Apixaban is used to lower the risk of stroke caused by a blood clot in people with a heart rhythm disorder called atrial fibrillation.

Apixaban is also used after hip or knee replacement surgery to prevent a type of blood clot called deep vein thrombosis (DVT), which can lead to blood clots in the lungs (pulmonary embolism).

Apixaban is also used to treat DVT or pulmonary embolism (PE), and to lower your risk of having a repeat DVT or PE.

Apixaban may also be used for purposes not listed in this medication guide.

Apixaban increases your risk of severe or fatal bleeding, especially if you take certain medicines at the same time (including some over-the-counter medicines). Tell your doctor about all medicines you have recently used.

Call your doctor at once if you have signs of bleeding such as: easy bruising, unusual bleeding, unexpected pain or swelling, feeling very weak or dizzy, bleeding gums, nosebleeds, heavy menstrual bleeding, blood in your urine or stools, coughing up blood or vomit that looks like coffee grounds, or any bleeding that will not stop.

Apixaban can cause a very serious blood clot around your spinal cord that can lead to long-term or permanent paralysis. This type of blood clot can occur during a spinal tap or spinal anesthesia (epidural), especially if you have a genetic spinal defect, if you use a spinal catheter, if you've had spinal surgery or repeated spinal taps, or if you use other drugs that can affect blood clotting.

Get emergency medical help if you have symptoms of a spinal cord blood clot such as tingling, numbness, or muscle weakness especially in your legs and feet.

Do not stop taking apixaban unless your doctor tells you to. Stopping suddenly can increase your risk of blood clot or stroke.

Apixaban comes as a tablet to take by mouth. It is usually taken with or without food twice a day. When apixaban is taken to prevent DVT and PE after hip or knee replacement surgery, the first dose should be taken at least 12 to 24 hours after surgery. Apixaban is usually taken for 35 days after a hip replacement surgery and for 12 days after knee replacement surgery. Take apixaban at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take apixaban exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

If you are unable to swallow the tablets, you can crush them and mix with water, apple juice, or applesauce. Swallow the mixture right after you prepare it. Apixaban can also be given in certain types of feeding tubes. Ask your doctor if you should take this medication in your feeding tube. Follow your doctor's directions carefully.

Continue to take apixaban even if you feel well. Do not stop taking apixaban without talking to your doctor. If you stop taking apixaban, your risk of a blood clot may increase.

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

You may take apixaban with or without food.

If you cannot swallow a tablet whole, crush it and mix with water, apple juice, or applesauce. Swallow the mixture right away without chewing.

A crushed tablet mixture may also be given through a nasogastric (NG) feeding tube. Read and carefully follow any Instructions for Use provided with your medicine.

Apixaban can make it easier for you to bleed, even from a minor injury. Seek medical attention if you have bleeding that will not stop.

Tell your doctor if you have a planned surgery or dental work. You may need to stop taking apixaban for a short time.

Do not stop taking apixaban unless your doctor tells you to.

If you stop taking apixaban for any reason, your doctor may prescribe another medicine to prevent blood clots.

Store at room temperature away from moisture and heat.

You should not take apixaban if you are allergic to it, or if you have active bleeding from a surgery, injury, or other cause.

Apixaban may cause you to bleed more easily, especially if you have a bleeding disorder that is inherited or caused by disease.

Tell your doctor if you have an artificial heart valve, or if you have ever had:

• bleeding problems;

• antiphospholipid syndrome, especially if you have a triple positive antibody test; or

• liver or kidney disease.

Apixaban can cause a very serious blood clot around your spinal cord if you undergo a spinal tap or receive spinal anesthesia (epidural). This type of blood clot could cause long-term paralysis, and may be more likely to occur if:

• you have a spinal catheter in place or if a catheter has been recently removed;

• you have a history of spinal surgery or repeated spinal taps;

• you have recently had a spinal tap or epidural anesthesia;

• you take aspirin or other NSAIDs (nonsteroidal anti-inflammatory drugs)--ibuprofen (Advil, Motrin), naproxen (Aleve), diclofenac, indomethacin, meloxicam, and others; or

• you are using other medicines to treat or prevent blood clots.

Taking apixaban may increase the risk of bleeding while you are pregnant or during your delivery. Tell your doctor if you are pregnant or plan to become pregnant.

Do not breastfeed.

Take the missed dose on the same day you remember it. Take your next dose at the regular time and stay on your twice-daily schedule. Do not take two doses at one time.

Get your prescription refilled before you run out of medicine completely.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from light, excess heat and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unless your doctor tells you otherwise, continue your normal diet.

Avoid activities that may increase your risk of bleeding or injury. Use extra care while shaving or brushing your teeth.

Get emergency medical help if you have signs of an allergic reaction: hives; chest pain, wheezing, difficult breathing; feeling light-headed; swelling of your face, lips, tongue, or throat.

Also seek emergency medical attention if you have symptoms of a spinal blood clot such as tingling, numbness, or muscle weakness especially in your legs and feet.

Apixaban may cause serious side effects. Call your doctor at once if you have:

• easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), bleeding from wounds or needle injections, any bleeding that will not stop;

• heavy menstrual bleeding;

• headache, dizziness, weakness, feeling like you might pass out;

• urine that looks red, pink, or brown; or

• black or bloody stools, coughing up blood or vomit that looks like coffee grounds.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective.

Many other drugs (including some over-the-counter medicines) can increase your risk of bleeding or blood clots. Tell your doctor about all medicines you have recently used, especially:

• any other medicines to treat or prevent blood clots;

• a blood thinner such as heparin or warfarin (Coumadin, Jantoven);

• an antidepressant; or

• aspirin or other NSAID (nonsteroidal anti-inflammatory drug) used long term.

This list is not complete and many other drugs may affect apixaban. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Keep all appointments with your doctor.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.