Last update May 15, 2021

Apixaban

Likely Compatibility

Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.

Apixaban is an oral direct inhibitor of factor Xa (activated factor X) with actions and uses similar to those of rivaroxaban.
It is indicated in the prevention and treatment of thromboembolism.
Administered orally twice daily.

It is excreted in human milk in a small amount, but it could be clinically significant (Zhao 2020).

Until there is further published data on this drug in relation to breastfeeding, known safer alternatives may be preferable (Daei 2021, Zhao 2020, Cohen 2016, Bates 2012), especially during the neonatal period and in cases of prematurity.

Alternatives

  • Acenocoumarol (Safe product and/or breastfeeding is the best option.)
  • Dabigatran etexilate (Safe product and/or breastfeeding is the best option.)
  • Dalteparin Sodium (Safe product and/or breastfeeding is the best option.)
  • Enoxaparin Sodium (Safe product and/or breastfeeding is the best option.)
  • Heparin (Safe product and/or breastfeeding is the best option.)
  • Rivaroxaban (Safe product and/or breastfeeding is the best option.)
  • Warfarin (Safe product and/or breastfeeding is the best option.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Apixaban in other languages or writings:

Tradenames

Main tradenames from several countries containing Apixaban in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 43 - 50 %
Molecular weight 460 daltons
Protein Binding 87 - 93 %
VD 0.3 l/Kg
pKa 13.1 -
Tmax 3 - 4 hours
12.7 hours
M/P ratio 2.6 -
Theoretical Dose 0.017 mg/Kg/d
Relative Dose 10.2 %

References

  1. Azenkot T, Schwarz EB. Special Considerations for Women of Reproductive Age on Anticoagulation. J Gen Intern Med. 2022 Aug;37(11):2803-2810. Abstract Full text (link to original source)
  2. Daei M, Khalili H, Heidari Z. Direct oral anticoagulant safety during breastfeeding: a narrative review. Eur J Clin Pharmacol. 2021 May 8. Abstract
  3. Zhao Y, Arya R, Couchman L, Patel JP. Are apixaban and rivaroxaban distributed into human breast milk to clinically relevant concentrations? Blood. 2020 Oct 8;136(15):1783-1785. Abstract
  4. Pfizer Canada. Apixaban (Eliquis). Drug Summary. 2019 Full text (in our servers)
  5. EMA. Apixabán (Eliquis). Ficha técnica. 2016 Full text (in our servers)
  6. Cohen H, Arachchillage DR, Beyer-Westendorf J, Middeldorp S, Kadir RA. Direct Oral Anticoagulants and Women. Semin Thromb Hemost. 2016 Oct;42(7):789-797. Epub 2016 Oct 5. Review. Abstract
  7. Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e691S-e736S. Abstract Full text (link to original source)

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