Understanding the Primary Form of ELIQUIS
For most adult patients, Eliquis (apixaban) is prescribed and dispensed as a solid oral tablet. These tablets are taken by mouth, twice daily, and can be consumed with or without food. The standard dosages for adults are 2.5 mg and 5 mg. Patients are typically instructed to swallow the tablet whole with water. However, swallowing difficulties, known as dysphagia, are common among various patient populations, including the elderly, and those receiving care via a nasogastric (NG) tube. These situations necessitate alternative methods of administration, which are detailed in the official prescribing information.
Preparing a Liquid Suspension from Tablets for Adults
For adult patients who are unable to swallow whole tablets, the official prescribing information provides specific instructions for preparing a liquid suspension from standard Eliquis tablets. This method allows for the safe and effective administration of the medication without a pre-made liquid version.
The process involves crushing the tablet and mixing it with a small amount of liquid or food. Here is a step-by-step guide based on the manufacturer’s instructions:
- Crush the tablet: Using a pill crusher or mortar and pestle, crush the Eliquis tablet into a fine powder. This is a critical step to ensure proper dissolution.
- Prepare the mixture: The powder should be mixed with one of several recommended substances for oral ingestion. This includes water, apple juice, or applesauce.
- Administer promptly: The prepared mixture must be administered to the patient immediately. Crushed Eliquis tablets are only stable in these mixtures for up to 4 hours. It is crucial not to prepare a dose in advance.
Administration Through a Nasogastric or Gastrostomy Tube
Patients with NG or gastrostomy tubes also have a valid method for receiving their Eliquis dose, which also involves creating a suspension from the tablets.
Instructions for Nasogastric Tube Administration:
- Crush the tablet: As with the oral method, crush the Eliquis tablet into a fine powder.
- Create the suspension: Suspend the crushed tablet in 60 mL of water or 5% dextrose in water (D5W).
- Deliver the dose: Administer the suspension promptly through a 12 French nasogastric tube.
- Flush the tube: After administering the dose, flush the tube with an additional 20 mL of water or D5W to ensure the full dose is delivered and to prevent clogging.
Specialized Liquid Formulations for Pediatric Patients
For children, particularly those under 35 kg, Eliquis is available in specialized liquid formulations that are not used for adults. These options are essential for ensuring accurate and consistent dosing in pediatric patients.
- ELIQUIS SPRINKLE Capsule: This formulation contains sprinkles that must be mixed with water or infant formula. The capsule is opened, the contents are sprinkled into the liquid, and the mixture is administered within two hours.
- ELIQUIS Tablet for Oral Suspension: A dedicated tablet in a packet is mixed with water, infant formula, apple juice, or apple sauce. Similar to the sprinkle capsule, the mixture must be administered promptly.
Comparison of ELIQUIS Administration Methods
To help clarify the various methods for taking Eliquis, the following table compares the different routes of administration for adult and pediatric patients.
| Feature | Oral Tablets (Adults) | Crushed Tablets (Adults) | Pediatric Formulations (Children) |
|---|---|---|---|
| Primary Form | Solid, film-coated tablets | Prepared suspension from crushed tablets | Sprinkles in a capsule or tablet packets for suspension |
| Availability | Standard prescription | Prepared at home or in a clinical setting | Specialized prescription for pediatric patients |
| Administration Route | Swallowed whole with water | Oral or via nasogastric tube | Oral or via nasogastric/gastrostomy tube |
| Vehicle | Water | Water, apple juice, applesauce, or D5W | Water, infant formula, or apple juice/sauce |
| Stability | Long-term as prescribed | Up to 4 hours in recommended vehicles | Up to 2 hours in liquid; applesauce must be administered immediately |
Alternatives to Eliquis
While Eliquis can be prepared as a liquid for those who cannot swallow tablets, some patients may seek alternative medications that are available as a pre-made liquid suspension. One such alternative is Xarelto (rivaroxaban), another direct oral anticoagulant (DOAC), which comes in a liquid suspension form in addition to tablets. Any decision to switch anticoagulants should be made in consultation with a healthcare provider, as different medications have different dosing schedules and indications.
The Importance of Medical Guidance
It is imperative that patients do not crush or alter Eliquis tablets without explicit guidance from their healthcare provider. The specific instructions on how to prepare and administer the medication are designed to ensure its safety and effectiveness. Changing the administration route or dosage without professional supervision could lead to serious bleeding or clotting risks. Always consult a doctor or pharmacist for personalized instructions and to confirm the correct procedure for your specific situation. Adherence to a consistent schedule is also key to maintaining the drug's therapeutic effects. For more detailed information on specific medical guidelines, consult resources from authoritative bodies like the National Institutes of Health.
Conclusion
While Eliquis for adults does not come in a commercially available pre-made liquid form, it can be safely and effectively prepared as a liquid suspension from the standard tablets for patients who require it. Specialized liquid and sprinkle formulations are also available for pediatric use, offering crucial options for children. This versatility ensures that patients with swallowing difficulties or tube-feeding requirements can still benefit from this vital medication. However, strict adherence to a healthcare provider's instructions for preparation and administration is essential to ensure patient safety and proper therapeutic effect. Patients should never attempt to alter their medication without professional medical guidance.
