Guide to Dabigatran, Rivaroxaban and Apixaban

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1 Page 1 of 8 Guide to Dabigatran, Rivaroxaban and Apixaban Medicines to Prevent Blood Clots If you are deaf or hard of hearing, please let us know. We provide many free services including sign language interpreters, oral interpreters, TTYs, telephone amplifiers, note takers and written materials.

2 Page 2 of 8 Contents When should I call my doctor? Call 911: If you have signs of bleeding or clotting (see pages 5-6). If you have a severe headache or other signs of stroke (see page 6). Call your doctor, clinic or pharmacy: If you have fallen, even if you are not hurt. If you hit your head or have a serious injury. Before taking new medicines, over-thecounter drugs or herbal products. Two weeks before taking a trip. About dabigatran... 3 About rivaroxaban... 4 About apixaban... 5 Problems that may occur... 5 Preventing bleeding or clotting...6 If you fall...6 Drug interactions... 7 Surgery... 7 Travel and exercise... 8 Tips to prevent injury and bleeding... 8 Medication management therapy... 8 Two weeks before having surgery or dental work. If you become sick with a high fever, vomiting (throwing up), diarrhea (loose, watery stools) or infection. If you become pregnant (call right away). If your pills do not look the same as usual, or the directions for taking them have changed. If you have any questions about taking your medicine.

3 Page 3 of 8 About dabigatran [Da-BIG-a-tran] (Brand name: Pradaxa) Why am I taking this medicine? You may have had a blood clot, or you may have a condition that puts you at risk for a clot, such as: Atrial fibrillation (rapid and irregular heartbeat): This may cause blood to pool in the heart chambers and form a clot. The clot could break free, travel to the brain and cause a stroke. How does it work? Dabigatran is sometimes called a blood thinner. This drug can prevent new clots from forming and stops existing clots from growing larger. It cannot break up a blood clot. The length of time you are on this drug depends on why you re taking it. Treatment may last several weeks or longer, up to a lifetime. How do I take it? Follow your doctor s directions when taking this medicine. We may change your dose based on how well your kidneys work while on it. The usual dose is 150 mg, two times a day. Take it at the same times every day. A good way to time your doses is to take one pill in the morning and one before bedtime (about 12 hours apart). You may take it with or without food. Swallow the whole capsule with a full glass of water. Do not take the capsule out of the package until you re ready to take it. If the capsule is out of the package for a long time, it may not work as well. Do not break, chew or open the capsules. Track your doses with a calendar or pillbox. If you miss a dose: Take it as soon as you can. If you forget to take it until the next scheduled dose, skip the missed dose. Never take two doses at the same time. (Write the missed dose in your calendar so you have a record.)

4 Page 4 of 8 About rivaroxaban [Riv-a-ROX-a-ban] (Brand name: Xarelto) Why am I taking this medicine? You may have had a blood clot, or you may have a condition that puts you at risk for a clot, such as: Atrial fibrillation (rapid and irregular heartbeat): This may cause blood to pool in the heart chambers and form a clot. The clot could break free, travel to the brain and cause a stroke. Deep vein thrombosis (blood clots in the leg, groin or arm): These clots can block the flow of blood back to the heart. They are usually painful. A clot may break away and travel to another part of the body. Pulmonary embolism (blood clot in a blood vessel of the lung): This can cause chest pain and breathing problems. Joint replacement: When you have a hip or knee joint replaced, your movement is limited while you heal. This increases the chances that a clot might form. How do I take it? The amount you take each day depends on the reason you re taking the medicine. Follow your doctor s directions. Atrial fibrillation: The dose is 20 mg with food one time each day. Deep vein thrombosis or pulmonary embolism: The dose is 15 mg with breakfast and 15 mg at dinner for 3 weeks. Then 20 mg with food one time each day. Joint replacement: The dose is 10 mg one time each day with or without food. If you have trouble swallowing the tablets whole, you may crush it and mix it with a soft food (like applesauce or pudding). Track your doses with a calendar or pillbox. If you miss a dose: Take it as soon as you can. If you forget to take it until the next scheduled dose, skip the missed dose. Never take two doses at the same time. (Write the missed dose in your calendar so you have a record.) How does it work? This medicine is sometimes called a blood thinner. This drug can prevent new clots from forming and stops existing clots from growing larger. It cannot break up a blood clot. The length of time you are on this drug depends on why you re taking it. Treatment may last several weeks or longer, up to a lifetime.

5 Page 5 of 8 About apixaban [a-pix-a-ban] (Eliquis) Why am I taking this medicine? You may have had a blood clot, or you may have a condition that puts you at risk for a clot, such as: Atrial fibrillation (rapid and irregular heartbeat): This may cause blood to pool in the heart chambers and form a clot. The clot could break free, travel to the brain and cause a stroke. How does it work? This medicine is sometimes called a blood thinner. This drug can prevent new clots from forming and stops existing clots from growing larger. It cannot break up a blood clot. The length of time you are on this drug depends on why you re taking it. Treatment may last several weeks or longer, up to a lifetime. How do I take it? Take this medicine as directed by your doctor or clinic. The usual dose is 5 mg, two times a day. Take it at the same times every day. A good way to time your doses is to take one pill in the morning and one before bedtime (about 12 hours apart). You may take the pill with or without food. Track your doses with a calendar or pillbox. If you miss a dose: Take it as soon as you can. If you forget to take it until the next scheduled dose, skip the missed dose. Never take two doses at the same time. (Write the missed dose in your calendar so you have a record.) Problems that may occur with blood-thinning drugs It is important to follow your doctor s directions. Do not skip any doses. This may lead to a blood clot. Blood clots can cause stroke, heart attack and other problems. Bleeding Blood thinning pills may cause you to bleed more easily. Some signs of bleeding are easy to see, and others are not. If you are bleeding from a cut or injury, press firmly with your hand on the injury and call 911. Call your doctor right away if you have: Coughing or throwing up with blood. Red or black stools (bowel movements). Red or orange urine. Nose bleeds that last 10 minutes or more. Sudden severe headache. At your next visit, tell your care team if you have: Bleeding gums Large bruises for unknown reasons Pale skin Tiredness Periods that are more heavy than normal, or unexpected bleeding from the vagina Lost a lot of weight recently Felt tired or very thirsty all the time.

6 Page 6 of 8 Call your doctor or 911 right away if you have any signs of a blood clot or a stroke. Signs of a blood clot: Sudden pain or tenderness in your leg or arm. Sudden swelling of your leg or arm. Changes in skin color on your leg or arm. Skin may become red, or it could be black, blue or green. Shortness of breath or other problems breathing. Signs of a stroke: Sudden numbness or weakness in your face, arm or leg, often on one side of your body. Sudden confusion or trouble speaking, reading or understanding what is being said. Preventing bleeding or clotting To prevent bleeding or clotting, you should: Take your blood thinning medicine as directed by your doctor. Use your calendar to track your doses. Follow the guidelines for travel, exercise and surgery. Watch for signs of bleeding or clotting. Carry or wear your medical ID. Call your doctor, pharmacist or clinic if you: - Are adding or changing any medicines. - Have questions about how food or drugs interact with your blood thinning medicine. - Have questions about bleeding or clotting. Sudden blurred or decreased vision in one or both eyes. Sudden trouble walking or moving a part of the body. This includes loss of balance or feeling dizzy. Sudden severe headache for no reason. Sudden fainting or seizures. If you fall During a fall, you may hit furniture and other objects. Each part of your body that gets hit may have bleeding, even if you can t see it. If you have bleeding: Put direct pressure on the area and call 911. If you have bruising: Draw a circle around all areas of the body that were hit in the fall. Check them every 5 minutes, drawing new circles as the bruises get larger. If they keep getting larger after 20 minutes, call your doctor.

7 Page 7 of 8 Drug interactions Some medicines can change how the blood thinning pills work. It is not possible to know them all. To make sure your drug works for you, follow these steps: Tell the clinic when you start or stop any medicine (prescribed or over-the-counter, or herbal products). Tell all of your care providers (including your dentist) that you take blood thinning pills. This will help them choose medicines that won t affect your blood thinning medicine. Get all your medicines at the same pharmacy. The pharmacist can check if your drugs might interact. If you have questions about a new medicine, call your doctor, pharmacist or clinic. Ask your doctor before taking aspirin, ibuprofen or naproxen Do not take aspirin, ibuprofen (Advil) or naproxen (Aleve) unless your doctor says it s okay. Note that some drug-store products contain aspirin (such as Pepto-Bismol and Kaopectate). Read the labels. Ask your doctor before taking any product that has: Aspirin Acetylsalicylic acid Salicylic acid Salicylate Talk to your doctor before starting or changing vitamins, minerals or other supplements Be sure your doctor knows about all products you are taking. Some health products, such as vitamin E and fish oil, may raise the risk for bleeding. If you take rivaroxaban or apixaban, do not drink grapefruit juice. It can increase the blood thinning effect of the drug. If you take dabigatran, talk to your doctor before starting a heartburn medicine. Heartburn medicines like Prilosec (omeprazole) can make it less effective. Ask your doctor before starting a new product or changing your dose. Surgery and other procedures If you are having surgery (medical or dental), tell your doctor at least two weeks ahead of time. Your doctor will tell you when to stop your medicine. You may need to stop your blood thinning medicine several days before surgery. This will prevent extra bleeding. Always talk to your doctor before you start or stop your blood thinning medication. You may also need to stop your blood thinner if you have: Several teeth pulled A root canal. Any exam using a scope (for example, a colonoscopy). A biopsy (where a doctor takes a tissue sample, such as skin or breast tissue). You can usually restart your medicine the day of surgery, unless your doctor tells you not to. Call your doctor or clinic if you have questions.

8 Page 8 of 8 Travel and exercise Travel Make sure that you have enough medicine for the length of your trip. If you travel by plane, keep it in your carry-on bag. Medication therapy management If you need help with your medicines, you may meet with a specially trained pharmacist. He or she will help you manage your medicines safely. Meetings are 30 to 60 minutes long. For details or to make an appointment, call Exercise and activity Exercise is good, but you should avoid contact sports (football, hockey, soccer and so on). Avoid activities that carry a high risk of injury. If you are not sure if a job or activity is high-risk, talk with your doctor. Tips to prevent injury and bleeding Use a soft toothbrush and waxed dental floss. Avoid toothpicks. Refills To get a refill of your medicine, call: Metro area: Toll free: Or visit Use an electric razor. Be very careful when trimming your toenails. Take care with knives, scissors and other sharp objects. Wear sturdy shoes and gloves when working outdoors. Wear shoes or non-skid slippers in the house. It is vital that everyone involved in your health care (doctors, dentists, nurses and pharmacists) knows that you take a blood thinning medicine. For informational purposes only. Not to replace the advice of your health care provider. Copyright 2014 Fairview Health Services. All rights reserved. SMARTworks REV 05/14.

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