The metabolism of apixaban primarily occurs in the liver, involving the cytochrome P450 system, particularly CYP3A4 and CYP3A5 enzymes. Apixaban is also a substrate for P-glycoprotein, which influences its absorption and excretion. The drug is eliminated via multiple pathways, including renal and biliary excretion, making it important to consider in patients with hepatic or renal impairment.
