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Eliquis vs Pradaxa
Introduction
For patients with a risk of stroke or blood clots due to conditions like atrial fibrillation or following certain surgical procedures, anticoagulant medications that limit the blood's ability to clot can be life-saving. Eliquis and Pradaxa are two such drugs that are prescribed for these conditions. These drugs affect the clotting process, but each one operates in a slightly different manner. Eliquis, also known as apixaban, is a direct factor Xa inhibitor that works by blocking a key clotting protein. Pradaxa, or dabigatran etexilate, is a direct thrombin inhibitor that prevents the formation of clots by inhibiting a different clotting protein. Both drugs can significantly reduce the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation.
Eliquis vs Pradaxa Side By Side
| Attribute | Eliquis | Pradaxa |
|---|---|---|
| Brand Name | Eliquis | Pradaxa |
| Contraindications | Cannot be taken with Ketoconazole, Itraconazole, Ritonavir, and Clarithromycin. Must be stopped before certain surgeries to reduce bleeding risk. | Cannot be taken with Ketoconazole, Itraconazole, Ritonavir, and Clarithromycin. Must be stopped before certain surgeries to reduce bleeding risk. |
| Cost | Around $470 for 60 tablets of 5 mg | Around $420 for 60 capsules of 150 mg |
| Generic Name | Apixaban | Dabigatran |
| Most Serious Side Effect | Unusual or prolonged bleeding, signs of severe allergic reaction, symptoms related to blood clots, severe headache or weakness indicating a stroke, blood in urine/stools, vision changes. | Signs of severe allergic reaction, unusual bleeding or bruising, dark urine or yellowing eyes/skin indicating liver problems, heartbeat changes, stomach/abdominal pain signaling serious internal bleeding. |
| Severe Drug Interactions | Medications such as Ketoconazole, Itraconazole, Ritonavir, and Clarithromycin. | Medications such as Ketoconazole, Itraconazole, Ritonavir, and Clarithromycin. |
| Typical Dose | 2.5–5 mg twice daily | 150 mg taken orally, twice daily |
What is Eliquis?
Apixaban (the generic name for Eliquis) and Dabigatran (the generic name for Pradaxa) both belong to a class of drugs known as direct oral anticoagulants (DOACs), which marked a major advancement from the traditional anticoagulant, Warfarin. Apixaban was first approved by the FDA in 2012. Eliquis works by inhibiting Factor Xa, an essential blood clotting protein, reducing the ability of your blood to form dangerous clots. It is prescribed primarily for preventing stroke in patients with atrial fibrillation and also used for prevention or treatment of deep vein thrombosis and pulmonary embolism. Compared to Dabigatran that directly inhibits thrombin, another key player in clot formation process, Apixaban has fewer gastrointestinal side effects while providing similar protection against stroke. This drug selection largely depends on each patient's individual risk factors and circumstances.
What conditions is Eliquis approved to treat?
Eliquis is approved for the treatment and prevention of several blood clot-related conditions:
- Prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation
- Deep vein thrombosis (DVT) prophylaxis, particularly post hip or knee replacement surgery
- Treatment of DVT and pulmonary embolism (PE), as well as to reduce the risk of recurrent DVT and PE after initial therapy.
How does Eliquis help with these illnesses?
Eliquis helps to manage blood clotting by blocking the action of an enzyme in the body called Factor Xa. This enzyme plays a crucial role in the coagulation cascade, a series of reactions that leads to the formation of a clot. By inhibiting Factor Xa, Eliquis reduces the ability for clots to form, therefore reducing risk in patients with conditions such as deep vein thrombosis (DVT) or atrial fibrillation where unwanted and dangerous clots can occur. Similarly to serotonin's role in mood regulation, Factor Xa is integral for hemostasis - maintaining equilibrium within our blood vessels and preventing excessive bleeding or clotting. By controlling levels of active Factor Xa within our bloodstream with Eliquis, we can manage these risks effectively and stabilize patients' health.
What is Pradaxa?
Pradaxa, also known by its generic name Dabigatran, is a type of anticoagulant, or blood thinner, that is used to prevent strokes and blood clots in patients who have atrial fibrillation. It works by inhibiting thrombin, an enzyme in your blood that is involved in the clotting process. Pradaxa was first approved by the FDA in 2010. Unlike Eliquis, Pradaxa does not inhibit Factor Xa, another enzyme involved in blood clotting. This distinction in mechanism of action means that its side-effect profile is slightly different from that of Factor Xa inhibitors like Eliquis. In particular, Pradaxa is less likely to cause bleeding, a common side effect of anticoagulants. Moreover, unlike Eliquis, Pradaxa has a specific reversal agent available, called Praxbind, which can be used in emergencies to prevent severe bleeding. The effects of Pradaxa on thrombin can be beneficial for the prevention of stroke, especially in patients who do not respond well to the "typical" Factor Xa inhibitors such as Eliquis.
What conditions is Pradaxa approved to treat?
Pradaxa is a well-accepted anticoagulant that's often prescribed for:
- Prevention of blood clots in patients with atrial fibrillation
- Treatment and prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE) It's important to note, unlike some other similar medications, Pradaxa does not require regular blood monitoring making it more convenient for many patients.
How does Pradaxa help with these illnesses?
Thrombin is a crucial enzyme in the process of blood clotting, acting as a catalyst in the conversion of fibrinogen to fibrin, and thereby facilitating the formation of blood clots. Pradaxa, a direct thrombin inhibitor, works by binding to thrombin's active site and inhibiting its function, thereby reducing the likelihood of blood clot formation. This mechanism of action is especially beneficial for patients with atrial fibrillation, a condition characterized by irregular heartbeat that can lead to blood clot formation and subsequent stroke. While Eliquis also prevents blood clot formation, it does so by inhibiting Factor Xa, another key player in the clotting cascade. Pradaxa may be prescribed when a patient cannot tolerate Eliquis, or it may be chosen for its unique advantage of having a specific reversal agent, idarucizumab, available in the event of severe bleeding or need for emergency surgery.
How effective are both Eliquis and Pradaxa?
Both apixaban (Eliquis) and dabigatran (Pradaxa) have proven track records in preventing stroke in patients with nonvalvular atrial fibrillation, and they were both approved by the FDA within a two-year span. Their mechanisms of action differ as apixaban is a factor Xa inhibitor while dabigatran is a direct thrombin inhibitor, which may influence their prescription under different circumstances.
A 2011 randomized trial compared these drugs directly; it was found that apixaban exhibited equal efficacy to warfarin in preventing stroke or systemic embolism but had comparatively fewer side effects. In another study conducted the same year, dabigatran also showed similar effectiveness to warfarin while presenting less bleeding risk at lower doses.
A 2016 meta-analysis demonstrated that apixaban has an excellent safety profile and appears effective from the first day of treatment. This review highlighted its benefits over other anticoagulants including well-tolerated use among elderly populations prone to falls and reduced interactions with food or other medications making it more convenient for daily use.
Another 2014 review indicated that dabigatran seems equally effective as warfarin in treating venous thromboembolism but might present higher gastrointestinal bleeding risks. Despite this concern, due its unique pharmacology and absence of regular blood monitoring requirement unlike traditional anticoagulants such as warfarin, it remains an important option for those who require long-term anticoagulation therapy.
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At what dose is Eliquis typically prescribed?
Oral dosages of Eliquis typically range from 2.5–5 mg twice daily, depending on the individual's health condition and body weight. Studies have suggested that a dosage of 5mg twice daily is generally effective for preventing strokes and blood clots in people with atrial fibrillation. The lower dose of 2.5mg twice daily may be used in patients with at least two of the following characteristics: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL. In contrast, Pradaxa is usually prescribed at a dose of 150 mg taken orally, twice daily for most patients with atrial fibrillation not caused by heart valve disease. A reduced dose of Pradaxa -75 mg taken orally, twice daily- is recommended for certain patients with kidney problems.
At what dose is Pradaxa typically prescribed?
Pradaxa treatment is typically initiated at a dosage of 150 mg taken orally, twice daily. In certain cases, such as for patients with renal impairment or increased risk of bleeding, the dose may be reduced to 75 mg taken twice daily. It's important to note that dosing intervals should not exceed 12 hours apart in order to maintain therapeutic levels in the bloodstream and effectively prevent blood clots. If there's no significant improvement or if side effects occur, your healthcare provider might reconsider your treatment plan after a few weeks.
What are the most common side effects for Eliquis?
Common side effects of Eliquis include:
- Nausea
- Minor bleeding, such as nosebleeds or bleeding gums
- Bruising more easily
- Heavy menstrual periods
While Pradaxa may cause similar side effects, it also includes:
- Upset stomach
- Heartburn, nausea and indigestion
- Diarrhea
- Stomach pain
Remember that these anticoagulants carry a risk of serious bleeding. If you notice any severe symptoms like coughing up blood, vomit that looks like coffee grounds or dark urine/stools, seek immediate medical attention.
Are there any potential serious side effects for Eliquis?
In some cases, taking Eliquis can lead to potentially serious side effects such as:
- Unusual or prolonged bleeding
- Signs of a severe allergic reaction: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
- Symptoms related to blood clots such as shortness of breath, chest pain and discomfort that worsens on deep breathing or coughing, lightheadedness, fainting
- Severe headache or weakness on one side of the body which could be signs of a stroke
- Blood in urine/stools (which may appear pink/dark brown) or coughing up blood
- Vision changes
It's worth noting that these adverse reactions are relatively rare but they do underscore the importance for regular check-ups with your healthcare provider while taking anticoagulants like Eliquis. If you experience any of these symptoms contact your doctor immediately.
What are the most common side effects for Pradaxa?
Pradaxa, like Eliquis, is an anticoagulant medication used to prevent stroke and blood clots. However, it has some unique side effects that need consideration:
- Indigestion or stomach upset
- Gastric reflux or heartburn
- Nausea or vomiting
- Diarrhea
- Minor skin rash
- Potential for easy bruising due to thinner blood consistency.
Although the list seems substantial, keep in mind that these adverse events do not occur in everyone who takes Pradaxa. Also note that while this drug does its job preventing dangerous conditions like strokes and pulmonary embolisms, it may also present a slightly increased risk of bleeding compared to other medications in its class. Always consult with your healthcare provider about potential risks versus benefits when considering any new medication.
Are there any potential serious side effects for Pradaxa?
Pradaxa, like any other medication, can have side effects. Although not everyone gets them and they are usually manageable, it's crucial to be aware of the potential adverse reactions:
- Signs of a severe allergic reaction such as swelling in your face or throat, hives, itching, difficulty breathing
- Unusual bleeding (nosebleeds or heavy menstrual flow), easy bruising
- Dark urine or yellowing eyes/skin which could indicate liver problems
- Heartbeat changes that feel too fast or irregular
- Stomach/abdominal pain potentially signaling serious internal bleeding.
If you notice these symptoms while taking Pradaxa, seek immediate medical attention.
Contraindications for Eliquis and Pradaxa?
Both Eliquis and Pradaxa, along with most other anticoagulants, may increase the risk of serious or even lethal bleeding. If you notice any unusual bruising or bleeding, please seek immediate medical attention.
Neither Eliquis nor Pradaxa can be taken if you are taking, or have been taking medications such as Ketoconazole, Itraconazole, Ritonavir and Clarithromycin which could significantly affect how these drugs work in your body. Always tell your physician about all the medicines you take; some may require a period of several days to clear from your system to prevent dangerous interactions with Eliquis and Pradaxa.
If you need surgery (including dental procedures), inform every healthcare professional involved in your care that you are on either drug as they might need to be stopped for a few days before certain surgeries or procedures to lower the risk of excessive bleeding.
How much do Eliquis and Pradaxa cost?
For the brand name versions of these drugs:
- The price of 60 tablets of Eliquis (5 mg) averages around $470, which works out to approximately $15.67/day based on a typical dosage of two pills per day.
- The price for 60 capsules of Pradaxa (150 mg) is about $420, working out to roughly $14/day.
Thus, if you are taking the standard dosage for both medications, then brand-name Pradaxa is less expensive on a per-day treatment basis than Eliquis. Please note that cost should not be a primary consideration in determining which blood thinner is right for you due to their different side effect profiles and interactions with other medications.
As yet there are no generic versions available in the U.S. for either apixaban (Eliquis) or dabigatran (Pradaxa). Thus costs remain relatively high compared to many other classes of medication where generics have been introduced.
Popularity of Eliquis and Pradaxa
Apixaban, both in its generic form and under the brand name Eliquis, was estimated to have been prescribed to about 11.8 million people in the US in 2020. Apixaban accounted for just over 34% of anticoagulant prescriptions in the US. However, it appears to be one of the most-common "direct oral" anticoagulants (DOACs), which are a newer class of blood thinners that directly inhibit certain clotting factors.
Dabigatran, including brand versions such as Pradaxa, was prescribed to approximately 1.5 million people in the USA in 2020. In the US, dabigatran accounts for around 4% of anticoagulant prescriptions and is another example of DOACs used frequently by patients with atrial fibrillation or deep vein thrombosis among other conditions. The prevalence of Dabigatran has remained fairly consistent over recent years despite competition from later entries into this drug class like apixaban.
Conclusion
Both Eliquis (apixaban) and Pradaxa (dabigatran) are popular choices in the category of oral anticoagulants, widely prescribed to prevent stroke and blood clots in patients with atrial fibrillation. They have been proven effective through numerous clinical trials and studies, often outperforming traditional medications like warfarin. Each works by a different mechanism: Eliquis is a factor Xa inhibitor while Pradaxa is a direct thrombin inhibitor.
Eliquis tends to be preferred as it doesn't require regular blood tests for monitoring its effectiveness, unlike Pradaxa which may need periodic checks for renal function. However, these recommendations can vary based on individual health circumstances and doctor's judgment.
Generic forms of both drugs are not yet available; hence they can be quite expensive especially for those paying out-of-pocket. Neither drug requires an adjustment period - the effects will typically begin within hours after taking the first dose.
While side effect profiles between two drugs are similar including potential risks such as bleeding or bruising easily, gastrointestinal issues etc., Eliquis has shown lower risk of major bleeding compared to both warfarin and dabigatran in several studies. It's crucial that any signs of unusual bleeding or bruising should prompt immediate medical attention when using either medication.
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Refrences
- 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
- Watson, J., Whiteside, G., & Perry, C. (2011, October). Apixaban. Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/11596820-000000000-00000
- Ganetsky, M., Babu, K. M., Salhanick, S. D., Brown, R. S., & Boyer, E. W. (2011, September 2). Dabigatran: Review of Pharmacology and Management of Bleeding Complications of This Novel Oral Anticoagulant. Journal of Medical Toxicology. Springer Science and Business Media LLC.http://doi.org/10.1007/s13181-011-0178-y
- Bendel, S. D., Bona, R., & Baker, W. L. (2011, April 26). Dabigatran: an oral direct thrombin inhibitor for use in atrial fibrillation. Advances in Therapy. Springer Science and Business Media LLC.http://doi.org/10.1007/s12325-011-0025-1
- Buckley, B. J. R., Lane, D. A., Calvert, P., Zhang, J., Gent, D., Mullins, C. D., … Lip, G. Y. H. (2022, June 30). Effectiveness and Safety of Apixaban in over 3.9 Million People with Atrial Fibrillation: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. MDPI AG.http://doi.org/10.3390/jcm11133788
- Agrawal, R., Jain, P., & N. Dikshit, S. (2012, May 1). Apixaban: A New Player in the Anticoagulant Class. Current Drug Targets. Bentham Science Publishers Ltd.http://doi.org/10.2174/138945012800564059