Rivaroxaban versus Pradaxa?

[Pdotg]

My medical insurance here in South Africa refuses to pay for Rivaroxaban, but will pay for Pradaxa when pushed. When I next visit my EP I will run this by him to see if he will change my prescription. I'm hoping that the two drugs are interchangeable. I have had no side effects on Rivaroxaban and don't want to change, but it is very expensive. Has anyone else switched to Pradaxa?

[Finvola]

How strange Pdotg - I can't help with experience of the drugs as I take Apixaban but Rivaroxaban is actually cheaper than Dabigatran at (US)$78 and $82 respectively. Is Rivaroxaban licensed in South Africa? Course it is - you are currently taking it - sorry senior moment!

[Pdotg in reply to Finvola]

Well, that's the silly thing. Here Rivaroxaban is also slightly cheaper than Pradaxa/Dabigatran, but I guess they can only cope with one NOAC at a time. As you might have guessed, I am underwhelmed by the medical insurance company!

[Peddling]

I used Pradaxa for several months before my cardiologist changed me to apixaban. I had no problems with Pradaxa at all.

[SRMGrandma Volunteer]

I started with Pradaxa but after a year or two had some stomach discomfort so switched to the Rivaroxaban and have been fine. It is frustrating to have to change meds when one is working well with no side effects, but hopefully you will do great on the Pradaxa.

[prairie2016]

I took Pradaxa daily for three months after my ablation procedure. No problems for me.

[jennydog]

Could it have anything to do with the fact that Pradaxa now has an antidote (Praxbind)? I have been on Pradaxa since Aug 2014. I have had no problems with it beyond an original stomach uneasiness caused by taking an antacid. Pradaxa needs an acid stomach.

[Pdotg in reply to jennydog]

I wasn't aware that Pradaxa has an antidote, but that would perhaps make a difference to me, but I don't think the medical insurance is interested in the antidote. Patient welfare is not their top priority. A young clerk, no medical background, instructed me to ask my cardiologist to prescribe half the dose to reduce the cost!

[jennydog in reply to Pdotg]

The normal dose is 2x 150 mg daily. If you are taking verapamil, have a high risk of bleeding or are over 80 then the dose is 2x 110 mg daily. The tablets are taken 1 per 12 hours.

I have just read the above from the leaflet in the Pradaxa box. I hope it's useful.

Best wishes

[Pdotg in reply to jennydog]

Thanks Jennydog. So it's twice a day - something to think about as Rivaroxaban is just once a day.

[Finvola in reply to Pdotg]

Aaarrgh - who needs doctors Pdotg, when pen pushers can do the job? Best wishes with your battle.

[teach2learn]

It's possibly not being covered by your insurance due to suits currently ongoing for internal bleeding. At least that's what advertising here in US on TV says. They're always trying to get people in on class action suits against pharmaceuticals.

[Pdotg]

Interesting idea. I hadn't thought of that, but I suspect the real reason is money. They are trying to force me to go on warfarin as it is dirt cheap!

[GolfMyrtleBeach in reply to Pdotg]

As someone who had a warfarin related stroke ( at least that was a MD's guess", I would resist warfarin with a passion. Not to mention the lifestyle restrictions warfarin brings.

[PeterWh in reply to GolfMyrtleBeach]

I have not heard of a warfarin related stroke. To me this means warfarin is the contributor to the stroke. Please could you explain.

I have heard of a stroke when on warfarin but that was when the INR was below the therapeutic range when warfarin doesn't provide protection anyway. That is one of the advantages of the NOACs.

[GolfMyrtleBeach in reply to PeterWh]

My stroke was hemorrhagic in nature and not related to clotting. Apparently there is a higher incidence of spontaneous bleeds while on warfarin compared to the newer medications and so I was switched to rivoraxaban as a result. It should be noted that this episode occured just 3 weeks after a PVI ablation and so my INR had been manipulated a bit for that, which could also have been a factor

[PeterWh in reply to GolfMyrtleBeach]

In preparation for my ablation my target range was 2.5 to 3.5 although in the event on the day of the ablation it was only 2.2 (it had been swinging all over the place due to some natural intollerance to warfarin and the AF itself)

The hospital's / hospital policy is to take the warfarin up to and including the night before and then also on the day of the ablation so there was no gap. Mine did actually dip in the few days afterwards (I bought a coaguchek for the swinging reasons) so I increased my daily warfarin.