I have just had an annual medication review over the phone with a pharmacist. I am taking Apixaban 5mg twice daily together with low dose Flecainide (50mg x 2 daily) and Bisoprolol (2.5mg daily). The latter to offset any possible side effects from Flecainide!! I have been in sinus rhythm since April 2021.
The pharmacist stated that the current recommendation is that for anyone taking an anticoagulant they should also be taking a PPI (proton pump inhibitor). I am just trying to gauge whether other people have received or are following this advice. My instinct is to only take medication that is necessary (eg the anticoagulant) rather than taking one pill to offset possible side effects from another pill . Surely PPIs like all other drugs will also have their own side effects which may or may not affect any particular individual. My EP has never mentioned taking PPIs.
Any feedback/experience with this would be most welcome. Thanks Steve
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Hi, yes I've had a similar phone call from my pharmacy, albeit a few months ago. I'm on Rivaroxaban. I declined.I was seriously thinking of asking to change to Apixaban as that is absorbed from the duodenum and it's not essentialt to have to take food with it.
Interesting that they are advocating a PPI with Apixaban.
Hi, yes I can recommend Apixaban compared to Rivaroxaban (I've taken both). I seem to remember that I read somewhere that Rivaroxaban is often prescribed rather than Apixaban because Rivaroxaban only has to be taken once a day and this makes it less likely that people will forget to take it!
As I am sure you will know by now I am totally against PPIs as they are a self perpetuating drug. Once started is is very very difficult to come off them. many yeasr ago I was put on them before I understood this and even after three months the weaning off process took ages.
Thanks Bob. I think I'll give PPIs a miss for now.
Hiya Steve,
Sorry Steve, I can't make a worthwhile contribution to what the others have said - beyond my pay grade. However, I would like to ask a question if you don't mind. You talk about "annual medication review". Now I know this seems silly but you clearly have a medication review every year .............. so, has this been going on for many years? Has it occurred without fail?
The reason for asking is that I have been feeling increasingly unwell since having my Bisoprolol increased from 5 mg to 7.5 mg in January 2021. The worst now is feelings of intense coldness, total abject lethargy and tiredness, and very low HR in the range of 41 to 58 bpm which occurs at anytime of day or night. (I am also on Ramipril and Felodopine).
I was originally put on all my medication at the time AF was diagnosed in January 2010, so 12 & half years without a medication review. After shaking the "bone china" with my GP and Pharmacy I now have a medication review on 1 September 2022 ! The first in 12 & half years. Just curious about your experience. Thank you.
Hi John. I only started taking medication 2 years ago so this is my second annual review. I didn't ask for one the surgery just contacted me out of the blue by text. Sorry you're having all these symptoms after increasing your bisoprolol. Hope the pharmacist or GP can suggest some alternative for you. Steve
I have always had a yearly review with my doctor and my heart consultant, with ref to bisoprolol, I was on 5mgs, felt awful, my hr was 38/45 when I spoke to consultant, taken off it completely my hr is usually 55 now, pill was not replaced and my af episodes reduced too.
12 and a half years? That’s not good John. Don’t have the best surgery in the world, but I have a review every year….since I was 65, 12 years ago. Keep at them and good luck.
The only thing I have done annually is blood tests ( usual kidney and liver etc) and my INR blood testing device readings are checked against surgery device readings.
I have a review every year. I think this is recommended by the NHS with a view to getting you off any medication you no longer need - saves money that way.
What! I’m afraid the onus is on us to ensure we get a check up, ask questions. I’ve learned no one will bother, gone are those days I’m afraid. I haven’t had a cardiac check up for months, my GP’s don’t think it’s their job since I resorted to a private Consultant, we have a great rapport and been seeing him when necessary for years. Reading this, I’ve a call with my GP in a week or 2 so this’ll go on my list.
HiI finally went private and the history considered to try CCB Diltiazem. Added to my meds it was the best CONTROLLED from rapid there was.
Try and discard. Metroprolol I had had and discarded it AGAIN.
I would go to Dr and asked to be referred back to public that's what my private specialist said. My priv specialist wrote to my Dr saying thay I wanted to go public. Dr referred me to public cardiac specialist who was lacking to get me CONTROLLED but I never got to see again, the clician did ECG and 24hr monitotr. And then I asked Dr to send me for possible Ablation. She wrote to say it would be a long wait. In July it came around also me ringing the booking clerk. She squeezed me in after 6 months. He didnt mention Ablation.but laid it on line to me.
My AF will be for a lifetime. and to take meds as prescribed. That I would need to take PRADAXA (an ant-coagulant ) for the rest of my life.
Your thyroid (which I haven't got) is abnormal. I think I had a 4.9 reading so have got it down to 2 TSH.
He said no cardiversion or ablation for me as I have an enlarged chamber. Probably left ventricle which is not seen by a front Xray. That was only just normal.
He was going to discharge me but my questions alerted him to see me next year.
Otherwise I would not have been Controlled. if I had not gone to a private specialist.
I'm told the public Northland Cardiac has been off sick and it seemed she may retire.
It may be based on this study or similar, that suggests AC's may increase the risk of upper GI bleeding which can be mediated by taking the AC with a PPI.
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Personally, I wouldn't make a decision to take AC's solely based on this study, but I wouldn't ignore it either. I would first choose my AC wisely and then monitor and go over your individual risk factors of a GI bleed with your doctor, not to mention research some more and keep up with the literature. You might also speak to your pharmacist and ask if this is something they would personally recommend or if he is simply reading a directive.
I am neither pro or anti PPI and reluctantly take one daily because of LPR/GERD which can at times be quite troublesome, not to mention trigger my afib. They certainly have their place but while there are studies that they do have a long term safety profile, there are not without consequence.
I had an ablation recently for AF and flutter. I was told to.stay on all usual meds apixabsn,flec and biso and to tale low dose of Ppi for 6 weeks in case of irritation to oesophagus . But not otherwise. Did they say why this was recommended?
It was to offset any risk of GI bleeding due to taking an anticoagulant. I suppose it's just a matter of balancing different risks and hoping you make the right decision!
It's a hard call sometimes but I'm with you on this, more and more drugs is not ideal.
This study, unfortunately, indicates that there is a dementia risk from long term use of PPIs. So people taking Apixaban -including myself- have to decide whether to accept the risk of a GI bleed or the risk of neurological damage. Presumably, for the pharmacist to recommend the PPI, they must think the risk of a bleed outweighs the latter risk.
Spot on there! If you do not have any side effects from Apixaban why take another med ( which is by no means benign for long term use) to counteract "possible" rather than actual side effects. I would like to know the NNT for this recommendation- if there is one.
I got pacemaker fitted 2014. i take bisoprolal3.75, fleconide 100, lanzaprazol15mg, ,warfarin 3mg, for my AF.also take tomlousin 400, and finasteride 5mg for BPH.
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