Are Eliquis, Pradaxa or Dabigatran available on the NHS? They are more efficient than Warfarin and are recommended by NICE

[Grandygrant]

[Beancounter Volunteer]

Hi Grandygrant

I think they are all available, but of course none of them have a reversal agent if you have an internal bleed, they work in a different way to warfarin.

So from my research

Pro's for alternatives No testing needed

Con's for alternatives No reversal agent, and I think more expensive, interacts with ome drugs seriously.

Pros for warfarin Easily reversible (Vitamin K), Cheap

Cons for warfarin Testing dependent, and interacts with some foods

My personal view, and it is personal is that warfarin is tried and tested, has almost no side effects, easy to comply with the food restrictions, and can be reversed with an injection.

Why would I need one of the newer ones?

Good table here sums it up really

dig.pharm.uic.edu/faq/2011/...

Best regards

Ian

[SRMGrandma Volunteer]

Latest studies of Dec 2012 add another pro for Pradaxa is that it has 30% greater stroke reduction than warfarin. It's short half life means that it clears the body quickly so not as urgent need for a reversal agent. Not getting blood tests and no food restrictions make it very attractive.

[Warriors]

Have been on pradaxa since my TIA last September following a AF episode that day and have found it easy to take without any side effects. The choice was mine and I don't regret it and appreciate the lack of a reversal agent but it allows you to carry on with life without restrictions. It is of course a personal choice! My consultant agreed with the choice but my GP didn't!

[johncb]

Pradaxa is far better than Warfrin. When I was on Warfrin I never really got the level right, couldn't eat certain foods, was never comfortable with it at any stage. Pradaxa is so much easier to take and studies say it is far more effective and the reversal agent for Warfrin isn't instant.

[Beancounter Volunteer]

I found this, which I think is an interesting discusssion on the merits of the two different types of treament. 2 Doctors who do not agree and lay out some of the arguments. Interestingly, even the one that agrees consider that the two factor X inhibitors Xarelto and Elkiquis, are slightly superior to Pradaxa.

medscape.com/viewarticle/77...

Anywa read and make up your own minds, personally I have not had any problems with warfarin other than settling into a compliant INR, others have different problems

It should be noted that anyone with renal problems is much more limited in their choice.

[SRMGrandma Volunteer in reply to Beancounter]

That's a good summary article. And yes, those with renal insufficiency are not candidates. Everyone has to make the decision about what works best based on their own situation. For me it was the superior stroke prevention of Pradaxa and my EP's enthusiasm about this newer drug. It came at the right time for me. I don't love the twice daily dosing and I try to dose it exactly 12 hours apart and some people don't want to do that. For me that is a small inconvenience. What is important is that we are all taking every step to avoid stroke and to be healthy.

[MarkS]

I think it depends whether you can achieve stability of INR on warfarin, I can with the help of Vit K2 and my monitor. I achieve about very good stability despite a very varied diet (I'm currently in India on business and eating a lot of vegetarian curries).

I've read that warfarin with greater than 90% time in therapeutic range is as good if not better that pradaxa. It can also be reversed in about 15 minutes with Prothrombin complex, which all hospitals carry. You would have to wait at least 24 hours on Pradaxa to have a similar effect.

If you can't achieve stability, then Pradaxa/Apixaban are good alternatives.

[Grandygrant]

Thank you to the 7 people who took the trouble to answer my query of 20th April.

I have had no trouble with warfarin bur understood the new medication reduces the risk of stroke by a small margin (about 7%) and anything that can reduce this risk is worthwhile.

I have met a blank wall with my GP and the consultant heart specialist who tell me our local Primary Care Trust will not finance the new medication unless there is an intolerance to warfarint. This in spite of the N.I.C.E. recommendation for the use of the new drugs in the NHS..

I guess treatment with these new drugs is subject to a post code lottery.

Grandygrant.

[foxleics]

Leicestershire Medicines Strategy Group approved apixaban (Eliquis) on 9th May 2013 and it has been given a red traffic light recommendation meaning the TIA clinic can prescribe it. Rivaroxaban (Xarelto) and dibigatran (Pradaxa) already have similar status.

My mother has atrial fibrillation and is a suitable candidate since she currently takes warfarin and her INR is unstable resulting in operational difficulties on the part of the pharmacy in preparing/altering and delivering dosette boxes. My mother has early stage dementia.

Her GP has referred my mother and am awaiting an appointment to decide upon which "new" anti-coagulant drug will be substituted for warfarin. Annoyingly, the GP told me that he thinks dabigatran is a good choice but when I researched the position I found that the manufacturers don't recommend it for pill boxes although it appears that the capsule can be kept in its blister -the drug is moisture sensitive and unstable out of its packaging.

Apixaban and rivaroxaban can be put in monitored dosage systems (MDS) such as pill boxes and automatic pill dispensers.

As a layman I would not expect to be able to distinguish between the three new drugs but the instability of dabigatran (Pradaxa) would be an important factor since many people use pill boxes etc.

I'd never heard of the new drugs and it was only a hiatus between the GP and the pharmacy over dosette box delivery and related complications caused me to blow a gasket and get them to come up with a practical solution.

It's a pity that the GP or anti-coagulant nurse hadn't suggested that one of the new drugs was an option a long time ago since my mother could then have avoided regular visits for INR tests and difficulties over the dosette box preparation. Also, with early dementia a simple pill taking regime is important for compliance.