APIXAB 2.5 mg Film-coated tablets

Contents of the leaflet

1. Introduction
2. What is Apixaban Farmalider and what is it used for
3. What you need to know before you take Apixaban Farmalider
4. How to take Apixaban Farmalider
5. Possible Adverse Effects
6. Storage of Apixaban Farmalider
7. Package Contents and Additional Information

Introduction

Package Leaflet: Information for theuser

Apixaban Farmalider 2.5 mg film-coated tablets EFG

Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.

• Keep this leaflet, you may need to read it again.
• If you have any further questions, ask your doctor, pharmacist, or nurse.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor, pharmacist, or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

Contents of theleaflet:

1. What is Apixaban Farmalider and what is it used for
2. What you need to know before you take Apixaban Farmalider
3. How to take Apixaban Farmalider
4. Possible side effects
5. Storage of Apixaban Farmalider
6. Package contents and further information

1. What is Apixaban Farmalider and what is it used for

Apixaban Farmalider contains the active substance apixaban and belongs to a group of medicines called anticoagulants. This medicine helps prevent the formation of blood clots by blocking Factor Xa, an important element in blood coagulation.

Apixaban Farmalider is used in adults:

• to prevent the formation of blood clots (deep vein thrombosis [DVT]) after hip or knee replacement surgery. After hip or knee replacement surgery, you may have a higher risk of developing blood clots in the veins of your legs. This can cause swelling in your legs, with or without pain. If a blood clot travels from your leg to your lungs, it can block blood flow, causing difficulty breathing, with or without chest pain. This medical condition (pulmonary embolism) can be life-threatening and requires immediate medical attention.

• to prevent the formation of a blood clot in the heart in patients with an irregular heartbeat (atrial fibrillation) and at least one additional risk factor. Blood clots can break loose, move to the brain, and cause a stroke, or move to other organs, preventing proper irrigation (also known as systemic embolism). A stroke can be life-threatening and requires immediate medical attention.

• to treat blood clots in the veins of the legs (deep vein thrombosis) and in the blood vessels of the lungs (pulmonary embolism), and to prevent these blood clots from recurring in the blood vessels of the legs and/or lungs.

2. What you need to know before you take Apixaban Farmalider

Do not takeApixaban Farmalider

• if you are allergic to apixaban or any of the other ingredients of this medicine (listed in section 6);
• if you bleed excessively;
• if you have a disease in an organ of the body that increases the risk of severe bleeding (such as an active or recent stomach or intestinal ulcer, or recent cerebral hemorrhage);
• if you have a liver disease that increases the risk of bleeding (hepatic coagulopathy);
• if you are taking medicines to prevent blood coagulation (e.g., warfarin, rivaroxaban, dabigatran, or heparin), except when switching from one anticoagulant treatment to another, while having an arterial or venous line and being treated with heparin to keep the line open, or when a tube is inserted into a blood vessel (catheter ablation) to treat an irregular heartbeat (arrhythmia).

Warnings andprecautions

Tell your doctor, pharmacist, or nurse before taking this medicine if you have any of these conditions:

• an increased risk of bleeding, such as:
  • bleeding disorders, including situations that result in a decrease in platelet activity;
  • uncontrolled high blood pressure;
  • you are over 75 years old;
  • you weigh 60 kg or less;

• severe kidney disease or if you are on dialysis;
• a liver problem or history of liver problems;

This medicine will be used with caution in patients with signs of altered liver function

• you had a catheter or received an injection in the spine (for anesthesia or pain relief), your doctor will tell you to wait at least 5 hours after removing the catheter before taking this medicine;
• you have a heart valve prosthesis;
• if your doctor determines that your blood pressure is unstable or you are scheduled to receive another treatment or undergo surgery to remove the blood clot from your lungs.

Be careful withApixaban Farmalider

If you know you have a disease called antiphospholipid syndrome (an immune system disorder that increases the risk of blood clots), inform your doctor to decide if it may be necessary to modify the treatment.

If you need to undergo surgery or a procedure that may cause bleeding, your doctor will tell you to temporarily stop taking this medicine for a while. If you are not sure if a procedure may cause bleeding, consult your doctor.

Children andadolescents

This medicine is not recommended for use in children and adolescents under 18 years of age.

Using Apixaban Farmalider with othermedicines

Tell your doctor, pharmacist, or nurse if you are using, have recently used, or might use other medicines.

Some medicines may increase the effects of apixaban, and some medicines may decrease its effects. Your doctor will decide if you should be treated with apixaban if you are taking these medicines and if you should be kept under closer observation.

The following medicines may increase the effects of apixaban and increase the possibility of unwanted bleeding:

• certain medicines for fungal infections (e.g., ketoconazole);
• certain antiviral medicines for HIV/AIDS (e.g., ritonavir);
• other medicines to reduce blood coagulation (e.g., enoxaparin);
• anti-inflammatory or pain-relieving medicines (e.g., acetylsalicylic acid or naproxen). Especially if you are over 75 years old and taking acetylsalicylic acid, there is a higher likelihood of bleeding;
• medicines for high blood pressure or heart problems (e.g., diltiazem);
• antidepressants called selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors.

The following medicines may reduce the ability of apixaban to prevent blood clot formation.

• medicines for the treatment of epilepsy or seizures (e.g., phenytoin);
• St. John's Wort (a herbal medicine for the treatment of depression);
• medicines to treat tuberculosis or other infections (e.g., rifampicin).

Pregnancy andbreast-feeding

If you are pregnant or breast-feeding, think you may be pregnant, or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

The effects of apixaban on pregnancy and the fetus are not known. You should not take this medicine if you are pregnant. Tell your doctor immediatelyif you become pregnant while taking this medicine.

It is not known if apixaban is excreted in human milk. Ask your doctor or pharmacist for advice before taking this medicine during breast-feeding. They will tell you whether to stop breast-feeding or whether to stop or not start taking this medicine.

Driving and usingmachines

Apixaban has no influence on the ability to drive or use machines.

Apixaban Farmalider contains lactose (a type of sugar) andsodium.

If your doctor has told you that you have an intolerance to certain sugars, consult with them before taking this medicine.

This medicine contains less than 1 mmol of sodium (23 mg) per tablet, which is essentially "sodium-free".

3. How to take Apixaban Farmalider

Follow exactly the instructions of administration of this medicine indicated by your doctor or pharmacist. If you are in doubt, consult your doctor, pharmacist, or nurse.

Dosage

Take the tablet with water. Apixaban can be taken with or without food.

Try to take the tablets at the same time each day to achieve a better effect of the treatment.

If you have difficulty swallowing the tablet whole, talk to your doctor about other possible ways to take apixaban. The tablet can be crushed and mixed with water, 5% glucose in water, apple juice, or apple puree, immediately before taking it.

Instructions forcrushing:

• Crush the tablets with a mortar.
• Transfer all the powder carefully into a suitable container, mixing the powder with a small amount, for example, 30 ml (2 tablespoons), of water or any of the other liquids mentioned to make the mixture.
• Take the mixture.
• Flush the mortar and the mortar's hand that have been used to crush the tablet and the container with a small amount of water or one of the other liquids (e.g., 30 ml), and take that liquid.

If necessary, your doctor may also administer the crushed apixaban tablet mixed in 60 ml of water or 5% glucose in water through a nasogastric tube.

Take Apixaban Farmalider according to the followingrecommendations:

To prevent the formation of blood clots in hip or knee replacement surgery.

The recommended dose of apixaban is one 2.5 mg apixaban tablet twice a day. For example, take one tablet in the morning and one in the evening.

You should take the first tablet between 12 and 24 hours after surgery.

If you have undergone major hip surgery, you will generally take the tablets for a period of 32 to 38 days.

If you have undergone major knee surgery, you will generally take the tablets for a period of 10 to 14 days.

To prevent the formation of a blood clot in the heart in patients with an irregular heartbeat and at least one additional risk factor.

The recommended dose of apixaban is one 5 mg apixaban tablet twice a day.

The recommended dose is one 2.5 mg apixaban tablet twice a day if:

• you have severely decreased kidney function;
• two or more of the following factors apply:
  • your blood test results suggest poor kidney function (the creatinine serum value is 1.5 mg/dl (133 micromoles/l) or higher);
  • you are 80 years old or older;
  • your weight is 60 kg or less

The recommended dose is one tablet twice a day, for example, take one tablet in the morning and one in the evening. Your doctor will tell you how long you should continue the treatment.

To treat blood clots in the veins of the legs and in the blood vessels of the lungs

The recommended dose is two 5 mg apixaban tablets twice a day for the first 7 days, for example, two tablets in the morning and two tablets in the evening.

After 7 days, the recommended dose is one 5 mg apixaban tablet twice a day, for example, one tablet in the morning and one in the evening.

To prevent blood clots from recurring after 6 months of treatment

The recommended dose is one 2.5 mg apixaban tablet twice a day, for example, one tablet in the morning and one in the evening.

Your doctor will tell you how long you should continue the treatment.

Your doctor may change your anticoagulant treatment as follows:

• Changing from apixaban to other anticoagulant medicines

Stop taking apixaban. Start treatment with other anticoagulant medicines (e.g., heparin) at the time you would take the next apixaban tablet.

• Changing from other anticoagulant medicines to apixaban

Stop taking other anticoagulant medicines. Start treatment with apixaban at the time you would take the next dose of an anticoagulant medicine, and then continue as usual.

• Changing from a treatment with anticoagulants that contain Vitamin K antagonists (e.g., warfarin) to apixaban

Stop taking the medicine that contains a Vitamin K antagonist. Your doctor will need to perform blood tests and tell you when to start taking apixaban.

• Changing from apixaban to a treatment with anticoagulants that contain a Vitamin K antagonist (e.g., warfarin).

If your doctor tells you to start taking a medicine that contains a Vitamin K antagonist, continue taking apixaban for at least 2 days after your first dose of the medicine that contains a Vitamin K antagonist. Your doctor will need to perform blood tests and tell you when to stop taking apixaban.

Patients undergoingcardioversion

If your heartbeat needs to be restored through a process called cardioversion, take this medicine at the times your doctor indicates to prevent blood clots in the blood vessels of the brain and other blood vessels in the body.

If you take more Apixaban Farmalider than youshould

Tell your doctor immediatelyif you have taken a dose higher than the prescribed dose of this medicine. Take the package of the medicine to your doctor, even if there are no tablets left.

In case of overdose or accidental ingestion, consult your doctor, pharmacist, or call the Toxicology Information Service, phone 91 562 04 20, indicating the medicine and the amount taken.

If you take more apixaban than the recommended dose, you may increase the risk of bleeding. If bleeding occurs, surgery, blood transfusions, or other treatments that can reverse the anti-factor Xa activity may be necessary.

If you forget to takeApixaban Farmalider

Take the dose as soon as you remember and

• take the next dose of apixaban at the usual time
• then continue taking the medicine as usual

If you have doubts about what to do or if you forget to take more than one dose, ask your doctor, pharmacist, or nurse.

If you stop takingApixaban Farmalider

Do not stop taking this medicine without talking to your doctor first, because the risk of developing a blood clot may be higher if you stop the treatment too soon.

If you have any other questions about the use of this medicine, ask your doctor, pharmacist, or nurse.

4. Possible Adverse Effects

Like all medicines, apixaban can cause adverse effects, although not all people suffer from them. Apixaban can be administered for three different diseases. The known adverse effects and the frequency at which they occur may be different and are therefore indicated separately below. For these conditions, the most frequent adverse effect of this medication is bleeding, which can put the patient's life at risk and requires immediate medical attention.

The following adverse effects have been reported when taking apixaban to prevent the formation of blood clots in hip or knee replacement surgeries.

Frequent Adverse Effects (may affect up to 1 in 10 people)

• Anemia, which can cause fatigue or paleness;
• Bleeding, including:
  • hematoma and swelling;

• Nausea (general discomfort).

Uncommon Adverse Effects (may affect up to 1 in 100 people)

• Decrease in the number of platelets in the blood (which can affect coagulation);
• Bleeding:
  • after surgery, including hematoma and swelling, bleeding or fluid discharge from the wound/surgical incision (suppuration), or at the injection site;
  • from the stomach, intestine, or bright red blood in the stool;
  • blood in the urine;
  • from the nose;
  • vaginal;

• Low blood pressure, which can cause fainting or a faster heart rate;
• Blood tests may show:
  • abnormal liver function;
  • increased liver enzymes;
  • increased bilirubin, a byproduct of red blood cells, which can cause yellowing of the skin and eyes;

• Itching.

Rare Adverse Effects (may affect up to 1 in 1,000 people)

• Allergic reactions (hypersensitivity) that can cause: swelling of the face, lips, mouth, tongue, and/or throat, and difficulty breathing. Inform your doctor immediately if you experience any of these symptoms.
• Bleeding:
  • in a muscle;
  • in the eyes;
  • from the gums and coughing up blood;
  • from the rectum;

• Hair loss.

Frequency Not Known (cannot be estimated from available data)

• Bleeding:
  • in the brain or spinal cord;
  • in the lungs or throat;
  • in the mouth;
  • in the abdomen or the space behind the abdominal cavity;
  • hemorrhoidal;
  • tests showing blood in the stool or urine;
  • Bleeding in the kidney, sometimes with blood in the urine, which can cause the kidneys to fail to function properly (anticoagulant-related nephropathy).
  • Skin rash that can form blisters and resemble small targets (dark spots in the center surrounded by a paler area, with a dark ring around) (erythema multiforme).
  • Inflammation of the blood vessels (vasculitis) that can cause skin rash, appearance of round, smooth red spots under the skin surface, or hematomas.

The following adverse effects have been reported when taking apixaban to prevent the formation of blood clots in the heart in patients with irregular heart rhythm and at least one additional risk factor.

Frequent Adverse Effects (may affect up to 1 in 10 people)

• Bleeding, including:
  • in the eyes;
  • in the stomach or intestine;
  • from the rectum;
  • blood in the urine;
  • from the nose;
  • from the gums;
  • hematoma and swelling;

• Anemia, which can cause fatigue or paleness;
• Low blood pressure, which can cause fainting or a faster heart rate;
• Nausea (general discomfort);
• Blood tests may show:
  • an increase in gamma glutamyl transferase (GGT).

Uncommon Adverse Effects (may affect up to 1 in 100 people)

• Bleeding:
  • in the brain or spinal cord;
  • in the mouth or coughing up blood;
  • in the abdomen or vagina;
  • bright red blood in the stool;
  • bleeding after surgery, including hematoma and swelling, bleeding or fluid discharge from the wound/surgical incision (suppuration), or at the injection site;
  • hemorrhoidal;
  • tests showing blood in the stool or urine;

• Decrease in the number of platelets in the blood (which can affect coagulation);
• Blood tests may show:
  • abnormal liver function;
  • increased liver enzymes;
  • increased bilirubin, a byproduct of red blood cells, which can cause yellowing of the skin and eyes;

• Skin rash;
• Itching;
• Hair loss;
• Allergic reactions (hypersensitivity) that can cause: swelling of the face, lips, mouth, tongue, and/or throat, and difficulty breathing. Inform your doctor immediately if you experience any of these symptoms.

Rare Adverse Effects (may affect up to 1 in 1,000 people)

• Bleeding:
  • in the lungs or throat;
  • in a muscle.

Very Rare Adverse Effects (may affect up to 1 in 10,000 people)

• Skin rash that can form blisters and resemble small targets (dark spots in the center surrounded by a paler area, with a dark ring around) (erythema multiforme).

Frequency Not Known (cannot be estimated from available data)

• Inflammation of the blood vessels (vasculitis) that can cause skin rash, appearance of round, smooth red spots under the skin surface, or hematomas.
• Bleeding in the kidney, sometimes with blood in the urine, which can cause the kidneys to fail to function properly (anticoagulant-related nephropathy).

The following adverse effects have been reported when taking apixaban to treat or prevent blood clots from recurring in the veins of the legs and in the blood vessels of the lungs.

Frequent Adverse Effects (may affect up to 1 in 10 people)

• Bleeding, including:
  • from the nose;
  • from the gums;
  • blood in the urine;
  • hematoma and swelling;
  • from the stomach, intestine, or rectum;
  • in the mouth;
  • vaginal;

• Anemia, which can cause fatigue or paleness;
• Decrease in the number of platelets in the blood (which can affect coagulation);
• Nausea (general discomfort);
• Skin rash;
• Blood tests may show:
  • an increase in gamma glutamyl transferase (GGT) or alanine aminotransferase (GPT).

Uncommon Adverse Effects (may affect up to 1 in 100 people)

• Low blood pressure, which can cause fainting or a faster heart rate;
• Bleeding:
  • in the eyes;
  • in the mouth or coughing up blood;
  • bright red blood in the stool;
  • tests showing blood in the stool or urine;
  • bleeding after surgery, including hematoma and swelling, bleeding or fluid discharge from the wound/surgical incision (suppuration), or at the injection site;
  • hemorrhoidal;
  • in a muscle.

• Itching;
• Hair loss;
• Allergic reactions (hypersensitivity) that can cause: swelling of the face, lips, mouth, tongue, and/or throat, and difficulty breathing. Contact your doctor immediately if you experience any of these symptoms.
• Blood tests may show:
  • abnormal liver function;
  • increased liver enzymes;
  • increased bilirubin, a byproduct of red blood cells, which can cause yellowing of the skin and eyes.

Rare Adverse Effects (may affect up to 1 in 1,000 people)

• Bleeding:
  • in the brain or spinal cord;
  • in the lungs.

Frequency Not Known (cannot be estimated from available data)

• Bleeding:
  • in the abdomen or the space behind the abdominal cavity.
  • in the kidney, sometimes with blood in the urine, which can cause the kidneys to fail to function properly (anticoagulant-related nephropathy).

Skin rash that can form blisters and resemble small targets (dark spots in the center surrounded by a paler area, with a dark ring around) (erythema multiforme).

• Inflammation of the blood vessels (vasculitis) that can cause skin rash, appearance of round, smooth red spots under the skin surface, or hematomas.

Reporting of Adverse Effects

If you experience any type of adverse effect, consult your doctor, pharmacist, or nurse, even if it is a possible adverse effect that is not listed in this leaflet. You can also report them directly through the Spanish Pharmacovigilance System for Human Use Medicines: https://www.notificaram.es. By reporting adverse effects, you can contribute to providing more information on the safety of this medication.

5. Storage of Apixaban Farmalider

Keep this medication out of sight and reach of children.

Do not use this medication after the expiration date shown on the packaging and on each blister, after "CAD". The expiration date is the last day of the month indicated.

This medication does not require special storage conditions.

Medicines should not be disposed of through wastewater or household waste. Deposit the packaging and unused medicines at the SIGRE Point in the pharmacy. In case of doubt, ask your pharmacist how to dispose of the packaging and unused medicines. This will help protect the environment.

6. Package Contents and Additional Information

Composition of Apixaban Farmalider

• The active ingredient is apixaban. Each tablet contains 2.5 mg of apixaban.
• Other components are:
  • Core of the tablet: lactose (see section 2 "Apixaban Farmalider contains lactose (a type of sugar) and sodium"), microcrystalline cellulose, croscarmellose sodium (see section 2 "Apixaban Farmalider contains lactose (a type of sugar) and sodium"), lauryl sulfate, magnesium stearate;
  • Coating: lactose monohydrate, (see section 2 "Apixaban Farmalider contains lactose (a type of sugar) and sodium") hypromellose, titanium dioxide (E171), triacetin, yellow iron oxide (E172).

Appearance of the Product and Package Contents

The film-coated tablets are round, yellow, and have "I1" engraved on one side, with a diameter of approximately 6.1 millimeters.

Apixaban Farmalider 2.5 mg film-coated tablets are presented in blisters within cartons containing 20, 60, and 100 (clinical packaging) film-coated tablets.

Patient Information Card: Handling of Information

Inside the packaging of Apixaban Farmalider, along with the leaflet, you will find a Patient Information Card or your doctor may give you a similar card.

This Patient Information Card includes useful information for you and will alert other doctors that you are being treated with apixaban. You must keep this card with you at all times.

1. Take the card.
2. Separate the language you need (this is facilitated through the perforated ends).
3. Complete the following sections or ask your doctor to complete them:
   • Name:
   • Date of birth:
   • Indication:
   • Dose: ........mg twice a day
   • Doctor's name:
   • Doctor's phone number:

1. Fold the card and carry it with you at all times.

Marketing Authorization Holder

Farmalider S.A.

C/ La Granja, 1

28108 Alcobendas – Madrid

Spain

Manufacturers

Farmalider S.A.

C/ Aragoneses, 2

28108 Alcobendas – Madrid

Spain

Date of Last Revision of this Leaflet: April 2025

Detailed information about this medication is available on the website of the Spanish Agency for Medicines and Health Products (AEMPS) http://www.aemps.gob.es/.