What Is Eliquis?
Eliquis (apixaban) is a direct oral anticoagulant that belongs to the class of Factor Xa inhibitors. It works by blocking the activity of Factor Xa, an enzyme essential for converting prothrombin into thrombin – the key step in clot formation. By preventing this conversion, Eliquis reduces the risk of blood clots without requiring the intense monitoring needed for warfarin.
The active ingredient is apixaban; it was developed by Pfizer and is manufactured under licence by other pharmaceutical companies worldwide. In the United Kingdom, Eliquis is available as a prescription-only medicine (POM) and must be prescribed by a registered clinician.
Clinically, Eliquis is approved for several indications: prevention of stroke in atrial fibrillation, treatment and secondary prevention of deep‑vein thrombosis (DVT) and pulmonary embolism (PE), and prophylaxis of DVT/PE following hip or knee replacement surgery. Its efficacy has been demonstrated in large trials such as ARISTOTLE and AMPLIFY.
Forms and Dosages
Eliquis is sold exclusively in oral tablet form in the UK, with a standard strength of 5 mg per tablet. The tablets are uncoated, scored for easy splitting (though this should only be done under medical advice), and come in packs of 56 or 112 tablets.
| Pack Size | Number of Tablets | Price (GBP) |
|---|---|---|
| Single Dose Pack | 5 mg × 56 | £119.00 |
| Extended Pack | 5 mg × 112 | £216.00 |
| Large Bulk | 5 mg × 168 | £323.00 |
The tablets are taken orally, twice daily (morning and evening). Because the drug is time‑dependent, it is crucial to maintain a consistent dosing interval of approximately 12 hours.
Who Can Take It?
Eliquis is suitable for adults of any gender. The typical age range is from 18 years upwards; however, prescribing in children and adolescents requires specialist assessment and is not routine.
Special caution is advised in the elderly (≥75 years) due to increased bleeding risk, as well as in patients with hepatic impairment or severe renal dysfunction (creatinine clearance <30 mL/min). Pregnancy and breastfeeding are contraindicated; if a woman becomes pregnant while on Eliquis, she should contact her clinician immediately.
Patients with a history of haemorrhagic stroke or active major bleeding should avoid the drug unless under strict medical supervision.
How to Take Eliquis
- With food: Take each tablet with a meal or snack to minimise gastrointestinal upset. The presence of food does not alter efficacy but can improve tolerability.
- Timing: Consistency is key; aim for the same times each day, roughly 12 hours apart.
- Duration: Treatment length varies by indication: 6–12 months for acute DVT/PE, lifelong for atrial fibrillation, and up to 30 days post‑orthopaedic surgery.
- Missed dose: If you miss a dose, take it as soon as remembered. Do not double the next dose; simply resume your normal schedule.
How It Works
Think of clotting as a chain reaction: Factor Xa is the catalyst that turns prothrombin into thrombin, which then forms fibrin strands to seal bleeding sites. Eliquis acts like a precise lock on this catalyst, preventing the reaction from proceeding. The result is a reduced tendency for clots to form while preserving normal haemostasis.
Contraindications
Eliquis should not be taken by:
- Individuals with active major bleeding or a history of haemorrhagic stroke.
- Patients on concomitant strong CYP3A4 inhibitors (e.g., ketoconazole) or inducers (e.g., rifampicin).
- Those with severe hepatic impairment (Child‑Pugh C).
- Pregnant women and nursing mothers.
Interactions
Drug–drug:
- NSAIDs, aspirin or other antiplatelet agents increase bleeding risk.
- CYP3A4 inhibitors (ketoconazole, clarithromycin) raise apixaban levels.
- CYP3A4 inducers (rifampicin, carbamazepine) lower efficacy.
Drug–food:
- Grapefruit juice may increase apixaban concentration; avoid concurrent consumption.
- Alcohol should be limited as it can exacerbate bleeding tendencies.
Side Effects
| Common (≥5 %) | Less Common (1–5 %) | Serious (<1 %) |
|---|---|---|
| Bleeding gums, nosebleeds | Abdominal pain, nausea | Major haemorrhage, intracranial bleed |
| Headache, dizziness | Rash, pruritus | Hypotension, organ dysfunction |
Any sign of excessive bleeding – persistent nosebleeds, blood in urine or stools, or sudden severe headache – warrants immediate medical attention.
Overdose Risks
An accidental intake exceeding the prescribed dose may lead to uncontrolled bleeding. Symptoms include haemorrhage from mucous membranes, bruising, and dizziness. In such cases, call emergency services (999) immediately and seek urgent care. Antidotes are not available; management focuses on supportive measures and reversal agents like activated charcoal if ingestion was recent.
Price and Availability
The cost of Eliquis varies with pack size and pharmacy pricing. Bulk purchases often offer better value per tablet. In the UK, it is dispensed through licensed pharmacies, both physical outlets and reputable online suppliers such as Medicade. Prices are regulated by the NHS in certain circumstances, but most consumers pay privately.
Buying Drugs without Prescription (UK)
Eliquis is a prescription‑only medicine; it cannot be legally purchased over the counter. However, you can order it online through authorised platforms that require a valid prescription. For example, Medicade accepts prescriptions and delivers within the UK.
| City | Estimated Delivery Time |
|---|---|
| Liverpool | 2–3 working days |
| Manchester | 2–3 working days |
| Birmingham | 3–4 working days |
| London | 1–2 working days |
Alternatives
Pharmaceutical: Rivaroxaban (Xarelto generic) and dabigatran (Pradaxa) are other direct oral anticoagulants with similar indications. They differ in dosing frequency and renal clearance profiles.
Natural: Fish oil supplements, vitamin K antagonists like warfarin, or herbal remedies such as garlic may influence clotting but lack the robust evidence base and predictability of apixaban. Their use should be discussed with a clinician to avoid interactions.
Precautions
Store at room temperature, away from moisture and direct sunlight. Avoid exposing tablets to heat or dampness. Prior to starting therapy, inform your doctor about any liver disease, kidney impairment, ongoing anticoagulants, or use of herbal supplements. Dietary restrictions are minimal but limit grapefruit juice intake.
FAQ
Q: Can I take Eliquis with my regular painkillers?
A: Non‑steroidal anti‑inflammatories (NSAIDs) should be used cautiously as they increase bleeding risk. Discuss alternatives with your clinician.
Q: Is it safe during pregnancy?
A: No, Eliquis is contraindicated in pregnancy and breastfeeding due to teratogenicity and haemorrhagic risks.
Q: What if I miss a dose?
A: Take the missed dose as soon as remembered; do not double up. If it’s almost time for the next dose, skip the missed one and resume your regular schedule.
Reviewed by a Medical Professional
Isabel D White, MD – Cardiology & Haematology Specialist
