edoxaban

[Monkry]

my surgery phoned yesterday to say I was being changed from apixaban to edoxaban as it helped save the nhs money it being a once a day tablet.

Is there a reversal agent for this tablet. Also I am assuming I can refuse to change tablets.

[Chappychap]

You ask excellent questions, but unfortunately the answers are far from straightforward.

Firstly, there is no reversal agent for Edoxoban, where as there are at least two reversal agents for Apixaban.

Game, set and match to Apixaban then?

Not quite.

Firstly Apixaban was simply the first of the new generation anti-coagulants to get a reversal agent approved, but Edoxoban is very close behind, with agents likely to be available within a few months.

What's more, many authorities argue that the importance of reversal agents is overstated. Presumably you're concerned about the risk of a bleed. But what type of bleed and where will it occur?

If it's the risk of a bleed from say a car accident then we don't really need a reversal agent. In reality we've plenty of time for other solutions to be used to keep us alive for a few hours until the anti-coagulant starts to exit our systems. But if it's a bleed on the brain then unless we happen to be in a hospital when this happens a reversal agent is unlikely to help us, as the hard truth is that outside of a hospital it's unlikely to be delivered fast enough.

For these reasons I personally would exclude reversal agents from the calculation.

Then there's the cost question. But if anything this is even more complicated!

We're into the world of "QALY's" (Quality Adjusted Life Years) which is how the NHS measure cost effectiveness. A large Spanish study was used for the data for this 2020 British study,

ncbi.nlm.nih.gov/pmc/articl...

Now I completed a post grad degree in the statistics and mathematics of Economics. Okay, it was a long time ago and I never used the qualification professionally, my point is that even though I trained in the techniques of this study I still struggle to understand it! But, the bottom line for me is that they're both extremely effective medicines, with Apixaban delivering 6.924 QALY's per patient compared with 6.882 for 60mg Edoxaban and 6.844 for 30mg Edoxaban. I'd personally be delighted to take either.

Finally, could you refuse to switch medication?

Well, that's another interesting question. In reality I suspect most GP's would try and factor a patient's preferences into the equation as long as it's medically practical. After all, talking to GP's it's clear that uppermost in their minds is the tragic fact that about a third of all the medication prescribed in this country is never taken. So doctors are acutely conscious of the need to have a motivated patient who gives their active agreement to a course of treatment.

But at the end of the day we're not empowered to prescribe our own medication. So even though we can refuse to take our meds, it's only our doctors who can choose what to prescribe in the first place.

[Monkry in reply to Chappychap]

Well thank you for that most helpful now all I have to worry about are the excipients the cause of most of my problems in the past. That's how my afib was discovered. I was about to have my cataract op. The nurse put my eyedrops in checked my pulse and it had shot through the roof! She then discovered I had an irregular pulse and freaked out. Needless to say the op wasn't done. I was told to come back when I was on warfarin.

I was also put on candersartin at one time. Went to the opticians who wanted to know what drugs I was taking as my pupils were enlarged. Went back to normal after discontinuation.

Have been on apixaban since 2017. It instantly brought my blood pressure down which was a plus but does make me feel as if I am taking sedatives.

I do think Big Pharma should make more effort with their excipients which I think are a big cause of people discontinuing their tablets especially ones which have to be taken for life.

Thank you once again.

[Captain_Birdseye in reply to Monkry]

Do you mind if I ask which excipients are causing the trouble?

[Monkry in reply to Captain_Birdseye]

not sure. I have another 5 weeks left before I transfer to Edoxaban so I will see if it makes any difference as there is some difference in the excipients between the two tablets. Be good if I could take probiotics with the new one as can't even eat yoghurt on apixaban without it affecting me.

[Captain_Birdseye in reply to Monkry]

We all tolerate things differently - the human body doesn't always work like the textbooks say 😁hopefully it's a smooth transition for you!

[scentedgardener]

I'm always interested to read others experience of blood thinners as this is something I'm really struggling with. I changed from Rivaroxaban to Edoxaban, but now have changed to Apixaban. None of them are suitable, si don't know where to go from here.With regard to staying on Apixaban, my opinion is that it will depend on a) how co-operative and understanding your GP is, and b) how strong a case you can make about your reasons for staying on Apixaban.

Sorry, that comes across as very unsympathetic, and it really isn't meant as such, but is based on my experience of working with my old GP, now retired, who knew me well, and listened to me, and working with whatever GP is available, who doesn't know or listen to me. It took me 14 months to get changed from Rivaroxaban. Good luck

[Monkry in reply to scentedgardener]

thank you for that I have to say I haven't felt my normal self since being on apixaban. Unable to have yoghurt or probiotics. It does seem to affect the digestive system. Also find it quite sedating. Will give Edoxaban a try as only once a day which suits me

[Wenlock]

Hello Monkray; I don't know much about Edoxaban * but I am on Apixaban 2.5 x 2 each day. I was on 5mg per day x 2, but my local Heart failure nurse reduced my tablets.No.adverse effects so far.I am older than you. Why not ask your Cardiologists to refer you to your local Heart failure nurse + if there is one near you. Think you need to have AF.. To be transfered. * Also think you can refuse any medication your doubtful about. I refused Cardio Conversion as I don't feel I need it yet. You can check on all medication on NHS..website. However the Cardiologist are very skilled ( and it's free). Good luck Wenlock.

[Breesha]

sorry I cannot help, Apixaban triggered gout in an hour , Edoxaban I am told was an improved tablet , but had same affect as did Rivoxaban , I am back on good old Warfarin , I self test and seems to suit me.

If you are Ok on Apixaban , I am sure the newer blood thinners will be fine.