Edoxaban question.

[6jane2]

I have been suffering really badly with anxiety and panic attacks that I have had to go on Citalopram 20mg to try and help me. The doc has now given me Edoxaban 60mg and after reading the notes that come with it it says to speak to a doctor first before you take these if you are on certain medications which Citalopram is one. I rang the docs and receptionist said the doc wouldn’t of prescribed if they thought there would be a problem and was very unhelpful. Anyone else out there take both of these so I can put my mind at ease? I also take bisoprolol 1.25mg and Candesartan 8mg

[jedimasterlincoln]

Just had a look in our BNF at work... it's because of the risk of bleeding events same as something like Ibuprofen or a none steroidal anti inflammatory would be a risk when taking Edoxaban/Warfarin/Apixaban "use with caution or avoid"

It's also worth noting it can result in QT-interval prolongation - an arrhythmia (the time it takes the heart to "recharge" and beat again.. and again..) as well as palpitations but I don't know if the bisoprolol will negate these potential problems.

[Hidden]

There are several warnings relating to heart arrythmias on the patient leaflet.

I was prescribed this a few months ago and tried to question my GP about it, I got the same response as you from the receptionist.

i felt terrible on this medication, I honestly felt like my heart was going to explode, and my Kardia readings looked very odd.

I persevered for 10 days and could not take the side effects any longer

Please be careful with this one

[Hidden]

The NICE BNF interaction chart for this combination suggests there is a theoretical risk of a severe interaction, based on an effect on platelet function. It also seems to suggest that they did not find any case reports. This action is different from the action of non steroidals which can have a direct effect on the lining of the upper gastrointestinal tract.

My impression is that when GPs prescribe, any interactions are “red flagged” on the screen, in which case your GP may well be aware.

When you consider the huge numbers of patients on anticoagulants and the even larger number of patients on SSRI antidepressants, with presumably tens of thousands on both, if there were a real world problem rather than a theoretical one, I think it would be quite apparent. Clearly if someone has a history of upper GI problems, especially bleeding, then caution is needed and a PPI may be necessary.

If anxiety and panic attacks are very disabling, your GP may feel the greater risk would be in withholding an SSRI, which as a class are usually highly effective. Have a look at the thread yesterday about SSRIs and potential prolonged QT, which I think you may feel is more significant. Have a word with your pharmacist if you can’t reach your GP.

My sense is that nearly all patients on this combination who do not have GI problems, are fine. I know how destructive anxiety can be and if your GP is fully aware of your medical history and medication, then it would be unfortunate not to take something that may well turn your life round, as it did me.

The article below explains about SSRIs and effect on platelets.

ncbi.nlm.nih.gov/pmc/articl...

By way of context, I should say that I have had AF, and taken a combination of SSRI and different anticoagulants for ten years without problems. I did not have a previous history of GI problems and have had none subsequently.

[cassie46]

Hi there - I was on Citalopram a few years ago due to stress - I think my dose was 10mg. My anticoagulant is Rivaroxaban and had no problems. I was also on Bisoprolol and Ramipril at the time. It did help and I was only on them for about 4 months. I know of others on the forum that have taken them also.

Cassie

[Geonome]

I also am on an SSRI, Escitalopram 5 mg, which is very similar to Citalopram, as the name suggests. I'm also on Metoprolol and Apixaban. I discussed the warnings with my psychiatrist, who prescribed the Escitalopram, and she didn't think it was an issue. The only issues I have is a low heartbeat (50bpm) and low blood pressure (100/50) with the Metoprolol, which I've reduced to 1/4 of a 25 mg tablet twice a day. And so I continue to have afib episodes, unknown whether related to stress, diet, etc. I'm still trying to control the episodes with various herbal products, diets, but so far the only success I have is when I increase the Metoprolol, which I'm not willing to do long term. I appreciate all the suggestions I have read on this forum, lots of ideas, but so far, limited success for me.

It's kind of frustrating when you cut out chocolate, fatty food, big meals, tea, sugar, etc. lie on your right side only, do not hold the computer tablet on your lap, etc. etc. etc. and then you feel the familiar irregular pounding of your heart. 3 times last week!!!! Stopped with PIP.

Sorry for the rant.