Availability and cost of Dabigatran exetilate, Atorvastatin and Amlodipine

[chrisinjapan]

I would be grateful if anyone could advise of costs and best places to buy the following or generic replacements (In Bangkok or Hua Hin):

 

Dabigatran etexilate 150mg capsules 

Atorvastatin 40mg tablets

Amlodipine 5mg tablets

 

Many thanks

[Oxx]

This thread has a couple of recommended pharmacies:

 

 

[tifino]

 

sorry to see you've been dragged down the vicious 'statin path.

 

 

 

Losing the bad LDL is good, but the good HDL is going to be stripped away along with it...

[lopburi3]

9 hours ago, chrisinjapan said:

Atorvastatin 40mg tablets

That will be expensive anywhere - cheapest would be Chlovas 40mg at about 23 baht each.  Most people can use Simvastatin, such as Bestatin, at about 1 baht each so may want to check with doctor.

[Sheryl]

There are several local brands of amlodopine and it will be inexpensive. Available over the counter without prescription.

 

There is only one locally made brand of atorvastatin, Chlovas, and as per post above still pretty expensive. If you can switch to simvastatin there are many local brands of that and it will save a great deal of money, suggest asking your doctor about this. Both atorvastatin and simvastatin sold over the counter without prescription.

 

There are no local brands of dabigatran. The only brand here is Pradaxa, an expensive import. I can't tell you exact cost but it will be higher than the full retail price in the west. In addition, it is a "special controlled drug", requires a prescription and will usually be available only in hospitals, for which you would have to see a doctor first (additional charge)...and if a private hospital there will be a further mark up to the drug cost. I suggest you either arrange to get it from your hoem country or discuss with your doctor older, alternative drugs. Warfarin is very cheap here and sold over the counter, though its use does require periodic blood tests.

[GarryP]

Most pharmacies stock amlodipine 5mg. I buy mine from a local wholesale pharmacy for Baht 190 (if I recall correctly - if not that then  Baht 160) for 100  5mg tablets. 

[chrisinjapan]

Many thanks for the replies so far.

 

Looks like I need to have further discussions with my GP.

 

Some background to my story. About 1 year ago I had a stroke. Subsequently diagnosed with High Blood Pressure, Type 2 Diabetes and eventually Paroxysmal Atrial Fibrillation. At the time of the stroke I weighed 112.9kg and at my peak I was taking 10mg/day of amlodipine, 2g/day of metformin for diabetes in addition to the atorvastatin and dabigatran.

 

I have subsequently lost a lot of weight, currently 74kg with a BMI of 25.5.

I am now not taking metformin and my HbA1c is 33mmol/mol. My total cholesterol has reduced to 2.6 mmol/L total with a Serum cholesterol/HDL ratio of 2.17. I have already asked my GP about reducing the atorvastatin dose, but he was not keen on this. I think atorvastatin was preferred as I also initially had high liver transfer function tests probably due to fatty liver, these results are now back in range (at the top) due to my weight loss. I did not discuss changing the statin.

 

For the atrial fibrillation I was initially taking Rivaroxoban 20mg (presumably this is controlled in the same manner Sheryl?) but the stroke consultant recommended I changed to the dabigatran although he said it was only a marginal call. I have asked the GP about being retested for the fibrillation as it has been about 4 months since I have felt an event, but I don't always feel them anyway. Normally I used to pick them up when checking my blood pressure, but when I had the seven day event heart recorder test in May 2017 several were detected which I knew nothing about.

 

Thanks again for the replies.

 

 

[Sheryl]

Rivaroxoban is same story - available only as an expensive import, and requires script and usually available only from a hospital.

 

Rivaroxoban and dabigatran are both anticoagulants. They do not treat atrial fibrillation per se, the connection is that with atrial fibrillation there is a risk of blood clots forming in the atria and breaking loose, causing stroke, heart attack or other pathology. Possibly this was the assumed mechanism for the stroke you had.

 

For many years warfarin was the main drug used for this. Dabigatran, rivaroxoban and edoxaban are newer drugs and quite expensive as still under patent. They are easier to take than warfarin, which requires frequent blood testing.  They are also somewhat safer as warfarin has a very narrow therapeutic range (easy to over "thin" the blood creating risk of bleeding), though careful regular monitoring can reduce the risks associated with warfarin.

 

The general consensus is that these newer drugs are preferrable to warfarin where it is possible to use them - the big constraint being their high cost. Because of this high cost, in many countries the normal protocol is still to use warfarin and switch to the more expensive drug only if it proves difficult to get the desired blood parameters with warfarin.