Apaxiban

[jeffsimon]

I am a 75 yr old male with paroxysmal AF. Over the years I have tried various anti-coagulants and they all give me very unpleasant side effects. The anti-coagulant with the least unpleasant side effect is Apaxiban. However the recommended dose of 5mg twice a day still gives me problems. My cardiologist is reluctant to prescribe a reduced dose of 2.5 mg twice per day, so for past month I have been slicing the 5mg pill in half. The result is no more unpleasant side effects. I'm not asking whether I should or shouldn't be self self-prescribing my dosage. My question is whether the total of 5 mg per day is giving me some, albeit a limited protection against stroke. In other words is half the recommended dosage better than not taking it at all?

[doodle68]

Hi Jeff only your Doctor can tell you if what you are doing is advisable.

The dose can be reduced under certain circumstances as mentioned below, maybe check if you meet any of the criteria. ...

bnf.nice.org.uk/drug/apixab...

then discuss it with your doctor, anticoagulation is not something to be 'taken lightly' is it .

Sometimes changing the time of day when you take a medication can reduce the side effects.

[jeffsimon in reply to doodle68]

Hi doodle68-- Thank you for very kindly responding. I'm fully aware of the criteria for taking a reduced dosage.

[Jlaine in reply to jeffsimon]

If you are fully aware of the risk you are taking then what are you asking?? I believe we both know you are playing Russian rollett! Perhaps you will be lucky hopefully or throw a clot that could be lethal!! I also have side effects from apixiban but not willing to out my life on the line!! Best of luck to you

[BobD Volunteer]

Your choice but never look back and say I wish. If you can that is. There are strict guidelines for reduced dose as Doodle has indicated.

At HRC last weekend I was button holed by a lady who was asking me why two of her freinds on reduced dose had strokes! I referred her to a pasing arrhhythmia nurse who explained the criteria for reduced dose and also that no anticoagulant could totally remove stroke risk. I believe the reduction in risk is about 70% where full dosing is present.

[Hidden]

I suspect only a pharmacologist with access to the dose response curves for apixaban, and clinical trials for outcomes of different dosing regimes, which must have been used by the manufacturer, could give you an informed answer to that.

Dose vs effect of medication is not necessarily linear, think of warfarin which has a narrow therapeutic range, and a small change in dose can have a major effect on blood levels.

I see the logic implicit in your question given the, on the face of it, somewhat arbitrary dose change at age 80.

I understand you have asked a specific question and not for advice, but nonetheless in my opinion the risk of halving the dose must be out of all proportion to possible side effects. Why not try another anticoagulant?

[Hidden]

I wonder what your side effects are jeffsimon. Clearly not a good idea to tinker about with recommended doses because the consequences are likely to be serious. The dose reduction due to age is to compensate for a reduction in renal and possibly liver function, which for most, but not all, tends to be age related.

[noviceAFIB]

To answer your last question directly, taking 1/2 dosage is definitely better not taking any at all for stroke protection.

Since

(1) there is no test now to determine if 10mg or 7.5mg is 'thin enough' with Eliquis &

(2) no Cardiologist will ever say '7.5mg is safe',

patients assume additional stroke risk of not taking 10mg.

7.5mg refers to taking 2.5mg in the morning & 5mg at dinner/bedtime for example.

Before taking reduced dosage, I would try 4x2.5mg spread out the 24 hour period to see if side effects would subside/become bearable.

In my case, I am 'fortunate' enough to have excessive nose bleed to tell me whether my blood is 'too thin'.

If one must continue to take reduced dosage, I would take blood-thinning agents like apple cider vinegar with water, ginger, and garlic etc.

[Jlaine in reply to noviceAFIB]

Good advice!!

[Hidden]

Hi again jeffsimon,

Just to make you aware, the vast majority of people on this forum are not medically trained therefore you should always follow your doctor’s advice regarding medication and dosages.......

[CDreamer]

Interesting. I have never understood about standardized doses when we are are all so different, absorp and metabolize very differently and react very differently.

I think there are two issues - the first the side effects which could be caused by a caking agent in the tablet and the amount of active ingredient being absorbed into your system giving you protection which for me would be the priority.

If the side effects are troublesome then I think you should return to your doctor and work through a resolution as I don’t the option of cutting them in half is a solution as far as anti-coagulation protection is concerned.

[GrannyE]

What are your unexceptable side effects? I have been told by my cardiologist that if you take apixaban then your stroke probability is reduced to more or less that of the normal population. They are giving me kidney tests to check it is not having a bad effect upon them. I was swapped to Apixaban from warfarin which made my hair fall out in handfuls I think you need to talk to your cardiologist or GP about halving your Apixaban. A stroke is a very high price to pay for not taking sufficient meds. Good luck

[jeffsimon]

Many thanks to everyone who kindly offered advice. It's very much appreciated.

[Jlaine]

Jeff its a no brainer! You are cutting your chances of protecting you from clots in half. Setting yourself up for possibly having a stroke !!!Just saying. I don't like taking them either but I don't want to have a stroke either. There are two procedures that can be done to eliminate having to take bloodthinners. They are the Larriet and the watchman! Talk to your dr about them..Good luck. and listen to your dr.

[radagast58 in reply to Jlaine]

Very useful article

citoday.com/2017/06/anticoa...

[Nugger]

Have you looked at nattokinase ?

[avrambaer]

The answer is yes and yes. My problem(?) with physicians has sometimes been that they become dogmatic. Anti-coagulants are, a priori, trial and error. As long as one is methodical, the results improve when modifying dosage of anti-coagulants.

[wilsond]

I saw on here that for patients who cannot tolerate anticoagulants that there is a proceedure called a Watchman device,which is availabke on nhs albeit limited to those who meetbthe criteria.

Do you mind sharing what side effects you have? I take apixaban and apart from blotchy legs,havent noticed and effects.Bisoprolol didnt suit me at all though.

[jeffsimon]

Once again many thanks to all the very kind people taking the time and trouble to offer their advice.