Tired of Warfarin side effects and food no goes!

[NewGuy]

I’ve been taking Warfarin since I was diagnosed with AFIB in 2008. It deals with the possibility of stroke by reducing blood coagulation though one must be careful to maintain INR readings in the 2.0-3.0 range. My right arm, wrist to elbow, is blotchy from poor recovery from knocks to the forearm. Doctors look at my arm and ask ‘Warfarin?’. 
 

My Thai heart doctor says that stopping Warfarin and replacing it with RIVANOXABAM 20 mg taken daily would be suitable. I wouldn’t have to get INR tests and forbidden/cautioned foods such as leafy green vegetables, cranberries and lots more could be eaten. Future arm knocks wouldn’t be a lasting problem. The new drug is expensive though.

 

Pattaya Tai Fascino quoted me 2,430 baht for a month’s supply (I didn’t note the brand); there would be a reduction when paying as I’m a card carrying customer.

 

My Bangkok druggist said that the price for Xarelto 20 mg price is 3,600 baht. I don’t know if Xarelto is a Thai generic or original. She also found a made-in-India generic for 1,890 baht.

 

I gather, perhaps mistakenly, that generics from Thailand or India are fine.

 

What do you think? What suggestions do you have for me?

 

Thanks.

 

[NewGuy]

What is the procedure for going from Warfarin to this new-to-me drug?

[georgegeorgia]

I hope Sheryl can help you 

 

I don't have any suggestions for you but I have empathy for you , it doesn't sound easy ,best of luck 💚

[richard_smith237]

I'm on Rivoroxaban (Xarelto 20mg daily)....    

 

Your info looks accurate on price, also accurate is that there are other alternatives from India that area equally as good (apparently). 

 

Making a switch would appear to be a wise idea (professional medical guidance permitting of course), Warfarin is now considered an antiquated drugs.

 

With Rivoroxaban (and similar) there are no dietary constraints as the drug itself works in a different way.

 

I'm not sure if the anticoagulation properties of Rivoroxaban also result in easy bruising I don't get bruises so easily.

[NewGuy]

I hope Sheryl comes across my post. Her advice is always appropriate and very helpful. We are lucky to have her advising us.

[ozimoron]

I suffered an abdominal blood clot in 2019 and was on warfarin (about 2 mg) for about 2 years until a specialist changed me to Eliquis (apixaban) 5 mg. It's very expensive. After a year, the doc was going to take me off them altogether until I said I was coming to Thailand when he decided to leave me on them just in case. I brought about a year's supply with me but when that ran out I had a video call with my specialist and he put me on a half dose. Eliquis is the most expensive but requires 2 tablets a day which means it has a 12 hour half life instead of 24 for the other doacs. The specialist explained that it was safer in the event of a bleeding event.

 

 

 

 

[Skipalongcassidy]

I have been on warfarin for 15 years and keep my pt/inr at 2.0 to 2.2 by taking 5mg per day... if I didn't eat green vegetables than I wouldn't take as much warfarin... it's all about having a balanced diet and learning how much warfarin to take according to that diet... your bruising will continue no matter what blood thinner you take.

[Sheryl]

There are 2  Indian made generic equivalents available:

 

Rivaxored manufactured by  Dr. Reddy Laboratories.  There have been quality control issued raised about this manufacturer https://www.statnews.com/pharmalot/2023/11/16/fda-reddy-india-manufacturing-violation-pharmaceuticals-biologics/

 

Rivoxan manufactured by Unison.  I don't see anything online about quality issues with them.

 

I don't know the cost of either.

 

Apibaxan is also an alternative. It has both Indian made generic equivalents and a locally made one called Apixa CCP 5 mg

 

 

[Old Croc]

I've also been on Warfarin for years after a DVT event. 

I looked for an alternative a couple of years ago, but all others had something unfavorable in comparison such as price, side effects or monitoring.  

I don't have any problems with warfarin and largely monitor myself using cheap clinical INR testing (2-3 range). I make slight adjustments to dosage if I creep outside that range.

I try to avoid paying fees to doctors when they are at the stage of just monitoring blood levels. I'm able to check, and plan when there's a need for a doctor, with my creatinine, uric acid, INR and ferritin levels.

 

[newbee2022]

21 hours ago, NewGuy said:

I’ve been taking Warfarin since I was diagnosed with AFIB in 2008. It deals with the possibility of stroke by reducing blood coagulation though one must be careful to maintain INR readings in the 2.0-3.0 range. My right arm, wrist to elbow, is blotchy from poor recovery from knocks to the forearm. Doctors look at my arm and ask ‘Warfarin?’. 
 

My Thai heart doctor says that stopping Warfarin and replacing it with RIVANOXABAM 20 mg taken daily would be suitable. I wouldn’t have to get INR tests and forbidden/cautioned foods such as leafy green vegetables, cranberries and lots more could be eaten. Future arm knocks wouldn’t be a lasting problem. The new drug is expensive though.

 

Pattaya Tai Fascino quoted me 2,430 baht for a month’s supply (I didn’t note the brand); there would be a reduction when paying as I’m a card carrying customer.

 

My Bangkok druggist said that the price for Xarelto 20 mg price is 3,600 baht. I don’t know if Xarelto is a Thai generic or original. She also found a made-in-India generic for 1,890 baht.

 

I gather, perhaps mistakenly, that generics from Thailand or India are fine.

 

What do you think? What suggestions do you have for me?

 

Thanks.

 

 

 

Rivaroxaban eg. Warfarin is an old ant-coagulant. Extremely cheap, most used in UK, AUS and US. Almost uncommon in EU.

With a lot a of uncomfortable side effects.

Read here for more information:

https://worcestershirecardiology.clinic/warfarin-alternatives/

 

[oobar]

I've been getting drugs from India for several years with no problems from this supplier: malcolmexporters AT gmail.com

 

Email and ask the price for whatever you need.  Very nice and helpful people.

 

[Man Mart]

23 hours ago, NewGuy said:

I’ve been taking Warfarin since I was diagnosed with AFIB in 2008. It deals with the possibility of stroke by reducing blood coagulation though one must be careful to maintain INR readings in the 2.0-3.0 range. My right arm, wrist to elbow, is blotchy from poor recovery from knocks to the forearm. Doctors look at my arm and ask ‘Warfarin?’. 
 

My Thai heart doctor says that stopping Warfarin and replacing it with RIVANOXABAM 20 mg taken daily would be suitable. I wouldn’t have to get INR tests and forbidden/cautioned foods such as leafy green vegetables, cranberries and lots more could be eaten. Future arm knocks wouldn’t be a lasting problem. The new drug is expensive though.

 

Pattaya Tai Fascino quoted me 2,430 baht for a month’s supply (I didn’t note the brand); there would be a reduction when paying as I’m a card carrying customer.

 

My Bangkok druggist said that the price for Xarelto 20 mg price is 3,600 baht. I don’t know if Xarelto is a Thai generic or original. She also found a made-in-India generic for 1,890 baht.

 

I gather, perhaps mistakenly, that generics from Thailand or India are fine.

 

What do you think? What suggestions do you have for me?

 

Thanks.

 

 

 

I took warfarin many moons ago for a fib and it’s worse than useless and virtually impossible to keep it within the INR range. Sounds like your from the UK where cost of an effective drug tends to prohibit its use. Dump warfarin and see a doctor for a proper and effective drug anti coagulant drug. I’ve been taking Pradaxa (German made) for 8 years now with no problem. It’s costs me around 3,500 baht for a months supply. 

[Man Mart]

I used to take warfarin many moons ago for afib and it’s worse than useless and virtually impossible to keep it within the INR range. Sounds like your from the UK where cost of an effective drug tends to prohibit its widespread use. Dump warfarin and first see a doctor, for an assessment, for a proper and effective anti coagulant drug. There’s a few. I’ve been taking Pradaxa (German made) for 8 years now with no problem. and no bruising etc.   It’s costs me around 3,700 baht for a months supply (two 150 mg tablets a day from good pharmacies like those near Sirirat Hospital, Bangkok). It’s not cheap, but what price does one put on one’s life for effective and reliable treatment. Plus you can eat your greens which are also vital for your health

[richard_smith237]

2 hours ago, Old Croc said:

I've also been on Warfarin for years after a DVT event. 

I looked for an alternative a couple of years ago, but all others had something unfavorable in comparison such as price, side effects or monitoring.  

I don't have any problems with warfarin and largely monitor myself using cheap clinical INR testing (2-3 range). I make slight adjustments to dosage if I creep outside that range.

I try to avoid paying fees to doctors when they are at the stage of just monitoring blood levels. I'm able to check, and plan when there's a need for a doctor, with my creatinine, uric acid, INR and ferritin levels.

 

 

After a sports injury I had a DVT and P.E. in my 30's..... I was on Warfarin for 6 months.

I purchased my own INR test kit (which as the time was about US$1000), but it meant I could track the INR levels daily.

It was quite surprising to see the swing in results when targeting an therapeutic INR range of 2.0 to 3.0.

My INR would swing from 1.0 to sometimes 5.0 - depending on what I'd been consuming and even the time of day.

 

At the time I wanted the alternative - the Dr's were very good an even knew the exact medical journals and papers I'd been reading when asking for the alternative to Warfarin (which had just been released for post Op patients in Canada at the time).

Dr's couldn't get that medication until FDA approval was secured. 

 

Fast forward 10 years and I had another P.E. (cause unknown), this time they put me on Xarelto and I'm on it for life.

No side effect, no issues monitoring and no 'swing'.

 

The only issue is that Rivoroxaban is  'irreversible' and lasts in the system for approximately 24 hours... 

 

 

 

 

[Dante99]

I get Rivaroxaban online from Medisafe.  Manufactured by United Bioceuticals, India. Call Rivasmart.

[bradiston]

Check out Indiamart. You can get a quote (actually a lot of quotes) for almost any drug under the sun. I get my riveroxaban from a trusted supplier I've been using for years, and all my other meds. Got retroviral meds for hepatitis b. Cleared in a week. She is on WhatsApp, speaks, or types, good English, and has a knack of getting stuff through customs at both ends. Never had a delivery stopped. She sends photos of everything before despatch including tracking numbers, batch numbers, boxes, packets, strips etc etc. She also has a Wise account.

 

Pm for details

[HarrySeaman]

I  have a heart condition called cardiomyopathy, which simply means that my heart has enlarged and weakened (cause unknown).  One of the dangers is a reduced flow of blood resulting in a blood clot causing a heart attack or stroke (so far so good).

 

I have been taking Elequis (apixaaban) for 13 years.  I take half a 2.5mg tablet after breakfast and again after dinner.  Elequis is more expensive than warfarin but a big advantage is that there are no blood tests required to make sure the dosage is correct and if you miss a dose the time the drug stays in your body is long enough that you are still protected until you take the next dose.  To me it is well worth the cost difference.

 

The only side effect is a tendency to bleed a little longer/more than before if I scratch or cut.  When I get blood drawn for my cardiologist visit I also get a bruise about an inch (2.5 cm) in diameter on the inside of my elbow - no big deal.

 

My cardiologist is Naval captain working at Queen Sirikit Naval Hospital in Chonburi so I get my medications there with a small discount vs buying at a drug store, but I would gladly pay a higher price at Fascino for the simplicity of taking this medication.

 

Ask Fascino the price and if it is acceptable ask you doctor about using it instead of warfarin.

 

[Old Croc]

14 hours ago, richard_smith237 said:

My INR would swing from 1.0 to sometimes 5.0 - depending on what I'd been consuming and even the time of day.

That a big range swing, mine is much more stable. It has never gone outside the parameters by more than a few fractions. I wouldn't suggest you follow my plan, you should definitely remain under the care of your doctor.

[Old Croc]

13 hours ago, HarrySeaman said:

I  have a heart condition called cardiomyopathy, which simply means that my heart has enlarged and weakened (cause unknown). 

A cardiologist told me that high BP over a long period caused my enlarged heart.

[Old Croc]

14 hours ago, richard_smith237 said:

I purchased my own INR test kit (which as the time was about US$1000), but it meant I could track the INR levels daily.

I once saw the girl in a hospital blood clinic use a small test kit to get my reading and write the figure on a form while I was still waiting for the bit of tape for my arm. I knew the result immediately, but still had to see the doc to be told officially and pay for the visit.  

[Adndrew]

Importing medications from abroad can lead to issues with customs, uncertainties about the medication's quality, and questions regarding its authenticity. Considering health is more important than cost savings, opting for locally sourced medications from reputable pharmacies in Thailand, where both generic and original versions are available, is a safer choice. This approach ensures the medications are stored correctly and are genuine, avoiding potential health risks associated with unverified imports.

[richard_smith237]

On 1/31/2024 at 3:56 AM, Old Croc said:

On 1/30/2024 at 1:04 PM, richard_smith237 said:

My INR would swing from 1.0 to sometimes 5.0 - depending on what I'd been consuming and even the time of day.

That a big range swing, mine is much more stable. It has never gone outside the parameters by more than a few fractions. I wouldn't suggest you follow my plan, you should definitely remain under the care of your doctor.

 

How often are you testing to evaluate that 'stability' ??

 

With my own test kit I took a scientific approach and tested regularly, sometimes 3x per day and at least every day - this is where I noticed the 'swing'.....  

Most people will get tested every 2 weeks or so, or every month - and when they do its usually at the same time of day etc and they are following similar dietary / lifestyle patterns....  so a range swing may not be identified.

 

For example: If I had some booze the INR would go high...   the dosage of Warfarin had a 3.5 day lag time... 

Thus, if I new I was going for dinner and drinking wine, I'd cut back a little on the dosage - it worked very well and I plotted the results in excel against diet, exercise etc...   Dr was incredibly surprised when he saw all this, kind of lost for words - he'd never seen such a study.

 

All moot now as Warfarin has been surpassed by far better medication, although one positive of warfarin still, is that it is reversible. 

[Old Croc]

6 minutes ago, richard_smith237 said:

How often are you testing to evaluate that 'stability' ??

Obviously, I don't test as often as someone with their own test kit.

I'm a little confused as to why you highlighted the word stability, nor why the double question mark. It seems you are trying to discredit me by suggesting I'm lying.

I don't engage with people who feel the need to go this route in the Health and Medicine forum. I truthfully relate my own medical knowledge and experience in the hope it helps others with similar ailments. 

[richard_smith237]

16 minutes ago, Old Croc said:

33 minutes ago, richard_smith237 said:

How often are you testing to evaluate that 'stability' ??

Obviously, I don't test as often as someone with their own test kit.

I'm a little confused as to why you highlighted the word stability, nor why the double question mark. It seems you are trying to discredit me by suggesting I'm lying.

I don't engage with people who feel the need to go this route in the Health and Medicine forum. I truthfully relate my own medical knowledge and experience in the hope it helps others with similar ailments. 

 

No.. you are reading too much into the manner in which I punctuate a sentence and becoming defensive - there's no need for that, you can back down and take the comment as intended pls.

 

I've highlighted that when testing INR regularly, 2-3 day, an INR swing of 1-5 was recorded - quite unstable. 

I've highlighted that when someone is testing every two weeks (or monthly) that INR swing through out the day would not be identified and the INR appears more stable. 

 

 

Thus my question how often are you tested ?... 

 

The reason I asked that is you stated... << That a big range swing, mine is much more stable. It has never gone outside the parameters by more than a few fractions >>

 

The point I want to make is the more often the testing, the greater the likelihood of a 'greater swing' in INR results is identified.

 

If getting tested once per month, on the same day, at the same time of day and your weekly habits are consistent, there is less likelihood that an INR swing will be identified... 

 

Thats all I wanted to point out,  no criticism of your comments, questioning of your information, or accusations of lying... 

 

 

 

 

 

[NewGuy]

I’ve just ordered two boxes of Rivalox (Rivaroxaban) 20 mg, Indian generic, at 1,890 baht each. If I tolerate them well I’ll buy lots more.

 

What is the procedure for stopping Warfarin and starting Rivaroxaban? Start the day after my last Warfarin dose or wait one or two days?

 

Thanks all.

[Old Croc]

24 minutes ago, richard_smith237 said:

No.. you are reading too much into the manner in which I punctuate a sentence and becoming defensive - there's no need for that, you can back down and take the comment as intended pls.

No....   I stated my blood readings were stable and you decided to use parenthesis and a double question mark to highlight a version of that word. That can only be an expression of disbelief.

It would be much more reasonable for you to 'back down', rather than justify your misuse of punctuation in this manner, and then decide you know my state of mind. 

My reply to you, after learning your readings greatly fluctuated, was to not follow my self-monitoring advice, but stay with a doctor. An attempt to assist, not be berated.

  

I no longer have an interest in discussions with you about medications. 

[richard_smith237]

Just now, Old Croc said:

48 minutes ago, richard_smith237 said:

No.. you are reading too much into the manner in which I punctuate a sentence and becoming defensive - there's no need for that, you can back down and take the comment as intended pls.

No....   I stated my blood readings were stable and you decided to use parenthesis and a double question mark to highlight a version of that word. That can only be an expression of disbelief.

It would be much more reasonable for you to 'back down', rather than justify your misuse of punctuation in this manner, and then decide you know my state of mind. 

My reply to you, after learning your readings greatly fluctuated, was to not follow my self-monitoring advice, but stay with a doctor. An attempt to assist, not be berated.

  

I no longer have an interest in discussions with you about medications. 

 

There really is not need to be so cranky...   I apologise if I've offended you some how...    you're over reacting and looking for an argument that isn't there... 

 

Please relax...   this is a good and useful thread and I believe I am contributing useful information to those both on Warfarin and its modern alternatives. 

 

 

I'll re-state... IF someone is on Warfarin and testing their INR on a Biweekly or Monthly basis this may not pickup up the same range swing that more frequent testing may identify... I t is this very range swing that makes the alternative such a viable option, but it must also be noted that the alternatives such as Rivoroxaban cannot be reversed in the same manner warfarin can.

 

 

[richard_smith237]

17 minutes ago, NewGuy said:

I’ve just ordered two boxes of Rivalox (Rivaroxaban) 20 mg, Indian generic, at 1,890 baht each. If I tolerate them well I’ll buy lots more.

 

What is the procedure for stopping Warfarin and starting Rivaroxaban? Start the day after my last Warfarin dose or wait one or two days?

 

Thanks all.

 

Obviously its best to do this under medical advice (as always)...  

 

Would you be able to visit your Doctor who prescribes the Warfarin and tell him of your intentions to switch ?

 

As I understand it (not medical advice) - The effects of Warfarin last 3-4 days (Rivoroxaban / 24 hrs)...

 

Thus, allow for that when making the switch as its possible switching 'too early' i.e. a day after stopping warfarin will be equivalent to 'extra dosing'... 

 

If I was doing this myself I would consider stopping Warfarin for 4 days then making the switch, but dosage also needs to be considered...  so seeing a knowledgable doctor is the only sensible option.

 

[bradiston]

4 hours ago, Adndrew said:

Importing medications from abroad can lead to issues with customs, uncertainties about the medication's quality, and questions regarding its authenticity. Considering health is more important than cost savings, opting for locally sourced medications from reputable pharmacies in Thailand, where both generic and original versions are available, is a safer choice. This approach ensures the medications are stored correctly and are genuine, avoiding potential health risks associated with unverified imports.

And where do you think the massive rip off hospitals buy their meds and then mark them up 5 fold and push them out by the trolley load in their pharmacies? 60% of Thai healthcare profits are via meds. Ever wondered how they do that? You're no safer buying here than in timbuctoo.

[bradiston]

3 hours ago, NewGuy said:

I’ve just ordered two boxes of Rivalox (Rivaroxaban) 20 mg, Indian generic, at 1,890 baht each. If I tolerate them well I’ll buy lots more.

 

What is the procedure for stopping Warfarin and starting Rivaroxaban? Start the day after my last Warfarin dose or wait one or two days?

 

Thanks all.

How many in each box?