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AF Association
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Can a GP swap you from Rivaroxaban to Apixaban?

I've tried to find this info here and on Google but still not sure although I don't see why not. My spell of AF has coincided with one of diverticulitis/IBS (chicken or egg?) and sometimes it would be best to have a very light meal, if any, in the evening but then my Rivaroxaban won't be effective. For several reasons I think Apixaban would suit me better.

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I've just recently changed from Dabigatran to Edoxaban after discussions with my Cardio. My GP was reluctant to change without the go-ahead from the Cardio. I found the Dabigatran was irritating my stomach and I'm feeling much better on Edoxaban.

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I saw my cardiologist recently so missed the boat there unfortunately.

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Just ask your GP to write to the cardiologist. It doesn't need you to visit the cardiologist - all he/she has to do is review your notes.

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Hi Buff :-) you can always ask and if they can't they should be able to ask your consultant .

I chose my own anticoagulant (Apixaban) the consultant just suggested I should have one but didn't specify which one.

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True, although last time I spoke with my GP about a cardiac issue she suggested I call the cardiologists secretary! I'm getting a monitor fitted on Wednesday so if she's unhelpful I may be able to ask then.

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Yes. This is not a heart medication it is for stroke prevention and what suits you , you should have. Not up to anybody .

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Your very right BobD ...I was given a selection to choose from

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My GP changed me from Warfarin to Apixaban without consulting anyone...or doesn't this count?

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Hi Buffafly - I sympathise and personally I would definitely try the switch. (When I did it after a year of rivaroxaban, I found it very liberating not to have to take the meds with a meal.)

Regarding who can prescribe it -yes I’m sure it’s under the GPs authority. My GP started me on rivaroxaban immediately when I told him I’d been diagnosed with AF (via my implanted loop recorder download - incidentally I was informed of the diagnosis by a technician, and not seen / contacted by any cardiologist. Horrendous!). So my GP was just concerned to get me anticoagulated. Even though a letter came from the hospital a month or so later asking the GP to anticoagulate me & suggested apixaban, the GP kept me on his preference of rivaroxaban.

Good luck - hope you get apixaban and it helps xx

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My GP was happy to change my anticoagulant from warfarin to a DOAC and asked me which one I preferred. I chose Apixaban and have no regrets.....

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My cardiologist chose Rivaroxaban for me but only because I asked him to so I don't think there should be a problem with changing.

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exactly what happened to me.

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yes GP can change you- mine did

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My GP wouldn't change me from warfarin to a doac, said I had to see my consultant.

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A few years ago I asked my GP about changing from Warfarin to an NOAC and he offered Rivaroxaban. When I told him my EP had recommended Dabigatran for me, he said he couldn't give that without a request from my EP and said they usually recommended Rivaroxaban as that was the one they knew most about. In my mind I'm afraid I thought he wanted me to have that as it was the cheapest one, though I had no idea if that was true. I decided to stay on Warfarin.

Jean

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GP's do not normally interfere with a consultant's diagnosis and medication they would sooner you return to the Consultant, why....because the Consultant is better qualified in their particular field of specialisation.

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Thanks everyone, I'll phone my GP on Tuesday and see what she says, then report!

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No trouble with my GP who was happy to move me from Warfarin to Rivaroxaban.

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Similar class of drugs that are used interchangeably so it should really be your preference. That said Rivaroxaban can be taken with or without food, nor have I read anything to suggest the content of your meal will effect its efficacy.

Jim

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See below, sorry, meant for you.

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The instructions for the Rivaroxaban dose I take are that it should be taken with or straight after a meal to be fully effective. Also I have seen several posts here saying on good authority that it needs to be a full meal with some fat in it. Last night I had a very painful stomach and bloating and could only manage light soup and a bread roll and would really have preferred just the soup!

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Buffafly, Well it seems you may be right but I also may be right! Let me explain. First, yes, the label says take with the evening meal and so does the Xerelto web site. However, if you google "Xerelto with or without food" you will find many reputable sources that say it doesn't matter. And then there's this study that said it doesn't matter.

From the study: "....Findings from a cross-study analysis of rivaroxaban (Xarelto; Janssen) indicate that neither the timing nor the content of a meal seem to clinically impact the pharmacokinetics (PK) of the drug..."

empr.com/news/rivaroxaban-x...

According to my pharmacist, the original Xerelto FDA study was done with with Xerelto taken at dinner and the pharmacist inferred that was the reason for the labeling. I'm certainly not telling anyone to take Xerelto without food but there do seem to be a couple of opinions on this.

FWIW I took Xerelto both with and without food but mostly without and never had any stomach upset or GERD which I have a strong tendency toward.

Jim

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Interesting but not totally reassuring as it still refers to 'a meal' which is defined as at least 300 calories.

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Interesting to read these replies. I recently changed from Pradaxa (I had been on it for more than five years) to Eliquis which was recommended after a consultation in a specialist hospital anticoagulant clinic run by Pharmacists. These noacs are all designed for the same purpose but they do not all act in the same way and side effects differ. Pradaxa has to be taken with food and a significant number of people find it affects their gut adversely. It is also known to be hard on the kidneys when used for a prolonged period. The selection of a noac and the dose to be taken should be made with specialist support and not without prior tests. Should also add that in some parts of England the CCG will only approve changing a noac on a hospital consultant’s recommendation - the GPs are not authorised to do it.

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