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Is Xarelto More Effective And Safer For Heart And Kidney Problems?

Posted on Tue, 29 Apr 2014

Question: His cardiologist wants to change his medication. He wants to stop Pradaxa and start him on Xarelto. the reason he states: is because Pradaxa requires healthy kidneys; his glucose levels have been higher, and the Dr is concerned about his kidney health, and possible bleeding in the kidneys. The Dr will also be stopping the toloxin at the same time due to the slower heart rate. My question: do you think that xarelto will be more effective and safer considering his condition? He has been doing relatively well on the Pradaxa, and before that coumadin. Any side effects have been minimal, that we have noticed. He has not been hospitalized at all since his diagnosis( more than 5yrs.) He has been on it for at least three yrs. There may have been some cumulative effects, but it's hard to distinguish. I do have to arrange to see his endocrinologist, for any adjustments to his diabetes medicine. Can Xarelto interfere with his diabetes medicine? and can it help lower his glucose by thinning his blood? I've read the drug side effect sheet. It doesn't give me confidence, but we're ready to try it if it helps. I do have confidence in his Dr's opinion, but I would like more info. Are the bleeding risks more with Xerelto or Pradaxa. Would you please give me a comparison and how it relate to his diabetes? These questions are for my father. I don't have his reports, but I will ask for them. Thanks, XXXXXXX

Answered by Dr. Dr. Prasad J (10 hours later)

Brief Answer: Switch to Xarelto is good.... Detailed Answer: Dear XXXXXXX I understand your concern. Your father was doing so well with dibagatran (pradaxa). Unfortunately your doctor's concerns are valid too. Dibagatran is solely excreted from kidney. If his kidneys are unhealthy, it is going to affect pradaxa metabolism leading to increased chances of bleeding. Further pradaxa excretion is a burden on his kidneys. Though pradaxa is known to have an edge over xarelto, considering the risks of bleeding and its burden on kidney, his doctors choice to make the switch is valid. Moreover he was on pradaxa 220mg/per day which is not the full dose of pradaxa. Xarelto can be as effective as the pradaxa in this case. Add to this, the burden of xarelto is shared by liver thereby reducing chances of bleeding. Therefore I believe your worries about this switch is unwanted. As far as interaction with antidiabetic medicines are concerned, there is no known interactions. Metformin and lipitor in some cases interfere with liver function. Discuss about monitoring liver functions with his endocrinologist since he will be on a new anticoagulant now. Hope I have cleared your doubts. Let me know if you need clarifications. Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar