Affect of tummy upsets on anti-coagulants,

[pusillanimous]

I was wondering what effect it has on the absorption of anti-coagulants, should something cause you to have diarrhoea - how long does it take after ingestion does it take something like an Eliquis tablet to become effective ?

[Hidden]

Interesting question. It’s my understanding that once taken, it’s not long before DOAC’s provide a good level of protection against the formation of blood clots. I certainly wouldn’t consider repeating the dose ahead of time without seeking proper medical advice. I guess much the same applies if someone vomits soon after taking their medication. Looking forward to reading the replies……

[pusillanimous in reply to Hidden]

I'm very interested too, hence the question. It's something that is bound to happen to most people at some stage !

[CDreamer]

How any medication is metabolized by the body will vary from person to person so from what researched it’s incredibly difficult to answer your question- especially as different anticoagulants are designed to be absorbed in different parts of the GI tract. I had a lot of problems with Dabigatran which needs acid to dissolve the gel capsule so if you take PPIs it’s not going to be absorbed properly. Rivaroxaban requires food, preferably protein & fat to be properly absorbed whilst Apixaban is probably the least fussy and is absorbed in upper colon.

It’s effective within a few hours and lasts about 24 hours maximum although we take twice a day.

Unfortunately every Med has side effects, I’ve not experienced any problems with Apixaban but both constipation & diarrhoea are reported affects for some.

[pusillanimous in reply to CDreamer]

Yes, I suppose it is rather an 'Angels on the head of a pin' type of question, and given that anti-coagulants themselves can cause the condition in some individuals a tricky one, just as all the possible side effects and other information on the package inserts are very generic and there will always be someone who reports something entirely different which can only be attributed to the drug they are taking. I very seldom have gastric problems (famous last words, but I have not vomited for 5 years, and it was the vomiting (long story) that led to the PAF diagnosis, )but on the odd occasion I have slight diarrhoea, usually due to eating something unsuitable, I take a couple of Kantrexil tablets, which do not appear to be contraindicated to any of the drugs I take and were prescribed by my GP a while ago when a 'bug' was doing the rounds, and have a long shelf life, and she renews the prescription for my medicine cabinet, when I ask.

[sunlovah in reply to CDreamer]

Curious then why is it taken twice a day ? I guessed perhaps incorrectly, that two times daily were smaller doses?

[pusillanimous in reply to sunlovah]

Yes, I understood that Apixaban, which is taken twice a day, is only effective for 12 hours per tablet, whereas Xarelto, which is taken once a day is effective for 24 hours per tablet. They are different chemical compositions so the dosage is different, but I understood that a bleed from Eliquis is easier to deal with because of the shorter acting duration per tablet.

[Ppiman]

Suffering with IBS and diverticular issues, I have had just this same thought many times. I believe, however, that drugs are quickly absorbed from the first part of the small intestine, so, with diarrhoea happening from the other end, all should be fine. If my tablets weren't being absorbed, though, since I also take a PPI antacid tablet and a beta-blocker, I suspect that I would soon know about it.

Steve

[pusillanimous in reply to Ppiman]

Thanks Steve, I would have thought because of the essential role played by anti-coagulants, the manufacturers would have made sure they put a caveat regarding precautions to be taken should such an episode occur, Afterall they usually cover every aspect to avoid being sued !!!!

[Ppiman in reply to pusillanimous]

They do! I never seem to bleed much even on Apixaban but when we had our covid booster jabs yesterday, the nurse giving mine said that many people on blood thinners don't bleed more than usual but that some do bruise easily (which I don't, either).

Steve

[pusillanimous in reply to Ppiman]

I don't bleed easily but I do bruise, but then I always have prior to anti-coagulants - if anyone breathed heavily on me, I bruised! - I put it down to being a premature baby and not developing the final layer of epidermis !!!!!!!!!!!😆

[Ppiman in reply to pusillanimous]

Well, that sounds a very plausible reason! 😉

Steve

[pusillanimous in reply to Ppiman]

👍😆😆😆

[Vonnegut]

I found the first anticoagulant I was put on gave me dreadful diarrhoea and the others came with constipation so since I have been on a dose of Flecainide that has put an end to episodes I have stopped taking them and have overcome its side effects apart from the added fatigue! Still alive at almost 80! But as we know, we are all different.

[doodle68]

Never had a problem with Apixaban and indigestion and I have also been on a large dose of steroids recently for temporal arteritis.

I drink a lot of Kefir which I think helps to protect my tummy and to add balance for the 'bad things' I told the consultant rheumatologist I was doing this and he said excellent.

[GuyThoma]

I have researched Apixaban extensively in PubMed because I like evidence rather than opinions or wishful thinking.

"Quantification of apixaban in human plasma using ultra performance liquid chromatography coupled with tandem mass spectrometry"

TCP (Trans Clin Pharmacol) 2019"

The article shows Apixaban peaks at 4hrs. However, on close inspection this was for 1x 10mg not 2x5 mg doses.

My point is if you have the time, you will find evidence based answers in PubMed.

[pusillanimous in reply to GuyThoma]

Thank you Guy, most interesting and I will read the report. One's natural instinct is to assume that the lower dose reacts in the same way but at lower concentration? It opens up a new train of thought though, i.e. should someone, assuming they qualify for the lower dose ( 2.5mg twice daily) be overly concerned should they take one dose a little late.? I for example am obsessed with ensuring I take my tablets exactly 12 hours apart.

[GuyThoma in reply to pusillanimous]

In a word “No”.

I quote:

“Maximal plasma concentration of apixaban is achieved in about 3-4 hours after the administration in healthy adult individuals, with a mean elimination half-life of about 12 hours.”

[Thus after even 24 hrs you would still have 25% of the Apixaban if you missed a dose completely.]

There are many procedures from dental work to colonoscopy where the doctors require you to STOP taking Apixaban ALTOGETHER before they will proceed. Thus, even missing a dose may not be serious.

As for me, I use an app called “Medisafe” to Keep my drug compliance near to 100%.

[JOY2THEWORLD49 in reply to GuyThoma]

Hi

Recently I had an operation and I had to stop PRADAXA 110 x twice daily.

for 3 clear days and operation day and another day abstinence until today.

During a operation last year I had 3 clear days prior to operation , the operation and 3 days the other side of operation.

Recognising that not taking my PRADAXA x twice a day has some risk of clots but I was wearing the surgical stockings and bed was moving up my legs for the time in hospital I waslet out day after.

cheers JOY. 74 (NZ)

[JOY2THEWORLD49]

Hi

Diarrhoea comes with high fat content foods.

Mine even points to Vegetable oil. It is so processed.

Because I take thyroxin I need to steer clear of soy products,

My Gall Bladder was finally removed after episodes after eating too much fat, some spices etc. It had disintegrated. I had flare ups from a little girl and as I got older just knew I had to keep away from fatty foods.

We all have different make ups and learn what meds are best.

cheri. JOY. 74. )NZ)