What happens if you take Eliquis only once a day?

In this article:

• Why Eliquis is taken twice a day
• What happens if you only take Eliquis once a day?
• Considerations in certain populations
• What to do if you miss a dose of Eliquis
• Why you should never self-adjust Eliquis dosing
• How to stay on track with your Eliquis dosing schedule

In this article

• Why Eliquis is taken twice a day
• What happens if you only take Eliquis once a day?
• Considerations in certain populations
• What to do if you miss a dose of Eliquis
• Why you should never self-adjust Eliquis dosing
• How to stay on track with your Eliquis dosing schedule

Eliquis (apixaban) is a prescription medication used to prevent blood clots. It’s part of a group of drugs called Factor Xa inhibitors, which interfere with the blood clotting process. Eliquis may be used to prevent stroke and blood clots in people with nonvalvular atrial fibrillation (NV AFib or NVAF), deep vein thrombosis (DVT), or pulmonary embolism (PE). According to its prescribing information, Eliquis is intended to be taken twice daily, 12 hours apart. But some people might forget to take the medication on time or miss a dose. We’ll explain why precise Eliquis dosing is important and what to do if you’ve missed a dose. 

Why Eliquis is taken twice a day

Eliquis is a medication that needs to be taken twice a day to keep a consistent level of drug in the blood. Eliquis has a half-life of about 12 hours, which means that roughly half of the drug’s concentration in your blood remains 12 hours after a dose. 

Eliquis has a warning on its drug label about consistent dosing. If you skip or reduce a dose, Eliquis’s effect fades, raising your risk of blood clots and stroke. On the other hand, taking doses too close together raises the risk of bleeding (gum bleeding with flossing, bleeding with urination or defecation, or increased bruising). This is why it’s important to be consistent and take Eliquis at scheduled times to get the most out of your medication.

RELATED: Eliquis starter pack directions

What happens if you only take Eliquis once a day?

Twice-daily dosing keeps the levels of Eliquis steady day and night. If you only take Eliquis once a day, the level of the drug can drop to a concentration that may not protect you from blood clots. Causing “a loss of protection and increasing the chances of serious events like stroke, deep vein thrombosis, and pulmonary embolism,” says Gail Clifford, MD, physician and consultant at ARRC LED in Orlando, Florida. 

It’s especially critical for people taking Eliquis after hip or knee surgeries to follow dosing instructions. The National Blood Clot Alliance (NBCA) says people who get knee or hip replacement surgeries are at the highest risk of developing DVT two to 10 days after surgery, and this increased risk continues up to three months after surgery. Taking your medication as prescribed helps to effectively prevent blood clots and complications after surgery. 

Considerations in certain populations

There are very few exceptions to Eliquis’ twice-daily dosing schedule: 5 mg twice daily for reducing the risk of stroke or blood clots in people with AFib and to treat DVT or PE. 

Certain populations may be prescribed a lower dose, 2.5 mg, still taken twice daily, for the prevention of DVT or PE after joint replacement surgery or to reduce the risk of recurrent DVT or PE. These include adults over 80 years old, people with a body weight under 60 kg (133 lbs), and people who have kidney dysfunction (a serum creatinine of more than 1.5 mg/dL). 

Considerations when switching from Eliquis to another blood thinner

If you’re switching to another blood thinner like warfarin, your Eliquis dosage may be adjusted. Follow your prescriber’s timing instructions exactly for your last dose of Eliquis and the first dose of your new medication to avoid gaps in your blood clot protection.

Eliquis considerations before surgery

People who are preparing for surgery may be instructed to stop their anticoagulant medication 24 to 48 hours prior to their procedure. When to stop your medication may depend on the type of procedure you’re getting and the risk of bleeding expected. Your healthcare team will provide instructions on when to stop and restart your Eliquis dosing. 

What to do if you miss a dose of Eliquis

If you miss your scheduled dose of Eliquis, there are several ways to get back on schedule safely. Nieca Goldberg, MD, cardiologist and Clinical Associate Professor of Medicine at NYU Grossman School of Medicine, says, “If you realize that you forgot to take a tablet either in the morning or evening, you can take the pill a little later than usual.” In general, you should take your dose as soon as you remember and resume your next dose after 12 hours. If your next dose is coming up soon, as in four hours or sooner, then you should wait for your next dose and resume your schedule. 

“You should never double your dose of Eliquis if you missed a dose,” Dr. Goldberg says. Doubling your dose can increase your risk of serious or fatal bleeding, a side effect of overdosing on Eliquis. 

“You should call your doctor if you’ve missed multiple doses,” Dr. Clifford says. Always follow your healthcare provider’s instructions on taking Eliquis. It’s best to contact them if you’re not sure when to take your next dose of medication if you’ve missed one. “Do not restart [the medication] on your own without confirming, as gaps increase clot risk,” she adds. 

Why you should never self-adjust Eliquis dosing

Eliquis is a medication that needs to be carefully dosed and precisely taken to be effective and safe. “Unlike painkillers or antibiotics, Eliquis is not a medication that you can safely adjust on your own. Eliquis has a very narrow safety margin, too little and you risk blood clot, stroke, or pulmonary embolism, too much and you risk dangerous bleeding,” Dr. Clifford says. Always follow your healthcare professional’s instructions and contact them if you have a dosing question.

Skipping doses or taking Eliquis only once daily can make the drug less effective and increase your risk of blood clots and stroke, especially if you take Eliquis for AFib, DVT, or PE.

Taking Eliquis doses too closely together or taking two pills at once can push the blood levels of the drug too high. This increases the risk of nosebleeds, gastrointestinal bleeding, or internal bleeding in other areas that could be dangerous (e.g., the brain). 

Your dose depends on your age, kidney function, weight, and other medicines. Your healthcare provider adjusts these factors for safety. If you miss a dose, start a new medication, plan a procedure, or notice any bleeding symptoms, ask your clinician what to do next rather than adjusting the medication yourself. The safest plan is the one you confirm with your healthcare provider. 

How to stay on track with your Eliquis dosing schedule

“Consistency is key to making Eliquis safe and effective, so it’s helpful to build Eliquis into your routine,” Dr. Clifford says.

Here are some ways to stay on track with your Eliquis dosing schedule, according to experts we interviewed:

• Choose a time when you’re awake to schedule your two doses, such as 8 a.m. and 8 p.m.
• Use pill organizers that make it easy to see if you’ve taken a dose.
• Schedule phone or smartwatch alarms 12 hours apart or add recurring calendar events with notifications.
• Use medication reminder apps on your smartphone or tablet.
• Link your Eliquis doses to everyday habits like brushing teeth or eating breakfast and dinner.
• Carry one day’s supply in a labeled container so you don’t miss your scheduled dose wherever you are.
• Plan for travel with your healthcare provider’s guidance, which may involve converting dosage times to the new time zone or slowly shifting your dosing schedule.
• If you rely on a caregiver, use a shared checklist or app so both of you can track when you’ve taken your medication.

If remembering to take Eliquis twice daily is difficult, talk to your healthcare provider for other strategies that can help or an Eliquis alternative. Don’t just switch to once-daily Eliquis dosing on your own. 

Bottom line

Eliquis must be taken orally twice daily, about 12 hours apart, to provide steady protection against blood clots. Taking it only once a day or changing your schedule on your own can increase the risk of stroke and other clot-related complications. If you’re considering any change to your dose or timing, talk with your healthcare provider first, and report side effects or new symptoms right away so your care team can keep you safe and on track.