Edoxaban switch

[rothwell]

I have just had a phone call from the pharmacist at my GP surgery. Because recent blood test indicated that my kidneys are not functioning well, he is suggesting that I change from Apixaban to Edoxaban 30mg as this will ensure that there will not be an excess of anticoagulant in my body which could cause a bleed. This does sound like good advice but just wondered if this has happened to anyone else and would also be grateful to hear about experiences with Edoxaban.

[meadfoot]

I had something similar with my anticoagulant, rivaroxaban, when my liver and kidney function blood test was an issue. In my case they just dropped my dosage from 20mg per day to 15mg. All subsequent kidney and liver function tests have been fine so i havent had to change anticoagulant. Cant help re edoxaban unfortunately. Hope the change of anticoagulant suits you better.

[rothwell in reply to meadfoot]

Thank you...the pharmacist did suggest Rivaroxaban. Maybe I'll consider that.

[cicek in reply to rothwell]

Same thing happened to me with Rivoraxaban. Like meadfoot my pharmacist reduced the dose to 15mg for a while and once things settled down went back back up to 20mg. No problem since. Good luck.

[meadfoot in reply to rothwell]

I have been taking Rivaroxaban for years without any bad effect. The reason it had slightly affected my liver and kidney function was purely, i am told by my medics, was because i am slight in build and dont weight much so the lower dose was better for me. Hope you are fine on it if you choose to take it. Best sishes.

[rothwell]

The pharmacist is now employed at my GP surgery. Apparently this is happening at lot of GP surgeries in order to work with the GPs on issues such as this and I think the GP had asked him to ring me. He quoted various kidney levels to me with regard to dosage of anticoagulants...sounded pretty knowledgeable to me..but hey what do I know!!!

[baba in reply to rothwell]

S/he probably has a much greater understanding of drugs and effects than your GP

[Storminnormin44]

I did the same change for other reasons and no other side effects.

[Hidden]

I am not a doctor but I believe that Apixaban is 25% renally excreted and Edoxaban is 40% renally excreted. Other NOACs have higher rates of renal excretion e.g. Dabigatran is 80%.Assuming that the pharmacist is comparing the standard doses of Apixaban and Edoxaban, I don't see how Edoxaban would be an improvement. There is a lower dose of Apixaban available for patients with impaired kidney function. Perhaps this is a cost decision as the NOACs are all about the same price except Edoxaban which is significantly cheaper. Perhaps you should ask your doctor for an explanation.

I notice from other posts that GP surgeries are now employing pharmacists who are indeed interfering with medication decisions. This happened to me when I messaged my GP asking to be changed from Dabigatran to Apixaban, as Apixaban has the best reputation amongst cardiologists, and my kidney function is not bad but not ideal, and Apixaban has the lowest renal excretion rate. The pharmacist rang me and started an interrogation, and I realised that he had no idea about renal excretion rates. I stopped the conversation and told him that prescribing was a matter for my GP.

[rothwell in reply to Hidden]

Thanks Mike for this interesting information. I am a bit confused by all of this It is my interpretation that because my kidneys are not functioning well then they may not be getting rid of the necessary level of Apixaban which means that more is remaining in my body thereby increasing the risk of a bleed. Is it not better then to have a higher excretion rate like that of Edoxaban. By the way the pharmacist is recommending that I take 30mg of Edoxaban not the standard dose of 60mg.

[Hidden]

The lower excretion rate is better with regarding renal function as it means that the kidneys are only excreting 25% of the total excretion figure. The pharmacist is reducing the standard Edoxaban dose to allow for your impaired renal function, so why did he not just reduce the Apixaban dose, which would have reduced the load on your kidneys even more than the lower dose of Edoxaban? I wouldn't be surprised if these pharmacists employed by GP surgeries have cost cutting targets.I have had a similar problem with a pharmacist who has just appeared in my GP surgery and has already attempted to interfere with my prescriptions.