Xarelto Vs Warfarin

What are the differences between Xarelto and Warfarin?

Blood thinners work by preventing the blood clotting process. They do this by inhibiting different blood clot factors essential for this process. For a time warfarin was the only blood thinner on the market, but in recent years there have been three new additions to the roster. Xarelto, as you may have guessed, is one of those new additions. Xarelto and warfarin may serve the same purpose but they work by inhibiting different blood clotting factors. But that is only one of several differences.

1. Warfarin works by inhibiting an enzyme that’s responsible for using vitamin K to produce vitamin K-dependent clotting factors. This, in turn, slows down the production of fibrin and increases the time taken for blood to clot. Xarelto, on the other hand, working by binding to and inhibiting factor Xa, which prevents the production of the blood clotting factor thrombin. As a result, fibrin takes a longer time to synthesize and blood clotting is impeded.
2. The prescribed dose of warfarin is subject to variation. It is strongly influenced by factors such as age, diet, and other medications. Since vitamin K reduces the effectiveness of the drug patients must constantly be monitored (once a month or more frequently) to re-evaluate the dosage required. Patients must regulate their diets to keep their vitamin K levels moderate. Xarelto, however, has no such restriction, but it does come with a standard dosage of 20 mg per day, taken with the evening meal.
3. If blood levels of warfarin increase too much vitamin K can be administered as an antidote to suppress its effect. Xarelto has no known antidote, but the risk of bleeding when on the drug is significantly less than warfarin.
4. Warfarin has another advantage over Xarelto: A generic form of warfarin     has been available for years. As such, on average, warfarin is less expensive than its counterpart Xarelto. The lowest available cost of 30 tablets of warfarin is $4 while that of Xarelto is $325.95.
5. Studies have shown that patients who have had hip and knee replacement and who are on Xarelto have a reduced risk of blood clot formation when compared to those on warfarin.

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Xarelto Vs Pradaxa

What are the differences between Xarelto and Pradaxa?

Choosing a prescription that’s right for you can be a tedious process. So many things must be taken into consideration. What are the possible side effects? How does it compare with the other drugs of its class? Hopefully this article can give you a little insight into the pros and cons of the blood thinners Xarelto and Pradaxa.

Xarelto

Xarelto is manufactured and marketed by Bayer and Janssen Pharmaceuticals. It’s primarily used as a preventative measure against blood clotting and strokes in patients suffering from nonvavular atrial fibrillation, deep vein thrombosis, pulmonary embolism, as well as those that have had hip and knee replacement surgery. Unlike its predecessor Camoudin the use of Xarelto does not require any dietary restrictions or monthly blood tests, which makes it convenient to use. It works by inhibiting the activity of the clotting factor factor Xa, which prevents the synthesis of thrombin. Once consumed Xarelto is rapidly absorbed and reaches 2-4 hrs after being administered. Some of the medication is removed unchanged by the kidneys. Xarelto, however, lacks an antidote to counteract its action and cannot be removed by dialysis. This has resulted in lawsuits being filed against Bayer and Janssen Phamarceuticals because users of Xarelto were either hospitalized or died from excessive bleeding while on the medication. Fortunately for Xarelto, it has a short half-life of 4-9 hrs of activity compared to camoudin’s 40 hrs, so some bleeding events can be managed by discontinuing the use of the medication. Unlike Camoudin, Xarelto comes in standardized doses that must be taken with food to increase absorption. Xarelto can be split, chewed, or crushed before being consumed.

Pradaxa

Pradaxa is the predecessor of Xarelto. It’s manufactured by Bayer’s competitor Boehringer-Ingelheim. Pradaxa much like Xarelto is primarily used as a preventative measure against blood clotting and strokes in patients suffering from nonvavular atrial fibrillation, deep vein thrombosis, pulmonary embolism, as well as those that have had hip and knee replacement surgery. But when Xarelto was introduced to the market in 2011 Pradaxa’s sales began to take a nosedive. Much like Xarelto, Pradaxa has no dietary restrictions or requirement for monthly blood tests, which makes it convenient to use. Instead of inhibiting factor Xa like Xarelto does, Pradaxa works by inhibiting the thrombin-dependent conversion of fibrinogen to fibrin. When consumed the drug is rapidly absorbed and reaches peak 1-2 hrs after being administered. After being administered most (80%) of it is removed by the kidney. Much like its successor Pradaxa lacks an antidote to counteract its activity in the case of an overdose or bleeding event. As a consequence of this, Boehringer-Ingelheim has received several lawsuits from individuals that have been hospitalized or from relatives whose loved ones have died as a result of uncontrolled bleeding caused by Pradaxa. Boehringer-Ingelheim later settled these lawsuits for a whopping $650 million. On the bright side, there is evidence out there that hemodialysis can remove Pradaxa. Clinical data, however, is limited. Unlike its successor, Pradaxa must be taken twice daily but can be taken with or without food. On the other hand, it cannot be crushed, split, or chewed before being consumed. A side by side comparison of Pradaxa’s and Xarelto’s efficacy cannot be made because no head to head studies have been done to compare this characteristic.

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Xarelto Vs Eliquis

Xarelto

Xarelto is manufactured and marketed by Bayer and Janssen Pharmaceuticals. It’s primarily used as a preventative measure against blood clotting and strokes in patients suffering from nonvavular atrial fibrillation, deep vein thrombosis, pulmonary embolism, as well as those that have had hip and knee replacement surgery. Unlike its predecessor, Camoudin the use of Xarelto does not require any dietary restrictions or monthly blood tests, which makes it convenient to use. It works by inhibiting the activity of the clotting factor factor Xa, which prevents the production of thrombin. Xarelto is rapidly absorbed and reaches peak activity 2-4 hrs after being administered. Some of the medication is removed unchanged by the kidneys. Xarelto, however, lacks an antidote to counteract its action and cannot be removed by dialysis. This has resulted in lawsuits being filed against Bayer and Janssen Phamarceuticals because users of Xarelto were either hospitalized or died from excessive bleeding while on the medication. Fortunately for Xarelto, it has a short half-life of 4-9 hrs of activity compared to camoudin’s 40 hrs. Unlike Camoudin, Xarelto comes in standardized doses that must be taken with food to increase absorption. Xarelto can be split, chewed, or crushed before being consumed.

Eliquis

Eliquis is manufactured by Bristol-Myers Squibb and was brought onto the market about a year after Xarelto was released. Being of the same drug class as Xarelto, Eliquis is similarly used as a preventative treatment against blood clotting and strokes in patients suffering from nonvavular atrial fibrillation, deep vein thrombosis, pulmonary embolism, as well as those that have had hip and knee replacement surgery. But Eliquis stands out from Xarelto because while using Eliquis there is significantly less risk of major bleeding or hemorrhagic stroke occurring. It shares the same mechanism of actions as Xarelto, inhibiting factor Xa to prevent the production of thrombin. Another benefit of Eliquis is that it can be used without the need for dietary restrictions or monthly blood tests, which makes it convenient to use. Once consumed Eliquis is rapidly absorbed and reaches peak activity in 3-4 hrs but only about 25% of the administered dose is removed by the kidneys. One major shortcoming of Eliquis is its lack of an antidote, so when a bleeding event occurs there is no way of counteracting the drug’s effect. But to its merit Eliquis does have a short half-life of 12 hrs as such bleeding events can often be managed by discontinuing the use of the medication. Unlike Xarelto it must be taken twice daily but can be consumed with or without food. And similar to Xarelto it can be split, chewed, or crushed before being consumed.

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Xarelto Lawsuits

Rivaroxaban or Xarelto, as it is more commonly known, is one of the newest additions to the family of blood thinners. It is manufactured by the drug company Bayer but is marketed in the U.S. by a subsidiary of Johnson & Jonhson’s, Janssen Pharmaceuticals. In 2011 Xarelto was approved by the FDA and was introduced to the market where it quickly began out-competing its predecessors, Camoudin and Pradaxa. So great was its competition that in 2013 it outsold Pradaxa two to one. In 2015, Xarelto earned its manufacturer and marketer $2 billion in revenues and sales continue to increase. It is now the single most prescribed blood thinner on the market. Despite all this success, Bayer and Janssen Pharmaceuticals are now facing numerous lawsuits because of the drug’s tendency to cause uncontrolled bleeding and in some cases death.

All blood thinners carry a risk of causing excessive bleeding. The problem is when on the blood thinner Camoudin the bleeding can be treated by administering vitamin K. Xarelto, however, has no known antidote and dialysis cannot remove Xarelto from a patient’s system. This opens up the possibility of a minor injury becoming fatal. The FDA has even been forced to warn the manufacturer of Xarelto about a print advertisement that did not properly disclose the risks of using the product.  The information on the print advertisement seemed to suggest that the risks were not noteworthy. Lawyers also claim that if physicians and patients had been sufficiently warned about the dangers of using Xarelto that they would have opted to use an alternative like Camoudin. It’s no wonder why many believe that Xarelto’s maker is putting profit over the wellbeing of its customers.

Presently the manufacturer and marketer of Xarelto are being sued for:

• The emotional distress caused by caring for loved ones who had medical complications while on Xarelto.
• Damages caused by emergency visits, ongoing care, and lost wages.
• Negligence on the part of Bayer and Janssen Pharmaceuticals for releasing a dangerous drug.
• Damages caused by funeral expenses for loved ones who died as a result of using Xarelto.

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Xarelto Drug Interactions

When a drug interacts with another drug the reaction can create unwanted side effects and can alter the way the drug works. Xarelto has 355 known drug interactions. 174 are major drug interactions, 173 are moderate drug interactions, and 8 are minor drug interactions. It is important that you know which drugs interact with Xarelto and to use your medication exactly as prescribed by your physician to avoid complications.

Some drugs like ritonavir can negatively affect the removal of Xarelto from the body, which may increase exposure to Xarelto and alter the way the medication works. Increased exposure to Xarelto can increase the risk of uncontrolled bleeding. Other drugs that alter the removal of Xarelto include itraconazole, posaconazole, lopinavir, rifamycins, carbamazepine, conivaptan, phenobarbital, cobicistat, phenytoin, and much more.

Aspirin has similar anticoagulant properties as blood thinners and when used alongside Xarelto it increases the risk of excessive bleeding. On the other hand, your physician may prescribe to you low dose aspirin while on Xarelto as a preventative measure against heart attacks and strokes if the benefits of its use far outweigh the risks.

Other drugs that may interact with Xarelto include venlafaxine, mifepristone, fluoxetine, Comtrex, nelfinavir oral, and sulindac oral. If you have doubts consult your doctor about the possible interactions Xarelto may have with the other medication you’re taking.

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What is Xarelto?

Xarelto is a blood thinner and like all blood thinners, its purpose is to prevent or treat the formation of blood clots. Atrial fibrillation (an irregular heartbeat) increases the likelihood of a blood clot forming in the heart. That blood clot can then be transported to the brain via blood vessel where its presence can lead to a stroke. Therefore patients with atrial fibrillation may have a physician prescribe Xarelto to prevent the formation of a blood clot and the occurrence of a stroke. Xarelto is also used to treat patients with deep vein thrombosis (DVT), which can cause blood clots to appear in the lungs (pulmonary embolism). It is also prescribed to reduce the risk of blood clot formation in patients that have recently had hip or knee replacement surgery.

Xarelto comes in 10, 15, and 20 mg tablets. The recommended dosage of Xarelto will depend on what it is being used to treat.

Nonvalvular Atrial Fibrillation

Patients with a CrCl of >50 mL/min should take a 20 mg tablet once daily with the evening meal. Patients with a CrCl of 15 to 50 mL/min should take a 15 mg tablet once daily with the evening meal.

Treatment of DVT or PE

Patients should take a 15 mg tablet twice daily with food for the first 21 days of treatment. But after the first 21 days, a 20 mg tablet should be taken twice daily for the remainder of the treatment.

Reducing the Risk or Recurrence of DVT or PE

It’s recommended that a 20 mg tablet be taken once daily with food.

After Hip or Knee Replacement Surgery

Patients that have had hip replacement surgery may be instructed to take the 10 mg Xarelto pill once daily for 35 days. When prescribed to patients after they have had knee replacement surgery Xarelto should be taken in doses of 10 mg once daily for 12 days.

Cost of Xarelto

Tablet Weight (mg)	Quantity	Cost ($)
10	30	388.09
	100	1,279.62
15	30	388.09
	90	1,152.26
	100	1,279.62
20	30	388.09
	90	1.152.26
	100	1.279.26

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Side Effects of Xarelto

Use of Xarelto like any other blood thinner carries with it the risk of excessive bleeding. That’s because blood clotting plays an essential role in sealing injured blood vessels and, well, Xarelto reduces the formation of blood clots. So if you happen to injure yourself or open an old wound while taking Xarelto medication, you’ll find that the wound will bleed longer than usual. And this applies to both the simplest cuts and more severe injuries. Normally the bleeding isn’t any cause for concern, but sometimes it requires immediate medical attention. You should avoid abrasive or sharp objects, activities that can cause physical injuries (like football and rugby), and medication (like aspirin) that increase the risk of excessive bleeding while on Xarelto. If you experience symptoms such as dizziness or weakness, excessive menstrual bleeding, coughing up blood, severe headache and stomache, and blood in the urine or feces seek medical attention.

Other common side effects of Xarelto include:

• Backpain
• Bowel or bladder dysfunction
• Burning, crawling, itching, numbness, prickling, and tingling sensations
• Difficulty with breathing or swallowing
• Leg weakness
• Nosebleeds
• Bleeding gums
• Paralysis
• Vomit which contains blood

Contact your doctor if you experience any of these side effects.

Less common side effects of Xarelto include:

• Fainting
• Pain in the arms and legs
• Muscle Spasms
• Lethargy
• Mouth irritation
• Sinus irritation and congestion
• Throat pain
• Toothache
• Small skin blisters

Contact your doctor if you experience any of these side effects.

Rare side effects include:

• Severe allergic reactions
• Difficult or painful urination
• Decreases blood platelets
• Yellowing of skin or eyes as a result of a defective liver
• Hemiparesis
• Stroke cause by bleeding in the brain

Seek medical help immediately if you notice any of these side effects. Remember, despite all these possible side effects your doctor will only prescribe Xarelto for you if he has determined that the benefits for you outweigh the risks.

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Is It Safe to Drink Alcohol While on Xarelto?

You’re a casual drinker. You probably even enjoy sipping red wine while having your dinner. You’ve been partaking in this custom for years. But you’ve just been prescribed Xarelto, now you’re wondering whether or not you have to quit drinking alcohol altogether. After all, alcohol does react with other medications and the result can sometimes be deadly.

The official website for Xarelto states that the use of the medication does not require a change in dietary habits. There is no mention of alcohol creating complications, so you’re left to assume that you’re free to consume alcohol while on the medication. But some experts would actually recommend that you not drink alcohol while on a blood thinner. That’s because research has shown that alcohol has the effect of reducing the blood’s ability to clot much like blood thinners, though the process is not fully understood. So when the two are taken together, the risk of bleeding significantly increases. Since alcohol isn’t explicitly prohibited but can cause problems with blood thinners, it is recommended that you err on the side of caution and limit your consumption of alcohol to two standard drinks a day and avoid heavy drinking.

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