 years old or older
• Have a body weight less than or equal to 60 kg (132 pounds)
• Have a serum creatinine baseline level greater than or equal to 1.5 mg/dl, indicating renal impairment or kidney disease

When Eliquis is taken with certain medications

According to DailyMed, there are some medications that may require you to reduce your Eliquis dose. For example, coadministration of Eliquis with combined P-glycoprotein (P-gp) and strong cytochrome P450 3A4 (CYP3A4) inhibitors requires you to reduce your daily dose of Eliquis by 50%. That means, if you previously took 5mg twice a day, you’d reduce it to 2.5mg twice a day. People who take Eliquis 2.5 mg twice daily should not take these interacting medicines at all. 

Examples of combined P-glycoprotein (P-gp) and strong cytochrome P450 3A4 (CYP3A4) inhibitors are ketoconazole, itraconazole, and ritonavir. However, the manufacturer of Eliquis, Bristol Myers Squibb, says that the antibiotic clarithromycin is safe to take with Eliquis and doesn’t warrant an Eliquis dose reduction.

During the course of treatment for DVT or PE

When you’re being treated for venous thromboembolism, which includes deep vein thrombosis (DVT) or pulmonary embolism (PE), your Eliquis dose will be reduced over the course of treatment. According to Bristol Myers Squibb, people with venous thromboembolism will be prescribed 10 mg of Eliquis for their first seven days of treatment. After this, they will transition to 5 mg, taken twice daily.

What is a reduced dose of Eliquis?

Standard doses of Eliquis are between 2.5 mg and 10 mg, as a twice-daily dose. Dosing depends on which condition is being treated:

• For stroke prevention or embolism reduction in people with nonvalvular atrial fibrillation: 5 mg twice daily.
• For the treatment of DVT or PE: 10 mg twice daily for seven days; after this, 5 mg twice daily
• For the risk reduction of recurrent DVT/PE after initial therapy: 2.5 mg twice daily, after at least six months of initial treatment
• For the prevention of DVT or PE following hip replacement surgery: 2.5 mg twice daily for 35 days
• For the prevention of DVT or PE following knee replacement surgery: 2.5 mg twice daily for 12 days

An Eliquis dose reduction depends on what your original treatment dose was, as well as why your dose needs to be reduced. Most commonly, Eliquis dose reduction is from 5mg to 2.5mg, twice daily. Whatever the case, when your dose is reduced, you will still take your medication twice per day, at the new dose prescribed by your healthcare provider.

Risks of incorrect Eliquis dosing

You should never adjust your dose of Eliquis without your healthcare provider’s guidance. That’s because taking the wrong dosage for your body can result in safety risks. People taking DOACs like Eliquis often have serious underlying conditions that the medication is being used to treat and prevent. Incorrect dosing can cause serious harm and increase your risk of thromboembolic events, major bleeding events, and other cardiovascular events.

“If you take too much Eliquis, the risk of bleeding events increases,” Dr. Oen-Hsiao says. “However, if you take too little Eliquis, the risk of forming blood clots increases.” According to Dr. Dahodwala, other consequences of incorrect dosing include ineffectiveness in preventing strokes or leg vein clots.

Bottom line

Most of the time, your Eliquis dose will not need to be reduced. But if your healthcare provider recommends a dose reduction, there is a medical reason for this, and they are basing their recommendation on clinical guidelines and individual health risk factors, such as weight, age, kidney disease, creatinine clearance or renal function, and drug interactions.

If you have further questions about taking Eliquis, Eliquis dose reduction, or the effects of apixaban or anticoagulant therapy in general, don’t hesitate to seek medical advice from your healthcare provider or pharmacist. You should also reach out to your provider if you have questions about Eliquis alternatives like Xarelto, warfarin, or heparin. Only a licensed healthcare provider can advise you on important decisions about your health and medication use.