I was diagnosed with paroxysmal atrial fibrillation four year ago and since I stopped drinking alcohol completely over a year ago I fortunately have had no episodes. my heart rate varies between 67 and occasionally 79 . I was called by the doctor to give bloods (first time in four years) kidneys are fine. however the surgery wishes me to change from Edoxaban to Apixaban , the surgery is being encouraged to change all patients on Edoxaban I understand . I would be grateful to comments advice as I have been fine on the Edoxaban and really do not want to change. No medical reason was given to me when I asked why change
thank you for your replies should you care to help me.
kind regards
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DougieWoggie
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That's odd since many people were switched from apixaban to edoxaban on cost grounds a few years ago here in UK. That said for the majority of people there is little difference between any of the DOACs.
I’m on apixaban because my kidneys functioned to well for edoxaban and would have flushed the medication out to quickly so they put me on apixaban 3 years ago I also have paf
Thank you for your reply I did ask the doctor why but did not get a satisfactory answer said pharmacist recommending and seems so strange as edoxaban is cheaper than the other one at present
Well I'd put it in writing that you want a full,proper,explanation as to why a PHARMACIST is interfering in your medical care and until then,you want to stay as you are.Address to your GP and copy into your practice manager. Be polite but firm.
Too much is being shipped out to non medical people ( no disrespect to any professional but I expect my medical treatment to be given by my Dr)
Pros and cons of the medication swop should be given patient knowledge and choice are still nhs principles!
The new diac offered may very well suit you,but it's clearly not a medical need as you have been well on your current one!
We've had a few posts saying that surgeries are ringing patients wanting them to change to Apixaban. Not long ago, as others have said, it was the other way round, when Edoxaban was the cheaper of the two. This is purely financial. Surgeries are looking to cut costs as they have a finite budget.
Last year they were trying to get people on Apixaban onto Edoxaban, sometimes without warning. That's why I'd say if it was a medical meed that would need to come from GP.
It doesn't sound as if the GP has a good reason for agreeing to the swop. I don't understand the arbitrary nature of the pharmacy just deciding to change. No one seems to have been able to justify it for this poster.
I changed the opposite way round a couple of years ago and have not noticed any difference. On Edoxaban now which I do prefer as it is only 1 tablet a day
I had always been on Warfarin from Jan 2010 onwards. Following the arrival of a new GP she tried several times to get me off Warfarin unto one of these NOAC's ........ which I refused to do on the grounds if it ain't broke, don't fix it.
Then from April 2023 to November 2023 my same GP got her wicked, wicked way ! She had to prescribe me another medication ( not cardiac related ) - can't remember which one now, ( might have been Amitriptyline ) and she told me due to combined side effects of Warfarin and this other drug I'd have to come off Warfarin. She then prescribed me Edoxaban.
I found the side effects of Edoxaban ... totally vile. I got the worst nightmares ever .......... vile, vivid and mind blowing. I gave the Edoxaban my best shot but in the end enough was enough and I rang her and told her I was going back on Warfarin. End of .............. my life and sleep then returned to normal. I also made it quite clear that based on the experience with Edoxaban I was not willing to be a drug company guinea pig and take any of the other NOAC's either, Apixaban, Dabigitran etc.
Morning, I have had exactly the same issue with my GP lately. They rang me a month ago wanting to change me from Edoxaban to Apixiban. I refused and asked for more information as I have been fine on Edoxaban and I like the fact that it’s once a day only. I asked for more guidance and my surgery contacted haematology at my local hospital for more information. Got a phone call yesterday from the surgery with an update and guidance. I was told Apixiban carried less risk of major bleeding and was now the safer tablet for the future. I was told I could carry on with Edoxaban but would have to accept the increased risk of clots. Based on this I have said yes to the change and will be making the swap in the next few days. Concerned how it will be but will give it a try and see how I get on. Will keep you updated.
I know exactly what you saying but see report in my Drs records * History: Discussed A&G from haematology regarding edoxaban. A&G noted fine to stay on edoxaban as it was patients preference however advised pt that if she was to continue on edoxaban she would need to accept the risks that she is at increased risk of clots. Pt asked how often to take the apixaban and if it needed to be taken with/or after food. Advised it is a bd dose and does not need to be taken with food.
Pt opted to swap to apixaban.
Plan: Stop edoxaban and start apixaban 5mg 1 bd
Any issues or concerns pt to call back sooner
Advice in this would be appreciated if you think above advice is incorrect. Thanks
There may of course be something I'm missing but it seems contradictory to me that Edoxaban carries both a higher risk of a major bleed and a higher risk of clotting. To be fair, there's nothing in the doc's report that mentions bleeding risk, but if, as you say, you were told that then personally I'd be asking for clarification if only to have a clear understanding of risk v benefit.
Funny how Edoxaban is suddenly an inferior drug carrying a dual risk now that Apixaban is cheaper...
I changed from Xarelto (the spelling of the chemical name eludes me at present), because Apixaban was supposed to be slightly more protective, however I found it gave me heartburn so returned to Xarelto , When I changed from it it was being marketed in South Africa where I am, as iXarolo - exactly the same pill, same manufacturer - just different name on box which was identical in every other way, and the price had been reduced dramatically. When I went back to it (where I am now) - still the same box, but it is now more expensive than Apixaban !
Just googled because i am a cynic and Apixaban is now cheaper than Edoxaban . The pharmaceutical newsletter went on to say that Edoxaban patients were healthier with less incidence of stroke etc and recommended patients stay on Edoxaban . I am on Edoxaban, apparently it costs £637 a year and Apixaban is now £4.90 something for 60 tablets. I am guessing there’s the reason right there . Personally if they said that to me, apart from refusing to change I would ask for the names of the studies they claim shows evidence for better safety of Apixaban and I suspect that will shut them up
I believe Eliquis held the patent for Apixaban and it was quite expensive which is why surgeries were trying to persuade people to change. I think the patent has now run out so several generic versions of Apixaban are now available such as Sandoz amongst others, so the price has come down dramatically. I preferred Eliquis but it seems impossible to get. Presumably, now, sugeries won't want to switch from Apixaban to Edoxaban in spite of the newsletter you mention because of the extra cost. I'd not heard about Edoxaban being better.
Re not hearing Edoxaban being better, I have previously mentioned this German research ...
Comparison of clinical outcomes of edoxaban versus apixaban, dabigatran, rivaroxaban, and vitamin K antagonists in patients with atrial fibrillation in Germany: A real-world cohort study
I commenced on Apixaban approx 3 months ago and I was not offered a choice. I didn't mind as cardiologist explained if this was not suitable, we could look at alternatives. I did have some initial problems with vertigo/dizziness but these side effects have settled down. I hope you find a satisfactory resolution.
As Peony has said the change is probably being made on cost grounds. My cardiologist told me recently Apixaban has just come off its patent in the UK so now is cheaper than Edoxaban. Previously the medics were swapping people the other way round because of cost.
I was asked to change and I understand that Apixaban is mainly a cost saving .I ,like you was happy on Edoxeban and just said I didn't want to change and there was no problem.It should be your choice. The once a day dosing with Edoxeban is preferable to me .I also have no gastric issues with it so these are 2 reasons I would not change.Let us know how you get on.
I’ve been on APIXABAN for five years now with no issues - in fact because it’s twice daily it suits me well. I prefer taking something that clears after 12 hours because I suffer from morning nosebleeds and I always have the option to miss a morning dose in the event of a bad nosebleed although that’s never yet happened. I’m not sure but I’m sure I read that of all the NOACS, Apixaban has the least side effects.
One issue for patients preferring edoxaban may be the once a day v. twice daily dosage. Is it possible that apixaban is preferred by the medics because it has a specific reversal agent in the event of a haemorrhagic stroke, whilst edoxaban has no specific reversal agent?
They are promoting Apixaban - which has a specific reversal agent - over Edoxaban, which doesn’t (though there are other means of tackling major haemorrhage). I have no idea whether this is or is not a consideration in the choice of DOAC alongside the fact that Apixaban is cheaper.
Oops, yes, I got myself confused in my first statement ... the Post is about promoting Apixaban, not Edoxaban.🤔
I really just wanted to confirm that the same reversal agent, Andexanet alfa, is used for both of these DOACs, and if a patient wanted to stay on Edoxaban as a personal choice, with cost not a consideration, your suggestion about not having a reversal agent is not true in practice and should not deter them.
I’ve been on Apixaban for a good few years. No issues. I am down for OHS for MVP some time soon and I after think I’ll be put on something else, but I’d prefer Apixaban as no issues with alcohol interactions.
It would seem, on reading this research paper, that in the very elderly (≥80 years) there is a higher risk of a major bleed with Edoxaban when compared to Apixaban .
The article was only published in March 2024, so quite a recent discovery so maybe that’s why the changes ?
I have no problem with apixaban except it gives me acid and wind which sets my chest off, so a great step forward. but if that lessons the stroke risk so be it. As for costs, the NHS is a bottomless pit as we are now treating 50% more people on the same resources, as people used to die earlier. So I guess we will all have to pay more to live longer. The only problem every government has is that the pipe flowing out is bigger than the pipe going in now.
I used to be on rivaroxaban but kept getting UTIs (?) so I was changed to apixaban as was told it was kinder to the brain and stomach than all of the anticoagulants
You’re lucky I think that your doctor wants to change to that one as I believe eliquis apixaban is the most expensive. Plus it also has a reversal if needed
I suspect it’s cheaper!! However I did not get on with edoxaban . It brought me out in a rash!!The only drawback of apixiban is that it has to be taken twice a day but that makes it safer. Otherwise great
The NHS now has a lower price for apixaban, I gather so this might be the cause of their wanting you to change from edoxaban. However, this latter is once daily, whereas apixaban is morning and evening dosing. Edoxaban might be more convenient for you. You will not be forced to change if you prefer it (and, so far as I know, it is also available to the NHS at a much lower price these days).
These drugs do cost the NHS a massive sum overall, though. The figures I saw once online are quite staggering.
We do still have a choice, so it's between you and your doctor. I came off Edoxaban recently because of side effects, and so far Apixaban is working better for me.
TBH if a medication is about as effective as another, it makes sense to me that the NHS would switch us to the cheaper one - simply because they are so strapped for funds.
Just a note of warning about the cohort of the study you referenced, offered humbly and just trying to understand the truth of such results. This study was restricted to patients =>80 years, which may be a significant factor. Other research seems to indicate that major bleeding risk is much higher in this age group, and has raised questions as to whether a half-dose regime may be more appropriate for this cohort. More research needed on this.
The German research I referenced earlier today had a cohort with a wider (less restricted) age distribution, but a smaller population, and couldn't differentiate Apixaban from Edoxaban re major bleeding risk, while giving Edoxaban lower stroke risk.
Bob thank you, I hadn't seen your earlier post ... I must have glossed over the =>80 yrs but depending how things go I'll be in that 'cohort' soon enough! I'm no scientist and only just about manage to grasp the conclusions of these studies.
On the financial issue I have to say it seems to me logical and right for the nhs to switch us to the cheaper options when they can, and particularly when two medications are broadly as effective as each other, because they are so strapped for cash ...
Having lived in a country without this kind of medical support I'm amazed and grateful for what they manage to do, given their lack of funding and staff etc.
Yes, but even though I have an unused prescription recommendation for apixaban, I have always liked the profile of edoxaban, and always stood up for it when it was so lazily dismissed as inferior on the Forum. So I am now a little disturbed that it (being a favourite son) is no longer to be the first choice DOAC.
Still it only takes until the next DOAC research study to revise one's individual notions of comparative bleed and stroke risks between the DOACs.🤔
My cardiologist (Canada) has told me the research indicates reducing Apixaban by half (5mg to 2.5mg) when turning 80.I have been on it for a few years and no problems.
I agree with Bob,appears no clinical reasoning on why to change other than financial. only advantage is only taking it once a day and my feet aren’t as cold as to when I was on Apixaban.
Perhaps ask your Pharmacist why the switch ? And I agree with others comments here, if you are stable on the current med & no sound medical reason to switch, I would ask to stay on your current treatment.
Based on my own research, apixaban appeared to have the best safety profile. So when I finally decided to take a DOAC, I asked for apixaban. That said, the safety profiles are quite similar, so for another person the ease of only having one daily tablet could be a deciding factor.
When I was prescribed a DOAC my GP gave me three choices which included Apixaban, edoxaban and a third one. I asked his opinion on the best one and he told me his Mother has AF. I asked which she takes and he said Apixaban so that's what I opted for and was given the brand Eliquis. At the first repeat I was given the generic Apixaban and suffered a lot of gastro pain. Was switched back to Eliquis and been on it since with no need for omeprezole to counter the stomach problems. Apixaban is taken twice daily whereas I believe the others are once daily. There will be a clinical reason for your GP switching. Dr Google might be able to help.
today I got a call from my surgery saying they want to do the same to me, I said ok, but it is 2 a day rather than 1 so a bit more to remember.. She said it was because my kidneys may be clearing out the Edoxaban too quickly, so I won't getting the full protection.
Seems Apixaban and Eloquis are the same drug with Apixiban being more or less a generic form. It isn't available in the US....since big pharma runs the show. My EP tells me that it will become available at some point but it is literally the same drug. Similar to you, I was diagnosed in 2020 just prior to COVID and when I gave up any form of alcohol, I have had very few and only minor moments of "flutter".
I do wonder if there are any concerns over edoxaban.I went for my LTC review today and initially said you only had your bloods done June so not sure you need them done then said ah you are on Edoxaban so this is every 3 months ? Definitely used to be yearly.
I live in South East Asia, and for what it’s worth, I have been on Apixaban for the last year and a half and it was expensive!
However, a couple of months ago my cardiologist informed me that generic Apixaban was out, and recommended the version manufactured by Sandoz. To my great delight, it cost half of the price of the original.
I also was switched from edoxaban to apixaban without any reason but did a little research and found that apixaban tends to be the preferred option for cardiologists. I had no issues with either of them. I don't know if cost of production is an issue.
I have been on Edoxaban for nearly 4 years with no problems, but yesterday I received a phone call from my surgery asking me to change to Rivaroxaban due to cost. I have agreed, with the proviso that I can go back on Edoxaban if I have any unwanted side effects.
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