Oral anticoagulant formulations suggested for adults with swallowing difficulties

Karoline Brennan, Senior Medicines Information Pharmacist, North West Medicines Information CentrePublished

A range of oral anticoagulants are suitable for adults with swallowing difficulties.

Licensed medicines in suitable formulations

Warfarin 1mg/1ml oral suspension

Available as a licensed preparation. It does not require fridge storage and has an expiry of 28 days once opened.

Apixaban (Eliquis) tablets

Film-coated but are licensed to be crushed and dispersed in water, glucose 5%, apple juice or apple puree.

Edoxaban tablets

Film-coated but are licensed to be crushed and mixed with water or apple sauce.

Rivaroxaban (Xarelto) tablets

Film-coated but are licensed to be crushed and mixed with water or apple puree. Crushed 15mg and 20mg strengths should be immediately followed by food.

Rivaroxaban granules for oral suspension

After reconstitution, the suspension has an expiry of 14 days. It does not require fridge storage.

Licensed medicines used in an unlicensed manner

Warfarin tablets

Can be crushed and/or dispersed in water or crushed and given with soft food.

Apixaban, edoxaban and rivaroxaban tablets

Can be crushed and given with soft food. (They are licensed to be given with apple puree/apple sauce.)
Note: Dabigatran capsules must not be opened; bioavailability of the capsule contents may be increased by 75% when taken without the shell.

Special-order medicines

In view of the licensed options available, special-order preparations are unlikely to be required.