Eliquis vs Plavix

Introduction

Heart attack is one of the most prevalent medical conditions in the US, with an estimated 800,000 Americans experiencing at least one heart attack per year. It is the leading cause of death in both men and women across the US, accounting for 25% of all deaths. Given the seriousness of heart attacks, medical researchers have pooled together their resources to work on medicines that would reduce the risk of myocardial infarction. Among these mediations, Eliquis (Apixaban) and Plavix (Clopidogrel) play an integral role in managing the symptoms of heart attack and may well have prevented many deaths.

Eliquis belongs to a class of medications known as factor Xa inhibitors that prevent the formation of blood clots by blocking a certain natural substance. Meanwhile, Plavix belongs to a class of medications known as antiplatelet medications that prevent platelets from forming clots that could lead to heart attacks. Although their purpose is similar, Eliquis and Plavix are two entirely different types of medications. Let’s take a more in-depth look.

About Eliquis and Plavix

What is Eliquis?

Eliquis (generic for Apixaban) is an anticoagulation medication that makes it easy for blood to flow through veins. This also means that the blood is less likely to form clots, which can lead to devastating health problems such as heart attacks and DVT. Eliquis works by blocking the activity of clotting factor Xa, which prevents the formation of clots.

The medication affects factor Xa both within the blood and within an existing clot. It is worth mentioning that they do not have any effect on platelet aggregation. Both intrinsic and extrinsic coagulation pathways can generate Factor Xa, which can activate prothrombin to thrombin.

The duration of treatment for each patient varies. For example, the length of surgery in patients can be a deciding factor in how long they may have to take Eliquis to prevent the formation of blood clots. For example, patients will need to take Eliquis for about 2 weeks if they’ve undergone knee replacement surgery.

Patients may have to take Eliquis for about 40 days after undergoing hip replacement surgery. Treating a blood clot usually requires at least 3 months. And you may have to commit to Eliquis permanently if you have a more serious heart condition such as atrial fibrillation.

This medication should be used regularly to derive maximum benefit. Eliquis is usually available in the form of 2.5mg and 5mg tablets. The exact dosage depends on your medical condition and other factors such as age and lifestyle. Make sure to check in with your doctor before administering Eliquis. The oral bioavailability of Eliquis is 50%, and food does not have a meaningful impact on the bioavailability rate. Eliquis has a half-life of about 12 hours, with maximum concentration occurring 3 to 4 hours after oral administration.

What conditions is Eliquis approved to treat?

Eliquis is used for reducing the risk of heart attack, stroke, and embolism in people with nonvalvular atrial fibrillation, acute pulmonary embolism, and deep vein thrombosis, among others. It has been approved for clinical use in many thromboembolic disorders, atrial fibrillation, thromboprophylaxis, and pulmonary embolism.

How does Eliquis work for Blood Clots?

The mechanism of action for Eliquis is the inhibition of both free and clot-bound factor Xa. It does not require antithrombin III for antithrombotic activities. By reducing factor Xa, Eliquis is able to prevent or slow down the development of thrombus. It does not have any impact on platelet aggregation but may indirectly inhibit platelet aggregation induced by thrombin, which is the final step in the coagulation cascade leading to clot formation.

It is metabolized mainly by the CYP3A4 enzyme and is discarded by the body through both urine and feces.

What is Plavix?

Plavix (generic name Clopidogrel) is an antiplatelet medication that is used for preventing the formation of blood clots. The empirical formula for Plavix is C16H16ClNO2S•H2SO4 with a molecular weight of 419.9.

It plays an important role in preventing heart attacks by stopping platelet aggregation. In most cases, patients may be asked to take about 75 mg of Plavix per day, depending on their risk level or medical conditions.

This medication isn't without its side effects, which include nosebleeds, bleeding gums, and bruising. Note that drinking alcohol with this drug is possible, but excessive consumption of alcohol could irritate the stomach. This medicine is not suitable for individuals over the age of 18. If you forget to take Plavix, remember to take it as soon as you remember.

Never take a double dose to make up for the forgotten dose. Skip the missed dose and take the next dose at its prescribed time. It is possible to overdose on Plavix if you take too many tablets. Talk to your doctor immediately if you believe you have overdosed and notice any signs of bleeding.

What conditions are Plavix approved to treat?

How does Plavix work for Blood Clots?

Plavix is an inhibitor of platelet aggregation. It has been shown to reduce morbid events in people who are at risk of cardiovascular disease, including strokes, myocardial infarction, and unstable angina. Plavix is metabolized by CYP540 enzymes that generate an active metabolite to inhibit platelet aggregation.

The active metabolite of Plavix selectively inhibits the binding of ADP to the PSY12 receptor. Platelets exposed to the active metabolite of Plavix are affected for the remainder of their lifespan (which is about a week or ten days). Note that CYP450 enzymes are subject to inhibition by other drugs, and not all patients will demonstrate adequate platelet inhibition.

It takes about 2 hours for single doses of Plavix to start working. Platelet aggregation inhibition becomes more uniform after about 3 to 7 days. It is unclear if food can affect the bioavailability of the active compound or the parent compound. Studies show that Plavix is excreted over the course of 5 days (46% in the feces and 50% in the urine).

Effectiveness

How effective are Eliquis and Plavix for treating Heart Attacks?

Both Eliquis and Plavix are extremely effective when it comes to reducing the risk of blood formation and, subsequently, heart attacks. They aren’t always prescribed together because of the risk of bleeding that could lead to fatal hemorrhage.

One study found that 98% of patients taking Eliquis did not experience another blood clot (DVT or PE). Moreover, Eliquis is less likely to lead to bleeding when compared to other drugs. Meanwhile, Plavix has also been shown to be very effective in preventing strokes. One study found that 4.6% of patients who took Plavix had a stroke.

It can take about 2 hours for Plavix to start working. Meanwhile, peak concentration of Eliquis can start to appear within 3 to 4 hours of an oral dose. This makes Plavix slightly more effective than Eliquis, but for most intents and purposes, both drugs help patients reduce their risk of strokes and blood clots.

Dosage information

How is Eliquis administered for Heart Attack?

Most patients are prescribed 5 mg of Eliquis twice a day, depending on their heart condition. Patients will usually take two 5mg tablets twice a day for the first week and switch to one 5mg tablet twice a day. Reducing the risk of a blood clot may require a 2.5mg tablet taken twice a day. The tablet can be taken with or without food. It can also be crushed and mixed with water for ease of consumption.

Side Effects

What are the most common side effects of Eliquis?

Here are the most common side effects of Eliquis:

• Nosebleeds
• Bleeding from the gums
• It takes longer for bleeding from cuts to stop
• Ease to get a bruise
• Headache
• Rash
• Nausea

Are there any potential serious side effects of Eliquis?

* If you experience any of these serious side effects, seek medical help immediately

• Joint pain
• Swelling
• Heavy bleeding in the vagina
• Red stools
• Passing red or brown urine
• Swelling in the facial region
• Severe bleeding following an injury
• Coughing up blood
• Pain in the chest
• Labored breathing

What are the most common side effects of Plavix?

Here are the most common side effects of Plavix:

• Shortness of breath
• Fast heartbeats
• Easy to get bruised
• Feeling weak
• Lethargic
• Problems with urination
• Headache
• Fever
• Confusion
• Sudden numbness
• Nosebleeds
• Itching
• Bruising

Are there any potential serious side effects of Plavix?

* If you experience any of these serious side effects, seek medical help immediately

• Vision loss and tunnel vision
• Serious heart conditions
• Severe headache
• Slurred speech
• High fever
• Coughing up blood
• Unusual bleeding in the vagina, rectum, mouth, or nose
• Purple or red pinpoint spots under the skin
• Sudden weakness
• Coughing up blood

Contraindications and interactions

Warnings and general precautions for Eliquis and Plavix

Contraindications and important interactions for Eliquis and Plavix

Contraindications

Eliquis

Eliquis has a black box warning for an increased risk of blood clots and the risk of epidural blood clots. This can be reversed in emergency situations, making the effect less dangerous.

Eliquis is contraindicated in patients with any of the following conditions:

• Those with severe hypersensitivity to the drug
• Active pathological bleeding
• Those undergoing elective or invasive surgical procedures
• Those with mechanical heart valves
• Those with dialysis
• Renal impairment
• Breastfeeding patients
• Lumbar puncture
• Spinal anesthesia
• Intramuscular injections
• Antiphospholipid antibody syndrome

Plavix

Plavix has a black box warning for patients with a genetic variation that prevents their bodies from metabolizing the drug. Such patients (known as poor metabolizers) are less likely to receive the full benefits of the drug.

Plavix is contraindicated in patients with any of the following conditions:

• Those with severe hypersensitivity to the drug
• Surgery
• Hepatic disease
• Renal disease
• Renal failure
• Renal impairment
• Poor metabolizers
• Pregnancy
• Spinal anesthesia
• Geriatrics
• Breastfeeding
• Children and infants
• Abrupt discontinuation

Drug/Medication Interactions

Eliquis

• Abciximab
• Acetaminophen;
• Aspirin
• Ado-Trastuzumab emtansine
• Alteplase
• Betrixaban
• Carbamazepine
• Defibrotide
• Dexamethasone
• Fondaparinux
• Fosphenytoin
• Mifepristone
• omacetaxine
• Phenytoin
• Prothrombin complex concentrate, human
• Secobarbital
• St John's Wort
• Vorapaxar

Plavix

• Omeprazole
• Esomeprazole
• Rifampin
• Aspirin
• Ibuprofen
• Sertraline
• Paroxetine
• Duloxetine
• Venlafaxine
• Warfarin
• Rivaroxaban
• Apixaban
• Dabigatran
• SSRIs

Food/Beverage/Supplement Interactions

Eliquis

Foods to avoid with Eliquis

• Grapefruit
• Pomelo
• Lime

Beverages to avoid with Eliquis

• Grapefruit juice
• Marmalade juice
• Lime juice
• Pomelo juice

Supplements to avoid with Eliquis:

• Chinese herbs
• Herbal tea

Plavix

Foods to avoid with Plavix

• Asparagus
• Broccoli
• Brussels sprouts
• Cauliflower
• Green onions
• Kale

Beverages to avoid with Plavix

• Grapefruit juice

Supplements to avoid with Plavix:

Talk with your doctor or pharmacist before taking any supplements with Plavix.

Cost Comparison

How much do Eliquis and Plavix cost?

The average cost for 60 tablets of Eliquis can cost anywhere from $550 to $600 or more. There are no generic alternatives for this medicine, but it is covered by most Medicare and insurance plans. Furthermore, you can also secure discounts with the help of pharmacy coupons.

Plavix, on the other hand, costs more moderately. A 30-tablet supply for Plavix starts at around $50, but you may be able to secure discounts depending on the pharmacy.

Popularity of Eliquis and Plavix

Plavix has had over 19.4 million subscriptions in the US in 2020 alone, making it one of the most popular drugs in the country. Meanwhile, Eliquis had about 13.9 million prescriptions in the US in 2020. The differences in popularity may be due to the price per prescription for Eliquis at around $740 compared to $18.39 for Plavix.

Conclusion

Takeaway

So there you have it, an in-depth comparison of Eliquis and Plavix as well as their mechanism of action, general dosage guidelines, and side effect profiles. Both drugs are very effective at managing blood clots, but you should always consult with your doctor for prescriptions and dosage guidelines.