Pradaxa

[Duff Man]

i just hope that in all this anti-pradaxa talk we haven't influenced Debster to be ACT free for any amount of time and/or to skip bridging to coumadin (with lovenox???) if that's what she's going for.... because that could be hazardous for her. Please don't stop taking the Pradaxa without talking to your doc about how to switch safely, if that's what you intend to do. Be careful.

To be perfectly honest, if it weren't more than 50 dollars a month, I might look pretty hard at taking it myself for prohpylaxis due to my having Factor V Leiden. If you have the money, it might be worth it. It could be worth it anyway, for many reasons. I think alot of people here are just very comfortable with coumadin... maybe we've even developed a sort of liking for the drug because it's protected us for so long.

 

[Jkm7]

JKM7--I didn't mean to minimize or discount your bad experience with warfarin. I certainly wouldn't want to take 10 or more pills every day. You're apparently one of a small group of people whose bodies don't react to warfarin in the same way most of the population do.

I hope you can find a suitable alternative for anticoagulation management (and Pradaxa may be a good one) - but not taking ANY anticoagulant is extremely unsafe and risky.

I'm certainly interested in learning how this all works out for you.

I have a tissue valve and only required ACT for what was to be three months post op while my tissue grew to smooth out the edges but my surgeon told me to stop at 2 1/2 months. He didn't like me on such high dosage. I am sure you know coumadin tablets come in many mg sizes. Of course, I didn't take ten - 1 mg tablets daily. I used larger mg sized tablets.


This is what I wrote previously in this thread:

During my brief time on coumadin post surgery, I was up to about 100 mg per week and still climbing in dose. I don't care what anyone says about the right dose for each of us is the amount each of us needs to stay in our range, I hated taking that quantity. My personal experience was so distasteful to me I'd do most any reasonable thing to avoid ever taking coumadin again. That is only my story and no one else's but it comes from personal experience and not just theory.

 

[Marty]

Marty: I really appreciate your comments. I'm sure that we all (doctors included) would appreciate a new medication that you can take once daily (or maybe even once a week, if possible) that is easily tolerated and minimizes or reduces the risk of clotting that warfarin does. It would be great to not have to worry about bruising from overdosing or clots from underdosing - or to have to EVER test again.

You were lucky to find such an enlightened doctor. I wish that all doctors with patients on warfarin were as flexible as yours. (Of course, for patients incapable of self-testing or self-dosing, it would also be great to have easily accessed specialty clinics that can handle those tasks).

In my mind there is no doubt that warfarin is on its way out. It will gradually over the next few years be replaced by the oral factor Xa inhibitors of which Pradaxa is one. Improvements are on the way with new compounds. I havn't seen so much excitement since the statins were introduced. I think we mechanical valvers will be the last holdovers.

 

[debster913]

I really don't have a problem with coumadin. I've only had 6 months worth of experience with it, but didn't have any problems with it during that time period. However, I find your extreme style (boarding obsessive) of posting about coumadin and home testing and buying equipment on e-bay a huge turn off and almost offensive.

By the way Debi, I think you'll do fine on coumadin. I'm sorry you are still in A-fib. I hope they can find a way to fix that so you don't have to deal with all of this. Is there a chance of an ablation?

Kim

Thanks, Kim for your insight-- I have no problem with coumadin either, since I was on it short-term four years ago after my surgery.

Anyway, no ablations for me--I saw my EP doctor back in September, and because my A-Fib isn't that bad right now, my doctor feels there is no sense in exposing me to more radiation to try to zap it.

 

[debster913]

Debi -

If you are interested in lowering the costs of medication to treat your A-Fib, you might want to discuss SOTALOL (generic for Betapace) with your Doctor. Sotalol is available for $4/30 or $10/90 at Walmart, CVS, and other pharmacies.
Several of our members report good control (i.e. prevention) of A-Fib with Sotalol.

You might also want to see if there is a dedicated Coumadin Clinic in your area (see www.acforum.com).
Coumadin Clinic nurses are usually well trained and see enough patients to know how they react to dosing changes.
(The 4 CRNP's at my clinic manage 3000 anticoagulation patients - 60+% A-Fib, 20+% DVT, 10% Mechanical Heart Valves).
Most insurance covers the cost of INR testing. (I've never had to pay anything for an INR test).
Warfarin Cost $4/30 or $10/90 at Walmart, CVS, and other pharmacies.

AL-- I have been on sotalol--I was on it for over a year, and it did nothing more for me than just make me very tired. It doesn't work for me. I'm now on Multaq. And yes, there is a coumadin clinic nearby that I went to those six weeks after my surgery while I was on the drug.

 

[debster913]

Something else--
Here's what happened to me a couple days ago on Christmas Eve. I haven't taken Pradaxa since. Take into consideration this is the note I wrote to my cardio that I will fax over to his office tomorrow:

I started the Pradaxa on Thursday as directed (with breakfast), and I had vague nausea all day. I didn’t think much of it since I know that one of the side effects of this drug, as the body gets used to it, is nausea.

However, on Friday, I took Pradaxa again with breakfast around 7. Then, around 9 I went out for a brisk walk. I felt fine the whole route, but when I stopped at Starbucks for iced tea (something I normally do on my walks), a huge wave of nausea washed over me, and I felt extremely sick to my stomach, faint, and hot. I thought I was going to pass out, so I sat down for a few minutes to see if the feeling would pass, but it didn’t. I ended up calling Mike to come pick me up since I felt too sick to walk home.

By the time Mike arrived, I was starting to feel a little better, but I felt ill the rest of the day, and I still feel a tad nauseated today, two days later.

I am not taking Pradaxa again until I talk to my cardio. Mike (the Hubster) says he is glad that I was out walking and could stop when I felt sick instead of driving, wich could have had a much more adverse effect!!!

 

[Marty]

Pradaxa direct thrombin inhibitor

Pradaxa direct thrombin inhibitor

In my mind there is no doubt that warfarin is on its way out. It will gradually over the next few years be replaced by the oral factor Xa inhibitors of which Pradaxa is one. Improvements are on the way with new compounds. I havn't seen so much excitement since the statins were introduced. I think we mechanical valvers will be the last holdovers.

Correction: Pradaxa is a "direct thrombin inhibitor" not a factor Xa inhibitor which is positioned proximal to thrombin in the coagulation pathway. This is supposed to be better. I think there will be continuing improvement in these oral anticoagulants-safer, cheaper,etc.

 

[ALCapshaw2]

Correction: Pradaxa is a "direct thrombin inhibitor" not a factor Xa inhibitor which is positioned proximal to thrombin in the coagulation pathway. This is supposed to be better. I think there will be continuing improvement in these oral anticoagulants-safer, cheaper,etc.

Marty -

I remember when you wrote that your Surgeon wouldn't want to use a new (mechanical) valve
until he could look at it's 10 year history (or something to that effect).

I think I might be inclined to follow a similar principle with regards to a new anti-coagulant...
(maybe a something less, but I don't anticipate being in the "Test Group"!

My Warfarin-based INR is pretty stable and other than some bruising
from an automated Blood Pressure Meter from Hell, I've had NO serious side-effects.

And you can't beat the cost of Warfarin (approximately 11 cents per tablet before taxes

 

[Philip B]

Geez... exciting?

Geez... exciting?

Yeah, statins are exciting. I'm not sure statins are much of a good thing. I remember the conversation with my cardiologist about statins and muscle damage that those kinds of drugs can cause. Somehow, his comment about only one in every thousand people who take statins encountering problems didn't sound as positive when he admitted that he took statins and was experiencing muscle difficulties when he exercised. My positive opinion of statin drugs was immediately altered as a result of that conversation.

The problem with medications (coumadin included) in general is the fact that most seem to come with some possibility of unwanted side effects.

I'm continually amazed when I see new medications advertised on television and they reference all of the potential negative side effects the new medications can pose.

-Philip

 

[Protimenow]

I'm with Al on this. It would be nice to have an oral drug that has the anticoagulation effects required without any side effects (for most people), affordable (oops, I just described warfarin), and not requiring regular INR monitoring. A pill a day, or maybe one every other day, would be great.

Research is getting closer - but, judging from the horror story just posted - its side effects can be pretty troubling.

Yes, it's amazing to see these great medication commercials that spend fifteen seconds telling how the drug will change your life, and 45 seconds about adverse effects. Amazing.

For me, for now, it'll be warfarin until something REALLY better comes along.

 

[catwoman]

And you can't beat the cost of Warfarin (approximately 11 cents per tablet before taxes

Move to Texas. No taxes on RXes, most (if not all) OTCs, first-aid items, etc.

 

[catwoman]

Something else--
Here's what happened to me a couple days ago on Christmas Eve. I haven't taken Pradaxa since. Take into consideration this is the note I wrote to my cardio that I will fax over to his office tomorrow:

I started the Pradaxa on Thursday as directed (with breakfast), and I had vague nausea all day. I didn’t think much of it since I know that one of the side effects of this drug, as the body gets used to it, is nausea.

However, on Friday, I took Pradaxa again with breakfast around 7. Then, around 9 I went out for a brisk walk. I felt fine the whole route, but when I stopped at Starbucks for iced tea (something I normally do on my walks), a huge wave of nausea washed over me, and I felt extremely sick to my stomach, faint, and hot. I thought I was going to pass out, so I sat down for a few minutes to see if the feeling would pass, but it didn’t. I ended up calling Mike to come pick me up since I felt too sick to walk home.

By the time Mike arrived, I was starting to feel a little better, but I felt ill the rest of the day, and I still feel a tad nauseated today, two days later.

I am not taking Pradaxa again until I talk to my cardio. Mike (the Hubster) says he is glad that I was out walking and could stop when I felt sick instead of driving, wich could have had a much more adverse effect!!!

Yes, you were very fortunate you were not driving.

You may want to ask your cardio or family doctor about some anti-nausea meds to see if that works -- and if it's an option you want to try, if you want to resume the Pradaxa.
We ran into similar nausea problems with the Exelon patch my dad is taking for Alzheimer's disease. He had no problem with the 4.6mg loading-dose patches (30 days' worth). When he moved up to the 9.5, he had problems the first day. So he's back on the 4.6mg patches. He's suffered from upper GI problems for 40+ years, due to hiatal hernia repair surgery in 1967. My sister & I are the medical POAs for our parents, so we chose the transdermal patch over the oral meds hoping it would work out.

 

[ALCapshaw2]

Something else--
Here's what happened to me a couple days ago on Christmas Eve. I haven't taken Pradaxa since. Take into consideration this is the note I wrote to my cardio that I will fax over to his office tomorrow:

I started the Pradaxa on Thursday as directed (with breakfast), and I had vague nausea all day. I didn’t think much of it since I know that one of the side effects of this drug, as the body gets used to it, is nausea.

However, on Friday, I took Pradaxa again with breakfast around 7. Then, around 9 I went out for a brisk walk. I felt fine the whole route, but when I stopped at Starbucks for iced tea (something I normally do on my walks), a huge wave of nausea washed over me, and I felt extremely sick to my stomach, faint, and hot. I thought I was going to pass out, so I sat down for a few minutes to see if the feeling would pass, but it didn’t. I ended up calling Mike to come pick me up since I felt too sick to walk home.

By the time Mike arrived, I was starting to feel a little better, but I felt ill the rest of the day, and I still feel a tad nauseated today, two days later.

I am not taking Pradaxa again until I talk to my cardio. Mike (the Hubster) says he is glad that I was out walking and could stop when I felt sick instead of driving, wich could have had a much more adverse effect!!!

And this is better than Coumadin / Warfarin because ???

I've been taking Coumadin and then Warfarin for several years with NO side effects that I am aware of.

(or should I say: "of which I am aware" to avoid ending a sentence with a preposition

 

[Protimenow]

Al -- sometimes things just read better if you don't worry much about a misplaced preposition. (Winston Churchill had a classic sentence about this -- something like 'A misplaced preposition is something up with I will not put.' Or something like that. There are times when following that rule just makes really awkward sentences).

I, too, have been taking warfarin for years and have experienced few side effects of which I am aware - except for the tendency to carefully read most things WORD BY WORD - and to sometimes even point out inconsistencies that I encounter.

If warfarin has caused my somewhat obsessive attention to words, phrases and grammar - I'll just have to live with it.

 

[watson524]

You know, it's interesting..... this new drug came up during my mom's visit with her GP today. He said he thought we might have heard about it and would be asking. He said that it doesn't require the testing for INR like her Coumadin does. I said you mean it just is or isn't, there's no levels to check, he said that's correct. BUT he said that it's not for patients with a fib caused by structural issues (i.e. damaged valves) so she wouldn't be a candidate for it. Just thought I'd throw that out there.

 

[Jkm7]

How did the GP feel about home testing? Is he supportive of it?

Thanks for sharing re: Pradaxa.

 

[watson524]

I updated my other post but in short answer to your question... does he!! go with "no"?? That was how unsupportive he was about home testing but I'm picking my battles.

 

[Jkm7]

Sorry to hear that, Watson. I'd be most frustrated with that position.
Good luck.

 

[Alistair]

I've been fortunate to experience only minimal complications and/or changes since my surgery and therefore feel I have very little to add however; I was curious when first I heard of this new drug. I've never been one to take medication and could never remember to take even a multivitamin with regularity. Surprisingly I have acclimated well to the routine of Warfarin up to and including self testing and self dosing (A sign of getting older I suppose:smile2. I feel my best with an INR above 3.0 which for me has been fairly easy to maintain. Since Warfarin/Coumadin has been used medically for a long time now I have a certain level of confidence as opposed to a newer drug. It stands to reason that any and all drugs have their side effects, be it long term or short term. For now, I prefer the tried and true with a wait and see attitude on this new one.