Medication – Kepplah Thu, 17 Nov 2022 05:09:07 +0000 en-US hourly 1 Medication – Kepplah 32 32 The price of drugs for atrial fibrillation begins to climb Thu, 17 Nov 2022 05:09:07 +0000

Dear Dr. Roach: My husband takes Eliquis for atrial fibrillation (AFib). The cost increases and there is no generic brand for Eliquis. Looking at drug websites, I found other drugs that are blood thinners: Xarelto, Heparin, and Warfarin are a few. Is there a generic brand you would recommend that we can ask his doctor to see if he will let him take it instead?

— CA

Dear CA: Most people with atrial fibrillation benefit from blood thinners to reduce the risk of stroke. The vast majority of people with atrial fibrillation without valve disease will take either a direct-acting oral anticoagulant (DOA) such as apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), rivaroxaban (Xarelto) or warfarin (Coumadin). Most experts choose one of the DOACs over warfarin because they have been shown to have a lower risk of stroke and major bleeding, compared to warfarin. Also, warfarin should be carefully monitored with clotting time blood tests. People with certain types of heart valve disease (rheumatic mitral stenosis or mechanical heart valve in particular) need treatment with warfarin.

Also: Leaky aortic valve can’t get better on its own

Generic forms of DOAC have been approved by the FDA, but are not available in pharmacies at the time of this writing.

Among the various DOAs, there is usually no valid reason to favor one over the other beyond cost. The cost, however, varies widely between different agents depending on insurance coverage, and you can ask your husband’s doctor if he can take a different medication from Eliquis. I looked on, and the costs range wildly from $200/month to over $500/month (without insurance). Some people take additional medications, which may interact with one or more of the DOACs, so this should be taken into consideration.