ELIQUIS 2.5 mg FILM-COATED TABLETS

2. What you need to know before you take Eliquis

Do not take Eliquis if

• you are allergicto apixaban or any of the other ingredients of this medicine (listed in section 6);
• you have excessive bleeding;
• you have a disease in an organof the body that increases the risk of severe bleeding (such as an active or recent stomach or intestinal ulcer, or recent brain hemorrhage);
• you have a liver diseasethat increases the risk of bleeding (hepatic coagulopathy);
• you are taking medicines to prevent blood clotting(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 having a tube inserted into a blood vessel (catheter ablation) to treat an irregular heartbeat (arrhythmia).

Warnings and precautions

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

• a increased risk of bleeding, such as:
• bleeding disorders, including situations that result in a decrease in platelet activity;
• very high blood pressure, not controlled by medical treatment;
• you are over 75 years old;
• you weigh 60 kg or less;
• a 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 liver function alteration
• you have had a catheter or received an injection in your 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 with Eliquis

• 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 have surgery or a procedure that may cause bleeding, your doctor will tell you to temporarily stop taking this medicine for a period of time. If you are not sure if a procedure may cause bleeding, consult your doctor.

Children and adolescents

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

Using Eliquis with other medicines

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 Eliquis and some medicines may decrease its effects. Your doctor will decide if you should be treated with Eliquis if you are taking these medicines and if you should be kept under closer observation.

The following medicines may increase the effects of Eliquis and increase the risk of unwanted bleeding:

• some medicines for fungal infections(e.g., ketoconazole, etc.);
• some antiviral medicines for HIV/AIDS(e.g., ritonavir);
• other medicines to reduce blood clotting(e.g., enoxaparin, etc.);
• anti-inflammatoryor 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);
• antidepressantscalled selective serotonin reuptake inhibitorsor serotonin-noradrenaline reuptake inhibitors.

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

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

Pregnancy and breastfeeding

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

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

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

Driving and using machines

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

Eliquis contains lactose (a type of sugar) and sodium

If your doctor has told you that you have an intolerance to some sugars, talk to them before taking this medicine.

This medicine contains less than 1 mmol of sodium (23 mg) per tablet; this is essentially “sodium-free”.

3. How to take Eliquis

Follow exactly the instructions for administration of this medicine given by your doctor or pharmacist. If you are unsure, consult your doctor, pharmacist, or nurse.

Dosage

Take the tablet with water. Eliquis 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 Eliquis. The tablet can be crushed and mixed with water, 5% glucose in water, apple juice, or apple puree, immediately before taking it.

Instructions for crushing:

• Crush the tablets with a mortar.
• Transfer all the powder carefully into a suitable container, mixing the powder with a small amount, e.g., 30 ml (2 tablespoons), of water or any of the other liquids mentioned to make the mixture.
• Take the mixture.
• Rinse the mortar and pestle 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 Eliquis tablet mixed in 60 ml of water or 5% glucose in water through a nasogastric tube.

Take Eliquis according to the following recommendations:

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

The recommended dose of Eliquis is one 2.5 mg 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 to 24 hours after surgery.

If you have had major hipsurgery, you will usually take the tablets for a period of 32 to 38 days.

If you have had major kneesurgery, you will usually 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 Eliquis is one 5 mg tablet twice a day.

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

• you have severely reduced kidney function;
• you have two or more of the following factors:
• • your blood test results suggest poor kidney function (the serum creatinine 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 tabletsof Eliquis 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 tabletof Eliquis twice a day, for example, one tablet in the morning and one tablet in the evening.

To prevent blood clots from recurring after 6 months of treatment

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

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

Use in children and adolescents

For the treatment of blood clots and to prevent these blood clots from recurring in the veins and blood vessels of the lungs.

Follow exactly the instructions for administration of this medicine given by your doctor or pharmacist. If you are unsure, consult your doctor, pharmacist, or nurse.

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

The dose of Eliquis depends on body weight and will be calculated by the doctor.

The recommended dose for children and adolescents with a weight of at least 35 kg is four 2.5 mg tabletsof Eliquis twice a day for the first 7 days, for example, four tablets in the morning and four in the evening.

After 7 days, the recommended dose is two 2.5 mg tabletsof Eliquis twice a day, for example, two tablets in the morning and two in the evening.

For parents and caregivers: observe the child to ensure they take the complete dose.

It is important to keep scheduled appointments with the doctor, as it may be necessary to adjust the dose based on changes in weight.

Your doctor may change your anticoagulant treatment as follows:

• Changing from Eliquis to other anticoagulant medicines

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

• Changing from other anticoagulant medicines to Eliquis

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

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

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 Eliquis.

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

If your doctor tells you to start taking a medicine that contains a vitamin K antagonist, continue taking Eliquis 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 Eliquis.

Patients undergoing cardioversion

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 Eliquis than you should

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.

If you take more Eliquis 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 take Eliquis

• If you forget a morning dose, take it as soon as you remember and you can take it with the evening dose.
• If you forget an evening dose, you can only take it during that same night. Do not take two doses in the morning, but continue taking the medicine the next day as usual, twice a day as recommended.

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

If you stop taking Eliquis

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 further questions on the use of this medicine, ask your doctor, pharmacist, or nurse.

4. Possible Adverse Effects

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

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

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, blood or fluid secretion 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 that can cause fainting or a faster heart rate;
• Blood tests may show:

• abnormal liver function;
• increase in some liver enzymes;
• increase in bilirubin, a product derived from 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 produce: swelling of the face, lips, mouth, tongue, and/or throat, and difficulty breathing. Inform your doctor immediatelyif you suffer from 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 the 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 that show blood in the stool or urine;

• 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 and smooth red spots under the skin surface or hematomas.

The following adverse effects have been reported when taking Eliquis 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 that 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, blood or fluid secretion from the wound/surgical incision (suppuration) or at the injection site;
• hemorrhoidal;
• tests that show 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;
• increase in some liver enzymes;
• increase in bilirubin, a product derived from red blood cells, which can cause yellowing of the skin and eyes;
• Skin rash;
• Itching;
• Hair loss;
• Allergic reactions (hypersensitivity) that can produce: swelling of the face, lips, mouth, tongue, and/or throat, and difficulty breathing. Inform your doctor immediatelyif you suffer from any of these symptoms.

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

• Bleeding:

• in the lungs or throat;
• in the space behind the abdominal cavity;
• 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 the available data)

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

The following adverse effects have been reported when taking Eliquis 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 that 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 that show blood in the stool or urine;
• bleeding after surgery, including hematoma and swelling, blood or fluid secretion from the wound/surgical incision (suppuration); or at the injection site;
• hemorrhoidal;
• in a muscle;

• Itching;
• Hair loss;
• Allergic reactions (hypersensitivity) that can produce: swelling of the face, lips, mouth, tongue, and/or throat, and difficulty breathing. Contact your doctor immediatelyif you suffer from any of these symptoms.
• Blood tests may show:

• abnormal liver function;
• increase in some liver enzymes;
• increase in bilirubin, a product derived from 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 the available data)

• Bleeding:

• in the abdomen or the space behind the abdominal cavity.
• 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 and smooth red spots under the skin surface or hematomas.

Additional Adverse Effects in Children and Adolescents

Inform the child's doctor immediatelyif you observe any of these symptoms:

• Allergic reactions (hypersensitivity) that can produce: swelling of the face, lips, mouth, tongue, and/or throat, and difficulty breathing. These adverse effects are frequent (may affect up to 1 in 10 people).

In general, the adverse effects observed in children and adolescents treated with Eliquis were similar to those observed in adults and were mainly of mild to moderate intensity. The most frequent adverse effects observed in children and adolescents were nosebleeds and abnormal vaginal bleeding.

Very Frequent Adverse Effects (may affect more than 1 in 10 people)

• Bleeding, including:

• vaginal;
• nasal.

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

• Bleeding, including:

• from the gums;
• blood in the urine;
• hematoma and swelling;
• from the intestine or rectum;
• bright/red blood in the stool;
• bleeding after surgery, including hematoma and swelling, blood or fluid secretion from the wound/surgical incision (suppuration) or injection site;

• Hair loss;
• Anemia, which can cause fatigue or paleness;
• Decrease in the number of platelets in the child's blood (which can affect coagulation);
• Nausea (general discomfort);
• Skin rash;
• Itching;
• Low blood pressure that can cause fainting or a faster heart rate in the child;
• Blood tests may show:

• abnormal liver function;
• increase in some liver enzymes;
• increase in alanine aminotransferase (GPT).

Frequency Not Known (cannot be estimated from the available data)

• Bleeding:

• in the abdomen or the space behind the abdominal cavity;
• in the stomach;
• in the eyes;
• in the mouth;
• hemorrhoidal;
• in the mouth or coughing up blood;
• in the brain or spinal cord;
• in the lungs;
• in a muscle;

• 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 and smooth red spots under the skin surface or;
• Blood tests may show:

• an increase in gamma-glutamyl transferase (GGT);
• tests that show blood in the stool or urine.

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 does not appear in this leaflet. You can also report them directly through the national reporting system included in Appendix V. By reporting adverse effects, you can contribute to providing more information on the safety of this medicine.

5. Storage of Eliquis

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiration date that appears on the packaging and on each blister, after EXP. The expiration date is the last day of the month indicated.

This medicine does not require special storage conditions.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of the packaging and any unused medicine. This will help protect the environment.

6. Package Contents and Additional Information

Composition of Eliquis

• The active ingredient is apixaban. Each tablet contains 2.5 mg of apixaban.
• The other ingredients are:

• Core of the tablet: (see section 2 "Eliquis contains lactose (a type of sugar) and sodium"), microcrystalline cellulose, sodium croscarmellose (see section 2 "Eliquis contains lactose (a type of sugar) and sodium"), sodium lauryl sulfate, magnesium stearate (E470b);
• Coating: , (see section 2 "Eliquis contains lactose (a type of sugar) and sodium"), hypromellose (E464), titanium dioxide (E171), triacetin, yellow iron oxide (E172).

Appearance of the Product and Package Contents

The film-coated tablets are round (6 mm in diameter), yellow in color, and have "893" engraved on one side and "2½" on the other.

• They are available in blisters within packages containing 10, 20, 60, 168, and 200 film-coated tablets.
• Unit-dose blisters are also available in clinical packages containing 60 x 1 and 100 x 1 film-coated tablets.

Not all pack sizes may be marketed.

Patient Information Card: Information Management

Inside the Eliquis package, 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 Eliquis. 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

Bristol-Myers Squibb/Pfizer EEIG

Plaza 254

Blanchardstown Corporate Park 2

Dublin 15, D15 T867

Ireland

Manufacturer

CATALENT ANAGNI S.R.L.

Loc. Fontana del Ceraso snc

Strada Provinciale Casilina, 41

03012 Anagni (FR)

Italy

Pfizer Manufacturing Deutschland GmbH

Mooswaldallee 1

79108 Freiburg Im Breisgau

Germany

Swords Laboratories Unlimited Company T/A Bristol-Myers Squibb Pharmaceutical Operations, External Manufacturing

Plaza 254

Blanchardstown Corporate Park 2

Dublin 15, D15 T867

Ireland

Pfizer Ireland Pharmaceuticals

Little Connell Newbridge

Co. Kildare

Ireland

Date of Last Revision of this Leaflet {MM/YYYY}.

Detailed information on this medicine is available on the European Medicines Agency website: http://www.ema.europa.eu/.