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Effient vs Eliquis
Introduction
For patients with conditions like acute coronary syndrome or those who have undergone angioplasty, certain drugs that inhibit blood clotting can help in reducing the risk of stroke and heart attack. Effient and Eliquis are two such medications prescribed for these purposes. They each impact different aspects of the blood's ability to form clots but both have anti-coagulant effects in patients at risk of thrombotic events. Effient, also known as Prasugrel, works by preventing platelets in your bloodstream from sticking together to form a clot. It is classified as an ADP receptor antagonist which means it blocks ADP receptors on platelet surface thereby inhibiting platelet aggregation. On the other hand, Eliquis (also known as Apixaban) belongs to a class of drugs called factor Xa inhibitors; it works by blocking the activity of clotting protein factor Xa thus slowing down the formation of blood clots.
Effient vs Eliquis Side By Side
| Attribute | Effient | Eliquis |
|---|---|---|
| Brand Name | Effient | Eliquis |
| Contraindications | Should not be taken with any medication that affects blood clotting such as warfarin or aspirin unless directed by a doctor. | Should not be taken with any medication that affects blood clotting such as warfarin or aspirin unless directed by a doctor. |
| Cost | Approximately $700 for 30 tablets (10 mg) | Approximately $485 for a month supply (28 tablets of 5 mg) |
| Generic Name | Prasugrel | Apixaban |
| Most Serious Side Effect | Unusual bleeding, symptoms of allergic reaction, signs of internal bleeding, dark-colored urine and pale stool due to liver problems, chest pain associated with shortness of breath, low platelet levels. | Signs of a serious allergic reaction, unusual bleeding from gums, reddish or brownish urine, vomiting blood, stools that are red, pink, brownish-black in color suggesting gastrointestinal bleed, unexpected pain and/or swelling in your joints. |
| Severe Drug Interactions | Interactions with drugs affecting blood clotting, requiring a certain period to clear from your system to prevent dangerous interactions. | Interactions with drugs affecting blood clotting, requiring a certain period to clear from your system to prevent dangerous interactions. |
| Typical Dose | 10 mg/day following a loading dose of 60 mg | 5 mg taken orally twice a day, reduced to 2.5 mg twice daily for patients over 80 or those with kidney impairment |
What is Effient?
Prasugrel (the generic name for Effient) is an antiplatelet drug that was a significant advancement over the first generation of blood thinning medications. Prasugrel was first approved by the FDA in 2009 and works by preventing platelets from clumping together, effectively reducing the risk of forming harmful blood clots. It's commonly prescribed to prevent clot-related strokes or serious heart problems after certain heart procedures. Effient has a more selective influence on specific types of platelets with only minor effects on other blood components, which results in it having fewer side effects than other anticoagulants that have stronger effects on these elements.
On the other hand, Apixaban (Eliquis), also an anticoagulant medication, inhibits Factor Xa in the coagulation cascade thus disrupting the formation of thrombin and subsequent cross-linking of fibrin; this action prevents clot formation. Eliquis is often used to lower the chance of stroke caused by a blood clot in people with atrial fibrillation and for treatment as well as prevention deep vein thrombosis and pulmonary embolism.
What conditions is Effient approved to treat?
Effient is approved for the treatment of the following medical conditions:
- Acute coronary syndrome (ACS) managed with percutaneous coronary intervention (PCI)
- To decrease the rate of thrombotic cardiovascular events in patients with ACS undergoing PCI
On the other hand, Eliquis is approved for:
- Prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation
- Prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE) in knee or hip replacement surgery patients
- Treatment of DVT and PE
- Reduction in the risk of recurrence of DVT and PE after initial therapy.
How does Effient help with these illnesses?
Effient aids in the prevention of blood clots by inhibiting platelet aggregation, a key step in the formation of dangerous blood clots. It works by blocking P2Y12 adenosine diphosphate (ADP) receptors on platelets, thereby reducing their ability to stick together and form clumps that can lead to blockages in the arteries. Platelets are small cell fragments that circulate in our bloodstream and play an essential role in hemostasis, or stopping bleeding when we have been injured.
Eliquis also helps prevent harmful clotting events but it does so through a different mechanism: it directly inhibits Factor Xa, an enzyme necessary for blood to clot. Inhibition of Factor Xa interrupts the intrinsic and extrinsic pathway of the blood coagulation cascade, preventing thrombin generation and development of thrombi.
Both Effient and Eliquis are used as anticoagulant agents but they target different aspects of clot formation; your doctor will choose between them based on your specific needs and medical history.
What is Eliquis?
Eliquis, known generically as apixaban, is an anticoagulant or blood thinner. It works by blocking the action of a certain clotting substance in the blood. Introduced by its manufacturer Bristol-Myers Squibb and first approved by the FDA in 2012, Eliquis reduces the risk of stroke and systemic embolism for people with non-valvular atrial fibrillation. Unlike Effient, which is primarily used to prevent clotting after chest pain or heart attack treatment procedures such as angioplasty or stents placement, Eliquis is more commonly used to reduce risk of strokes and dangerous blood clots especially for people who have atrial fibrillation (not due to heart valve disease). This makes it versatile in treating different cardiovascular conditions where prevention of thromboembolic events are crucial. The side effect profile also varies from that of Effient; common ones include minor bleeding incidents like bruising easily or longer than normal bleeding cuts, but serious bleedings can occur.
What conditions is Eliquis approved to treat?
Eliquis is an anticoagulant that's FDA approved for use in the following conditions:
- Prevention of stroke and systemic embolism in people with nonvalvular atrial fibrillation
- Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrent DVT and PE after initial therapy.
How does Eliquis help with these illnesses?
Eliquis, similar to Effient, is an anticoagulant medication used to lower the risk of stroke caused by a blood clot in people with atrial fibrillation. Eliquis works by blocking Factor Xa, which is a key enzyme involved in blood clotting. This effectively slows down the formation of clots and can help prevent conditions like deep vein thrombosis or pulmonary embolism. It has been found that Eliquis may be associated with fewer major bleeding events than other anticoagulants such as warfarin and even Effient itself, making it a preferred choice for many patients. Furthermore, unlike some other anticoagulants, Eliquis doesn't necessitate regular monitoring of blood-clotting levels but still requires careful management under healthcare professionals' supervision. Thus it offers convenience alongside efficacy when compared to different antiplatelet drugs like Effient.
How effective are both Effient and Eliquis?
Both prasugrel (Effient) and apixaban (Eliquis) have established histories of success in preventing blood clots, particularly in patients with atrial fibrillation or who have undergone surgery. Prasugrel was approved by the FDA in 2009, while apixaban received approval three years later. Their mechanisms of action differ: prasugrel is an antiplatelet drug that prevents platelets from clumping together to form a clot, whereas apixaban works as an anticoagulant that interferes with the body's ability to form blood clots.
A direct comparison between these two drugs is challenging due to their different indications and mechanisms; however, both are part of comprehensive treatment strategies for managing cardiovascular disease risk. In terms of safety profiles, both medications carry a risk of bleeding complications which needs to be balanced against their benefits.
Prasugrel has been shown effective at reducing thrombotic cardiovascular events such as stent thrombosis after percutaneous coronary intervention compared to clopidogrel[1]. However, it may cause more major bleeding events than clopidogrel[2].
Apixaban's effectiveness has been demonstrated through multiple clinical trials including ARISTOTLE[3] and AVERROES[4], where it showed superior efficacy compared to warfarin in preventing stroke or systemic embolism and resulted in less bleeding.
Nonetheless, choice between these agents must take into account individual patient factors including renal function, risk for stroke or clotting versus risk for bleeding, cost considerations among others.
[1] https://www.ncbi.nlm.nih.gov/pubmed/19608028 [2] https://pubmed.ncbi.nlm.nih.gov/26482318/ [3] https://www.nejm.org/doi/full/10.1056/nejmoa1107039 [4] https://www.nejm.org/doi/full/10.1056/NEJMoa1007432
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At what dose is Effient typically prescribed?
Oral dosages of Effient usually start at 10 mg/day following a loading dose of 60 mg, often used to prevent clotting in patients with acute coronary syndrome who are undergoing an angioplasty procedure. For Eliquis, the typical dosage for preventing stroke and systemic embolism in nonvalvular atrial fibrillation is 5 mg taken orally two times per day. In some cases such as elderly patients or those with kidney impairment among other factors, a lower dose of 2.5 mg twice daily may be recommended. As always, these doses can be adjusted based on the patient's response and tolerance to the medication. It should also be noted that exceeding prescribed doses could increase risks including bleeding complications.
At what dose is Eliquis typically prescribed?
Eliquis therapy is typically initiated at a dosage of 5 mg taken orally twice a day. For patients over the age of 80, or those with kidney impairment, the dose may be reduced to 2.5 mg taken orally twice daily. The exact dosing regimen should always be determined by your healthcare provider based on your specific medical condition and response to treatment. If there is no adequate clinical response observed after several weeks of treatment at this initial dosage, your doctor may adjust the dose as necessary but it should not exceed a maximum daily dosage of 10 mg divided into two doses spaced approximately 12 hours apart.
What are the most common side effects for Effient?
Common side effects of Effient and Eliquis include:
- Bleeding more easily, including nosebleeds
- Bruising more easily
- Fatigue (general weakness and tiredness)
- Headache
- Nausea
- Stomach pain or discomfort (dyspepsia)
- Diarrhea
- Rash or itching
- Shortness of breath
It is crucial to note that both medications carry a risk of severe bleeding. If you notice any signs of excessive bleeding, such as dark or bloody stools, coughing up blood, unusual bruising, prolonged bleeding from cuts, dizziness, weakness or confusion; seek immediate medical attention.
Are there any potential serious side effects for Effient?
Effient, like Eliquis, is an anticoagulant medication used to prevent blood clots. While generally safe and effective, there are potential risks involved in its use. Here are some possible side effects of Effient:
- Unusual bleeding (nosebleeds, unusual bruising or discoloration on the skin)
- Symptoms of allergic reaction: hives; difficulty breathing or swallowing; swelling of your face, lips, tongue, or throat
- Signs of internal bleeding such as stomach pain with bloody stools or vomit that looks like coffee grounds
- Dark-colored urine and pale stool due to liver problems
- Chest pain associated with shortness of breath indicating a heart problem
- Low platelet levels - easy bruising and unusual bleeding from gums/nose/eyes/genitals
In rare cases there might be severe reactions affecting nervous system causing confusion, weakness on one side of the body, slurred speech.
If you experience any adverse symptoms while taking Effient it's important to seek medical attention immediately.
What are the most common side effects for Eliquis?
Eliquis, a commonly prescribed blood thinner, can cause a variety of side effects. Some individuals may experience:
- Nosebleeds or bleeding from the gums
- Unusual bruising or discoloration on the skin
- Excessive fatigue and weakness
- Nausea and minor stomach discomfort
- Decreased appetite
- Swelling in your hands or feet (edema)
- Headaches and dizziness Remember that these are potential side effects; not every person will experience them. It's important to monitor any changes in your health while taking Eliquis and report them to your healthcare provider promptly.
Are there any potential serious side effects for Eliquis?
While Eliquis is typically well-tolerated, it can occasionally cause severe side effects. These may include:
- Signs of a serious allergic reaction: rashes, itching or hives on the skin; shortness of breath, wheezing or difficulty breathing; swelling of the face, lips, tongue or other parts of the body
- Unusual bleeding from gums when brushing teeth; nosebleeds that happen often
- Reddish or brownish urine
- Vomiting blood (which could look like coffee grounds in texture)
- Stools that are red, pink, brownish-black in color suggesting gastrointestinal bleed
- Unexpected pain and/or swelling in your joints.
If you notice any such symptoms while taking Eliquis, seek immediate medical attention. It's crucial to remember not to discontinue Eliquis without consulting with your healthcare provider as this might increase your risk for stroke.
Contraindications for Effient and Eliquis?
Both Effient and Eliquis, along with many other anticoagulant medications, may increase the risk of bleeding. If you notice unusual bruising or bleeding (including nosebleeds), blood in urine or stool, prolonged bleeding from cuts or gums, coughing up blood, vomiting that is bloody or looks like coffee grounds, severe headache, dizziness/fainting; unusual or persistent tiredness/weakness - seek immediate medical attention.
Neither Effient nor Eliquis should be taken if you are taking any medication that affects blood clotting such as warfarin or aspirin unless directed by a doctor. You should always inform your healthcare provider about all the medications you are currently using; some drugs will require a certain period to clear from your system to prevent dangerous interactions with Effient and Eliquis. For example, if you were previously on warfarin therapy it can take up to 5 days for its effects on clotting factors to wear off before starting a new anticoagulant such as Effient/Eliquis.
How much do Effient and Eliquis cost?
For the brand name versions of these drugs:
- The price for a month supply (28 tablets) of Eliquis (5 mg) averages around $485, which works out to approximately $17/day.
- The price for 30 tablets of Effient (10 mg) averages about $700, working out to approximately $23/day.
Thus, if you are prescribed the standard dose for each medication, then brand-name Eliquis is less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which of these drugs is right for you; effectiveness and safety profile must also be considered.
As far as generic versions go:
- There isn't currently a generic version available in the U.S. market either for Effient or Eliquis.
Prices can vary depending on your location and insurance coverage. In general, consult with your healthcare provider or pharmacist regarding costs and potential savings strategies such as manufacturer coupons or patient assistance programs.
Popularity of Effient and Eliquis
Prasugrel, available as the brand name Effient, was prescribed to around 615,000 people in the US in 2020. This antiplatelet medication is often used to prevent clotting after angioplasty and stent procedures. Prasugrel accounted for just over 2% of prescriptions for antiplatelet medications in the US.
On the other hand, Apixaban (Eliquis) has seen a dramatic increase in use since its introduction. It was prescribed to about 10 million people in the USA during 2020 alone. In America, apixaban accounts for about one-third of all anticoagulant prescriptions and approximately half of all novel oral anticoagulant prescriptions. The prevalence of apixaban has been on a steady rise since it received FDA approval back in late 2012.
Conclusion
Both Effient (prasugrel) and Eliquis (apixaban) are medications commonly prescribed to patients with cardiovascular conditions, particularly those who have undergone angioplasty or stent placement. They have proven their effectiveness in preventing harmful clot formation through numerous clinical trials and meta-analyses, exceeding the performance of placebo treatments significantly.
Effient works by irreversibly binding to platelet receptors thereby inhibiting platelet aggregation, while Eliquis acts as a direct factor Xa inhibitor that reduces thrombin production and thus blood clots. Because of these different mechanisms of action, they are often used under varied circumstances: while Effient is generally recommended following angioplasty or stents placement for acute coronary syndrome patients, Eliquis is more broadly applied in cases like atrial fibrillation and deep vein thrombosis prophylaxis.
While both drugs come in generic forms offering cost benefits especially for self-paying patients, it's important to note that their effects may not be immediately noticeable since they work by preventing future cardiovascular events rather than providing symptomatic relief.
The side effects between the two medications are somewhat similar but differ in intensity; bleeding being common for both but usually less severe with Eliquis use compared to Effient. It’s crucial when taking either medication to monitor any unusual symptoms or signs of excessive bleeding such as prolonged nosebleeds or unusually heavy menstrual flow - immediate medical help should be sought if these occur.
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Refrences
- Lazar, L. D., & Lincoff, A. M. (2009, December). Prasugrel for acute coronary syndromes: Faster, more potent, but higher bleeding risk. Cleveland Clinic Journal of Medicine. Cleveland Clinic Journal of Medicine.http://doi.org/10.3949/ccjm.76a.09116
- Koo, M. H., Nawarskas, J. J., & Frishman, W. H. (2008, November). Prasugrel. Cardiology in Review. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1097/crd.0b013e318189a701
- Keating, G. M. (2013, May 16). Apixaban: A Review of its Use for Reducing the Risk of Stroke and Systemic Embolism in Patients with Nonvalvular Atrial Fibrillation. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-013-0063-x