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Apixaban Teva

Apixaban Teva

About the medicine

How to use Apixaban Teva

Leaflet attached to the packaging: information for the user

Apixaban Teva, 2.5 mg, coated tablets

Apixaban

You should read the contents of the leaflet before taking the medicine, as it contains important information for the patient.

  • You should keep this leaflet, so that you can read it again if necessary.
  • In case of any doubts, you should consult a doctor, pharmacist, or nurse.
  • This medicine has been prescribed specifically for one person. It should not be given to others. The medicine may harm another person, even if the symptoms of their illness are the same.
  • If the patient experiences any side effects, including any side effects not listed in this leaflet, they should tell their doctor, pharmacist, or nurse. See section 4.

Table of contents of the leaflet

  • 1. What is Apixaban Teva and what is it used for
  • 2. Important information before taking Apixaban Teva
  • 3. How to take Apixaban Teva
  • 4. Possible side effects
  • 5. How to store Apixaban Teva
  • 6. Contents of the packaging and other information

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

Apixaban Teva contains the active substance apixaban and belongs to a group of so-called anticoagulant medicines. This medicine helps prevent the formation of blood clots by blocking factor Xa, which is an important factor in blood clotting.
Apixaban Teva is used in adults:

  • to prevent the formation of blood clots (deep vein thrombosis) after hip or knee replacement surgery. After hip or knee surgery, the patient may be at increased risk of developing blood clots in the veins of the lower limbs. This can lead to swelling of the legs, with or without pain. If a blood clot moves from the lower limb to the lungs, it can block blood flow through the lungs, causing shortness of breath with chest pain or without. This condition (pulmonary embolism) can be life-threatening and requires immediate medical attention.
  • to prevent the formation of blood clots in the heart in patients with irregular heart rhythm (atrial fibrillation) and at least one additional risk factor. Blood clots can break loose and move to the brain, leading to a stroke, or to other organs, making it difficult for these organs to receive blood (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 lower limbs (deep vein thrombosis) and in the blood vessels of the lungs (pulmonary embolism), as well as to prevent the recurrence of blood clots in the blood vessels of the lower limbs and/or lungs.

Apixaban Teva is used in children from 28 days of age to less than 18 years of age, for the treatment of blood clots and to prevent the recurrence of blood clots in the veins or in the blood vessels of the lungs.
Information on body weight and recommended dose can be found in section 3.
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2. Important information before taking Apixaban Teva

When not to take Apixaban Teva:

  • if the patient is allergicto apixaban or any of the other ingredients of this medicine (listed in section 6),
  • if the patient has excessive bleeding,
  • if the patient has organ diseasethat increases the risk of significant bleeding (such as active or recently diagnosed stomach or intestinal ulcer, recently diagnosed bleeding into the brain),
  • if the patient has liver diseasethat leads to an increased risk of bleeding (hepatic coagulopathy),
  • if the patient is taking medicines that prevent blood clotting(e.g., warfarin, rivaroxaban, dabigatran, or heparin), except in situations where the anticoagulant treatment is changed, when the patient has a venous or arterial access line and heparin is administered through this line to maintain its patency or when the patient is undergoing catheter ablation (a catheter is inserted into their vein) due to irregular heart rhythm (arrhythmia).

Warnings and precautions

Before starting to take this medicine, the patient should discuss it with their doctor, pharmacist, or nurse if they have any of the following conditions:

  • increased risk of bleeding, for example:
    • bleeding disorders, including cases that result in decreased platelet activity
    • very high blood pressure, uncontrolled with medication
    • if the patient is over 75 years old
    • if the patient weighs 60 kg or less
  • severe kidney disease or if the patient is on dialysis
  • liver problems or a history of liver problems. This medicine should be used with caution in patients with signs of liver function changes.
    • The patient should be closely monitored by their doctor.
  • tube (catheter) or injection into the spine(anesthetic or pain-relieving), in which case the doctor will recommend taking this medicine after 5 or more hours after the catheter is removed
  • if the patient has a heart valve prosthesis
  • if the doctor determines that the patient's blood pressure is unstable or if other treatment or surgery is planned to remove a blood clot from the lungs.

When to be particularly careful when taking Apixaban Teva

  • if the patient has a condition called antiphospholipid syndrome (an immune system disorder that increases the risk of blood clots), the patient should inform their doctor, who will decide whether to change the treatment.

In case of need for surgery or a procedure that may be associated with bleeding, the doctor may ask the patient to temporarily stop taking this medicine for a short time. If there is any uncertainty about whether a given procedure may be associated with bleeding, the doctor should be consulted.

Children and adolescents

This medicine is not recommended for children and adolescents with a body weight below 35 kg.

Apixaban Teva and other medicines

The patient should tell their doctor, pharmacist, or nurse about all medicines they are currently taking or have recently taken, as well as any medicines they plan to take.
Some medicines may enhance the effect of Apixaban Teva, and some may weaken its effect.
The doctor will decide whether the patient should receive Apixaban Teva while taking other medicines and how closely they should be monitored.
The following medicines may enhance the effect of Apixaban Teva and increase the risk of unwanted bleeding:

  • some antifungal medicines(e.g., ketoconazole and others)
  • some antiviral medicines used to treat HIV/AIDS(e.g., ritonavir)
  • other medicines used to reduce blood clotting(e.g., enoxaparin and others)
  • anti-inflammatory or pain-relieving medicines(e.g., acetylsalicylic acid or naproxen). In particular, if the patient is over 75 years old and takes acetylsalicylic acid, they may be at increased risk of unwanted bleeding.
  • medicines used for high blood pressure or heart problems(e.g., diltiazem)
  • antidepressant medicinescalled selective serotonin reuptake inhibitorsor serotonin and norepinephrine reuptake inhibitors.

The following medicines may reduce the ability of Apixaban Teva to prevent blood clot formation:

  • medicines used to prevent seizures or convulsions(e.g., phenytoin and others)
  • St. John's Wort(a herbal supplement used for depression)
  • medicines used to treat tuberculosisor other infections(e.g., rifampicin).

Pregnancy and breastfeeding

If the patient is pregnant or breastfeeding, thinks they may be pregnant, or plans to have a child, they should consult their doctor, pharmacist, or nurse before taking this medicine.
The effect of apixaban on pregnancy and the unborn child is unknown. This medicine should not be taken during pregnancy. If the patient becomes pregnant while taking this medicine, they should immediatelycontact their doctor.
It is not known whether apixaban passes into breast milk. Before taking this medicine while breastfeeding, the patient should consult their doctor, pharmacist, or nurse. The patient may be advised to stop breastfeeding or stop/restart taking this medicine.

Driving and using machines

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

Apixaban Teva contains lactose (a sugar) and sodium

If the patient has been diagnosed with intolerance to some sugars, they should consult their doctor before taking this medicine.
This medicine contains less than 1 mmol (23 mg) of sodium per tablet, which means that the medicine is essentially 'sodium-free'.

3. How to take Apixaban Teva

This medicine should always be taken exactly as prescribed by the doctor or pharmacist. In case of doubts, the patient should consult their doctor, pharmacist, or nurse.
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Dose

The tablet should be swallowed, with a glass of water. Apixaban Teva can be taken with or without food. To achieve the best treatment results, it is recommended to take the tablets at the same time every day.
If the patient has difficulty swallowing the tablets whole, they should talk to their doctor about other ways of taking Apixaban Teva. The tablet can be crushed just before taking and mixed with water or 5% aqueous glucose solution, juice, or apple sauce.

Instructions for crushing tablets:

  • Crush the tablet with a pestle in a mortar.
  • Carefully transfer the powder to a suitable container and then mix it with a small amount, e.g., 30 mL (2 tablespoons), of water or another liquid mentioned above to prepare a mixture.
  • Swallow the mixture.
  • Rinse the pestle and mortar used to crush the tablets and the container with a small amount of water or another liquid (e.g., 30 mL) and swallow the liquid after rinsing.

If necessary, the doctor may administer a crushed Apixaban Teva tablet mixed with 60 mL of water or 5% aqueous glucose solution through a nasogastric tube.

Apixaban Teva should be taken as recommended in the following indications:

Prevention of blood clot formation after hip or knee replacement surgery

The recommended dose is one 2.5 mg tablet twice a day.
For example, one tablet in the morning and one in the evening.
The first tablet should be taken 12 to 24 hours after surgery.
If the patient has undergone major hip surgery, they will usually take the tablets for 32 to 38 days.
If the patient has undergone major knee surgery, they will usually take the tablets for 10 to 14 days.
Prevention of blood clot formation in the heart in patients with irregular heart rhythm (atrial fibrillation) and at least one additional risk factor

The recommended dose is one 5 mg tablettwice a day.
The recommended dose is one 2.5 mg tablettwice a day if:

  • the patient has severe kidney problems
  • two or more of the following conditions are met:
    • the patient's blood test results suggest impaired kidney function (serum creatinine level of 1.5 mg/dL (133 micromole/L) or higher),
    • the patient is 80 years old or older,
    • the patient weighs 60 kg or less.

The recommended dose is one tablet twice a day, for example, one tablet in the morning and one in the evening. The doctor will decide how long to continue treatment.
Treatment of blood clots in the veins of the lower limbs and blood clots in the blood vessels of the lungs

The recommended dose is two 5 mg tabletstwice a day for the first 7 days, for example, two tablets in the morning and two in the evening.
After 7 days, the recommended dose is one 5 mg tablettwice a day, for example, one tablet in the morning and one in the evening.
Prevention of recurrence of blood clots after completing 6 months of treatment

The recommended dose is one 2.5 mg tablettwice a day, for example, one tablet in the morning and one in the evening.
The doctor will decide how long to continue treatment.

Use in children and adolescents

Treatment of blood clots and prevention of recurrence of blood clots in the veins or in the blood vessels of the lungs.
This medicine should always be taken or administered exactly as prescribed by the pediatrician or pharmacist. In case of doubts, the patient should consult their pediatrician, pharmacist, or nurse.
To achieve the best treatment results, the dose should be taken or administered at the same time every day.
The dose of Apixaban Teva depends on body weight and will be calculated by the doctor.
The recommended dose for children and adolescents weighing at least 35 kg is four tabletsof Apixaban Teva 2.5 mg, administered twice a day for the first 7 days, for example, four in the morning and four in the evening. After 7 days, the recommended dose is two tabletsof Apixaban Teva 2.5 mg, administered twice a day, for example, two in the morning and two in the evening.
For parents and caregivers: the child should be observed to ensure that they have taken the full dose.
It is essential to follow the scheduled doctor's appointments, as the dose may need to be adjusted if the patient's body weight changes.
The doctor may change the anticoagulant treatment as follows:

  • Switching from Apixaban Teva to other anticoagulant medicinesThe patient should stop taking Apixaban Teva. Treatment with other anticoagulant medicines (e.g., heparin) should be started at the time of the scheduled intake of the next tablet.
  • Switching from other anticoagulant medicines to Apixaban TevaThe patient should stop taking other anticoagulant medicines. Treatment with Apixaban Teva should be started at the time of the scheduled intake of the next dose of the other anticoagulant medicine, and then continue with the usual intake.
  • Switching from treatment with a vitamin K antagonist (e.g., warfarin) to Apixaban TevaThe patient should stop taking the vitamin K antagonist. The doctor will perform blood tests and inform the patient when to start taking Apixaban Teva.
  • Switching from Apixaban Teva to treatment with a vitamin K antagonist (e.g., warfarin)If the doctor informs the patient that they should start taking a vitamin K antagonist, they should continue to take Apixaban Teva for at least 2 days after taking the first dose of the vitamin K antagonist. The doctor will perform blood tests and inform the patient when to stop taking Apixaban Teva.

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Patients undergoing cardioversion

Patients who need to undergo cardioversion to restore a normal heart rhythm should take this medicine at the times specified by their doctor to prevent the formation of blood clots in the blood vessels of the brain and other blood vessels.

Taking a higher dose of Apixaban Teva than recommended

If the patient has taken a higher dose of this medicine than recommended, they should immediatelyinform their doctor. They should take the packaging with them, even if it is empty.
If the patient has taken a higher dose of Apixaban Teva than recommended, they may be at increased risk of bleeding. In case of bleeding, surgical treatment, blood transfusion, or other treatment that can reverse the effect of factor Xa inhibition may be necessary.

Missing a dose of Apixaban Teva

  • If the patient misses a morning dose, they should take it as soon as they remember and can take it together with the evening dose.
  • If the patient misses an evening dose, they can take it only on the same evening. They should not take two doses the next morning instead; they should continue taking the medicine the next day as recommended, twice a day.

In case of doubts about taking the medicine or missing more than one dose

The patient should consult their doctor, pharmacist, or nurse.

Stopping treatment with Apixaban Teva

The patient should notstop taking this medicine without consulting their doctor, as stopping treatment too early may increase the risk of blood clot formation.
In case of any further doubts about taking this medicine, the patient should consult their doctor, pharmacist, or nurse.

4. Possible side effects

Like all medicines, Apixaban Teva can cause side effects, although not everybody gets them.
Apixaban Teva can be used in three different medical conditions. The known side effects and their frequency in each of these medical conditions may be different and are listed separately below. In these conditions, the most common overall side effect of this medicine is bleeding, which can be life-threatening and may require immediate medical attention.
The following side effects may occur when taking apixaban to prevent blood clot formation after hip or knee replacement surgery.

Common side effects (may affect up to 1 in 10 people)

  • Anemia, which can cause fatigue or pallor
  • Bleeding, including:
    • bruises and swelling
  • Nausea (vomiting).

Uncommon side effects (may affect up to 1 in 100 people)

  • Decreased platelet count (which can affect blood clotting)
  • Bleeding:
    • after surgery, including bruising and swelling, bleeding or fluid leakage from the surgical wound/incision (wound discharge) or injection site
    • from the stomach, intestines, or rectum
    • blood in urine
    • from the nose
    • from the vagina
      • Low blood pressure, which can lead to fainting or rapid heartbeat
      • Blood test results may indicate:
    • liver function disorders
    • increased activity of certain liver enzymes
    • increased bilirubin levels - a product of red blood cell breakdown, which can cause yellowing of the skin and eyes
      • Itching.

    Rare side effects (may affect up to 1 in 1000 people)

    • Allergic reactions (hypersensitivity), which can cause: swelling of the face, lips, mouth, tongue, and/or throat, as well as difficulty breathing. In case of any of these symptoms, the patient should immediatelycontact their doctor.
    • Bleeding:
      • into the muscle
      • into the eyes
      • from the gums and coughing up blood
      • from the rectum
    • Hair loss.

    Side effects with unknown frequency (frequency cannot be estimated from the available data)

    • Bleeding:
      • into the brain or spinal cord
      • into the lungs or throat
      • into the abdominal cavity or retroperitoneal space
      • from hemorrhoids
      • blood test results indicating blood in stool or urine
    • A skin rash, which can cause blisters and resembles small targets (dark spots in the center surrounded by a lighter border, with a dark ring around the edge) (erythema multiforme).
    • Vasculitis (inflammation of blood vessels), which can cause a skin rash or elevated, flat, red, round patches under the skin, or bruising.
    • Bleeding in the kidneys, sometimes with blood in the urine, leading to kidney function disorders (nephropathy associated with the administration of anticoagulant medicines).

    The following side effects may occur when taking apixaban to prevent blood clot formation in the heart in patients with irregular heart rhythm (atrial fibrillation) and at least one additional risk factor.

    Common side effects (may affect up to 1 in 10 people)

    • Bleeding, including:
      • into the eye
      • from the stomach or intestines
      • from the rectum
      • blood in urine
      • from the nose
      • from the gums
    • bruises and swelling
      • Anemia, which can cause fatigue or pallor
      • Low blood pressure, which can lead to fainting or rapid heartbeat
      • Nausea (vomiting)
      • Blood test results may indicate:
    • increased gamma-glutamyltransferase (GGT) activity.

    Uncommon side effects (may affect up to 1 in 100 people)

    • Bleeding:
      • into the brain or spinal cord
      • into the mouth or coughing up blood
      • into the abdominal cavity or vagina
      • blood in stool
      • bleeding after surgery, including bruising and swelling, bleeding or fluid leakage from the surgical wound/incision (wound discharge) or injection site
      • from hemorrhoids
      • blood test results indicating blood in stool or urine
    • Decreased platelet count (which can affect blood clotting)
    • Blood test results may indicate:
      • liver function disorders
      • increased activity of certain liver enzymes
      • increased bilirubin levels - a product of red blood cell breakdown, which can cause yellowing of the skin and eyes
    • Skin rash
    • Itching
    • Hair loss
    • Allergic reactions (hypersensitivity), which can cause: swelling of the face, lips, mouth, tongue, and/or throat, as well as difficulty breathing. In case of any of these symptoms, the patient should immediatelycontact their doctor.

    Rare side effects (may affect up to 1 in 1000 people)

    • Bleeding:
      • into the lungs or throat
      • into the abdominal cavity or retroperitoneal space
      • into the muscle

    Side effects with unknown frequency (frequency cannot be estimated from the available data)

    • Vasculitis (inflammation of blood vessels), which can cause a skin rash or elevated, flat, red, round patches under the skin, or bruising.
    • Bleeding in the kidneys, sometimes with blood in the urine, leading to kidney function disorders (nephropathy associated with the administration of anticoagulant medicines).

    The following side effects may occur when taking apixaban for the treatment or prevention of recurrence of blood clots in the veins of the lower limbs and blood clots in the blood vessels of the lungs.

    Common side effects (may affect up to 1 in 10 people)

    • Bleeding, including:
      • from the nose
    • from the gums
    • blood in urine
    • bruises and swelling
    • from the stomach, intestines, or rectum
    • from the mouth
    • from the vagina
      • Anemia, which can cause fatigue or pallor
      • Decreased platelet count (which can affect blood clotting)
      • Nausea (vomiting)
      • Skin rash
      • Blood test results may indicate:
    • increased gamma-glutamyltransferase (GGT) or alanine aminotransferase (ALT) activity.

    Uncommon side effects (may affect up to 1 in 100 people)

    • Low blood pressure, which can lead to fainting or rapid heartbeat
    • Bleeding:
      • into the eyes
      • into the mouth or coughing up blood
      • blood in stool
      • blood test results indicating blood in stool or urine
      • bleeding after surgery, including bruising and swelling, bleeding or fluid leakage from the surgical wound/incision (wound discharge) or injection site
      • from hemorrhoids
      • into the muscle
    • Itching
    • Hair loss
    • Allergic reactions (hypersensitivity), which can cause: swelling of the face, lips, mouth, tongue, and/or throat, as well as difficulty breathing. In case of any of these symptoms, the patient should immediatelycontact their doctor.
    • Blood test results may indicate:
      • liver function disorders
      • increased activity of certain liver enzymes
      • increased bilirubin levels - a product of red blood cell breakdown, which can cause yellowing of the skin and eyes

    Rare side effects (may affect up to 1 in 1000 people)

    • Bleeding:
      • into the brain or spinal cord
      • into the lungs

    Side effects with unknown frequency (frequency cannot be estimated from the available data)

    • Bleeding:
      • into the abdominal cavity or retroperitoneal space
    • A skin rash, which can cause blisters and resembles small targets (dark spots in the center surrounded by a lighter border, with a dark ring around the edge) (erythema multiforme).
    • Vasculitis (inflammation of blood vessels), which can cause a skin rash or elevated, flat, red, round patches under the skin, or bruising.
    • Bleeding in the kidneys, sometimes with blood in the urine, leading to kidney function disorders (nephropathy associated with the administration of anticoagulant medicines).

    Additional side effects in children and adolescents

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    If the patient experiences any of the following symptoms, they should immediatelyinform their pediatrician:

    • Allergic reactions (hypersensitivity), which can cause: swelling of the face, lips, mouth, tongue, and/or throat, as well as difficulty breathing. The frequency of these side effects is "common" (may affect up to 1 in 10 people). In general, side effects reported in children and adolescents taking Apixaban Teva were similar to those observed in adults and were mostly mild or moderate. Side effects that occurred more frequently in children and adolescents were nosebleeds and abnormal vaginal bleeding.

    Very common side effects (may affect more than 1 in 10 people)

    • Bleeding, including:
      • from the vagina
      • from the nose

    Common side effects (may affect up to 1 in 10 people)

    • Bleeding, including:
      • from the gums
      • blood in urine
      • bruises and swelling
      • from the intestines or rectum
      • blood in stool
      • bleeding after surgery, including bruising and swelling, bleeding or fluid leakage from the surgical wound/incision (wound discharge) or injection site
    • Hair loss
    • Anemia, which can cause fatigue or pallor
    • Decreased platelet count (which can affect blood clotting)
    • Nausea (vomiting)
    • Skin rash
    • Itching
    • Low blood pressure, which can lead to fainting or rapid heartbeat
    • Blood test results may indicate:
      • liver function disorders
      • increased activity of certain liver enzymes
      • increased alanine aminotransferase (ALT) activity

    Side effects with unknown frequency (frequency cannot be estimated from the available data)

    • Bleeding:
      • into the abdominal cavity or retroperitoneal space
      • into the stomach
      • into the eyes
      • into the mouth or coughing up blood
      • from hemorrhoids
      • into the brain or spinal cord
      • into the lungs
      • into the muscle
    • A skin rash, which can cause blisters and resembles small targets (dark spots in the center surrounded by a lighter border, with a dark ring around the edge) (erythema multiforme).
    • Vasculitis (inflammation of blood vessels), which can cause a skin rash or elevated, flat, red, round patches under the skin, or bruising.
    • Blood test results may indicate:
      • increased gamma-glutamyltransferase (GGT) activity
    • Blood in stool or urine.
      • Bleeding in the kidneys, sometimes with blood in the urine, leading to kidney function disorders (nephropathy associated with the administration of anticoagulant medicines).

    Reporting side effects

    If the patient experiences any side effects, including any side effects not listed in this leaflet, they should tell their doctor or pharmacist.
    Side effects can be reported directly to the Department of Adverse Reaction Monitoring of Medicinal Products, Medical Devices, and Biocidal Products, Al. Jerozolimskie 181C, 02-222 Warsaw, Tel.: +48 22 49 21 301, Fax: +48 22 49 21 309,
    Website: https://smz.ezdrowie.gov.pl;
    Side effects can also be reported to the marketing authorization holder.
    Reporting side effects can help to gather more information on the safety of this medicine.

    5. How to store Apixaban Teva

    The medicine should be stored out of sight and reach of children.
    This medicine should not be used after the expiry date stated on the carton, bottle, and blister after EXP. The expiry date refers to the last day of the month.
    This medicine does not require any special storage conditions.
    Medicines should not be disposed of via wastewater or household waste. The patient should ask their pharmacist how to dispose of medicines that are no longer needed. This will help protect the environment.

    6. Contents of the packaging and other information

    What Apixaban Teva contains

    • The active substance is apixaban. Each tablet contains 2.5 mg of apixaban.
    • The other ingredients are:
      • Tablet core: lactose (see section 2), microcrystalline cellulose, sodium croscarmellose, sodium lauryl sulfate, magnesium stearate.
      • Coating: lactose monohydrate (see section 2), hypromellose 2910 (6 MPA.S), titanium dioxide (E 171), macrogol MW3350, triacetin, iron oxide yellow (E 172), iron oxide red (E 172).

    What Apixaban Teva looks like and contents of the pack

    Light yellow, round, film-coated tablets with the inscription "TV" on one side and "G1" on the other side. Dimensions: diameter 5.9 - 6.5 mm, thickness 3.0 - 3.6 mm.
    Transparent single-dose blisters of PVC/PE/PVDC/Aluminum, in a cardboard box containing: 10 x 1, 14 x 1, 20 x 1, 30 x 1, 56 x 1, 60 x 1, 100 x 1, 120 x 1, 168 x 1, 200 x 1 film-coated tablets.
    A white HDPE bottle with a white PP cap with a child-resistant closure, containing 180, 200, and 500 film-coated tablets, in a cardboard box.
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    A white HDPE bottle with a white PP cap with a child-resistant closure and a cotton plug, containing 180, 200, and 500 film-coated tablets, in a cardboard box.
    Not all pack sizes may be marketed.

    Patient Alert Card: information for use

    Inside the packaging of Apixaban Teva, next to the patient information leaflet, there is a Patient Alert Card or the doctor may give the patient a similar card.
    The Patient Alert Card contains information that is helpful to the patient and warns other doctors that the patient is taking Apixaban Teva. The patient should always carry this card with them.

    • 1. The patient should take the card
    • 2. The patient should fill in the following points or ask their doctor to fill them in:
      • Name:
      • Date of birth:
      • Indication:
      • Dose: ........ mg twice a day
      • Doctor's name:
      • Doctor's phone number:
    • 3. The patient should fold the card and always carry it with them

    Marketing authorization holder

    Teva Pharmaceuticals Polska Sp. z o. o.
    ul. Emilii Plater 53
    00-113 Warsaw

    Importer

    Balkanpharma-Dupnitsa AD
    3 Samokovsko Shosse Str.,
    Dupnitsa, 2600,
    Bulgaria
    Teva B.V.
    Swensweg 5
    2031GA Haarlem
    Netherlands
    To obtain more detailed information, the patient should contact the local representative of the marketing authorization holder:
    Teva Pharmaceuticals Polska Sp. z o.o., ul. Emilii Plater 53, 00-113 Warsaw, tel. (22) 345 93 00.

    This medicine is authorized in the Member States of the European Economic Area under the following names:

    Member State
    Marketing authorization holder

    Austria

    Apixaban ratiopharm 2,5 mg Filmtabletten
    BelgiumApixaban Teva Generics 2,5 mg filmomhulde tabletten / comprimés pelliculés / Filmtabletten
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    Bulgaria

    Апиксабан Тева 2,5 mg филмирани таблетки

    Czech Republic

    Apixaban Teva

    Germany

    Apixaban-ratiopharm 2,5 mg Filmtabletten

    Denmark

    Apixaban Teva

    Estonia

    Apixaban Teva

    Spain

    Apixaban Teva 2,5 mg comprimidos recubiertos con película EFG

    Finland

    Apixaban ratiopharm 2,5 mg tabletti, kalvopäällysteinen

    France

    Apixaban TEVA 2,5 mg, comprimé pelliculé

    Croatia

    Apiksaban Pliva 2,5 mg filmom obložene tablete

    Hungary

    Apixaban-Teva 2,5 mg filmtabletta

    Ireland

    Apixaban 2.5 mg and 5 mg Film-coated Tablets

    Iceland

    Apixaban Teva

    Italy

    APIXABAN TEVA

    Lithuania

    Apixaban Teva 2,5 mg plėvele dengtos tabletės

    Latvia

    Apixaban Teva 2,5 mg apvalkotās tabletes

    Luxembourg

    Apixaban-ratiopharm 2,5 mg Filmtabletten

    Netherlands

    Apixaban Teva 2,5 mg, filmomhulde tabletten

    Norway

    Apixaban Teva

    Romania

    Apixaban Teva BV 2,5 mg Film-coated tablets

    Poland

    Apixaban Teva

    Sweden

    Apixaban Teva 2,5 mg, 5 mg filmdragerade tabletter

    Slovenia

    Apiksaban Teva 2,5 mg filmsko obložene tablete

    Slovakia

    Apixaban Teva 2,5 mg

    United Kingdom

    Apixaban Teva 2.5 mg and 5 mg Film-coated Tablets

    Date of last revision of the leaflet: May 2025

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  • Country of registration
  • Active substance
  • Prescription required
    Yes
  • Importer
    Balkanpharma-Dupnitsa AD Teva B.V.

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She offers expert care for:

  • Headaches and migraines, including tension-type and cluster headaches.
  • Neck and back pain, both acute and chronic.
  • Chronic pain syndromes – fibromyalgia, neuropathic pain, post-traumatic pain.
  • Mononeuropathies – carpal tunnel syndrome, trigeminal neuralgia, facial nerve palsy.
  • Polyneuropathies – diabetic, toxic, and other types.
  • Multiple sclerosis – diagnosis, monitoring, long-term support.
  • Dizziness and coordination disorders.
  • Sleep disturbances – insomnia, daytime sleepiness, fragmented sleep.
  • Anxiety, depression, and stress-related conditions.

Dr. Agapova helps patients manage complex neurological symptoms like pain, numbness, weakness, poor sleep, and emotional distress. Her consultations focus on accurate diagnosis, clear explanation of findings, and tailored treatment plans.

If you’re struggling with chronic pain, migraines, nerve disorders, or sleep problems, Dr. Agapova offers professional guidance to restore your well-being.

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Doctor

Yevgen Yakovenko

General surgery11 years of experience

Dr. Yevgen Yakovenko is a licensed surgeon and general practitioner in Spain and Germany. He specialises in general, paediatric, and oncological surgery, internal medicine, and pain management. He offers online consultations for adults and children, combining surgical precision with therapeutic support. Dr Yakovenko works with patients across different countries and provides care in Ukrainian, Russian, English, and Spanish.

Areas of medical expertise:

  • Acute and chronic pain: headaches, muscle and joint pain, back pain, abdominal pain, postoperative pain. Identifying the cause, selecting treatment, and creating a care plan.
  • Internal medicine: heart, lungs, gastrointestinal tract, urinary system. Management of chronic conditions, symptom control, second opinions.
  • Pre- and postoperative care: risk assessment, decision-making support, follow-up after surgery, rehabilitation strategies.
  • General and paediatric surgery: hernias, appendicitis, congenital conditions, both planned and urgent surgeries.
  • Injuries and trauma: bruises, fractures, sprains, soft tissue damage, wound care, dressing, referral when in-person care is required.
  • Oncological surgery: diagnosis review, treatment planning, and long-term follow-up.
  • Obesity treatment and weight management: a medical approach to weight loss, including assessment of underlying causes, evaluation of comorbidities, development of a personalised plan (nutrition, physical activity, pharmacotherapy if needed), and ongoing progress monitoring.
  • Imaging interpretation: analysis of ultrasound, CT, MRI, and X-ray results, surgical planning based on imaging data.
  • Second opinions and medical navigation: clarifying diagnoses, reviewing current treatment plans, helping patients choose the best course of action.

Experience and qualifications:

  • 12+ years of clinical experience in university hospitals in Germany and Spain.
  • International education: Ukraine – Germany – Spain.
  • Member of the German Society of Surgeons (BDC).
  • Certified in radiological diagnostics and robotic surgery.
  • Active participant in international medical conferences and research.

Dr Yakovenko explains complex topics in a clear, accessible way. He works collaboratively with patients to analyse health issues and make evidence-based decisions. His approach is grounded in clinical excellence, scientific accuracy, and respect for each individual.

If you are unsure about a diagnosis, preparing for surgery, or want to discuss your test results – Dr Yakovenko will help you evaluate your options and move forward with confidence.

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Doctor

Jonathan Marshall Ben Ami

Family medicine8 years of experience

Dr. Jonathan Marshall Ben Ami is a licensed family medicine doctor in Spain. He provides comprehensive care for adults and children, combining general medicine with emergency care expertise to address both acute and chronic health concerns.

Dr. Ben Ami offers expert diagnosis, treatment, and follow-up for:

  • Respiratory infections (cold, flu, bronchitis, pneumonia).
  • ENT conditions such as sinusitis, ear infections, and tonsillitis.
  • Digestive issues including gastritis, acid reflux, and irritable bowel syndrome (IBS).
  • Urinary tract infections and other common infections.
  • Management of chronic diseases: high blood pressure, diabetes, thyroid disorders.
  • Acute conditions requiring urgent medical attention.
  • Headaches, migraines, and minor injuries.
  • Wound care, health check-ups, and ongoing prescriptions.

With a patient-focused and evidence-based approach, Dr. Ben Ami supports individuals at all stages of life — offering clear medical guidance, timely interventions, and continuity of care.

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Doctor

Salome Akhvlediani

Pediatrics11 years of experience

Dr Salome Akhvlediani is a paediatrician providing online consultations for children of all ages. She supports families with preventive care, diagnosis, and long-term management of both acute and chronic conditions.

Her areas of focus include:

  • Fever, infections, cough, sore throat, and digestive issues.
  • Preventive care – vaccinations, regular check-ups, and health monitoring.
  • Allergies, asthma, and skin conditions.
  • Nutritional advice and healthy development support.
  • Sleep difficulties, fatigue, and behavioural concerns.
  • Ongoing care for chronic or complex health conditions.
  • Guidance for parents and follow-up after medical treatment.

Dr Akhvlediani combines professional care with a warm, attentive approach – helping children stay healthy and supporting parents at every stage of their child’s growth.

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