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Eliquis vs. Pradaxa – What is the Difference?

By Rosanna Sutherby, PharmD

March 29, 2021

Ask A Pharmacist

The last ten years have brought about new medications used to treat or prevent blood clots. These newer drugs work differently than warfarin (Coumadin), an older blood thinner. They generally do not require extensive monitoring and have fewer side effects and drug and food interactions than warfarin. Eliquis (apixaban) and Pradaxa (dabigatran) represent two of four newer oral anticoagulants (blood thinners) that have emerged in the last decade.

How Do Eliquis and Pradaxa Work?

Eliquis and Pradaxa block the action of substances in your bloodstream called clotting factors. Eliquis blocks the action of factor Xa, and Pradaxa blocks the clotting factor called thrombin. By blocking the action of factor Xa or thrombin, Eliquis and Pradaxa prevent blood clots from forming in your blood vessels.

What Conditions Do Eliquis and Pradaxa Treat?

Eliquis is used to:

Lower the risk of stroke and developing blood clots in patients with atrial fibrillation (a type of heart arrhythmia)
Prevent deep vein blood clots, which can travel to the lungs, after you have had knee or hip replacement surgery
Prevent and treat deep vein and pulmonary (lung) blood clots in patients who have had other blood clot treatments

Pradaxa is indicated for the following:

Lower the risk of stroke and developing blood clots in patients with atrial fibrillation
Prevent deep vein and lung blood clots after you have had hip replacement surgery
Treatment of deep vein and lung blood clots in patients who have received injectable blood thinners for 5 to 10 days
Prevent deep vein and pulmonary blood clots in patients who have had other blood clot treatments

What Are the Side Effects of Eliquis and Pradaxa?

The most common side effect seen with Eliquis and Pradaxa is bleeding. You may be more prone to bruising and bleeding if you are taking Eliquis or Pradaxa. Be cautious when brushing your teeth, shaving, or using any sharp objects, including nail clippers or tweezers.

Try to avoid rough sports or activities where you may be injured. Let your healthcare provider know if you experience any of the following signs of bleeding:

Bleeding gums
Blood in the urine
Bloody or tarry stools
Coughing up or vomiting blood
Excessive or unusual bruising
Heavier than typical menstrual bleeding
Inability to stop bleeding after a cut
Nose bleeding
Pinpoint red marks on the skin

In addition to bleeding, Pradaxa may also cause gastritis or stomach upset.

Which Medications Interact with Eliquis and Pradaxa?

Eliquis and Pradaxa are both processed by your liver. Other medications that are processed similarly may increase or decrease the effects of Eliquis or Pradaxa. Some medications should not be used with Eliquis or Pradaxa. Other medicines may need dose adjustments when taken with Eliquis or Pradaxa.

Taking Eliquis or Pradaxa with other medications that act as blood thinners may increase your risk of bleeding. Avoid the following drugs if you are taking Eliquis or Pradaxa:

Aspirin
Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn)
Other blood thinners, including heparin and warfarin (Coumadin)

This is not a complete list of drug interactions for Eliquis and Pradaxa. Be sure to discuss all your medications with your pharmacist or prescriber to check for drug interactions or see if any of your medicines need dose adjustments.

How Do You Take Eliquis and Pradaxa?

Your dose of Eliquis or Pradaxa will depend on what condition your doctor is treating or preventing. Your provider will determine what dose is correct for you.

The dose of Eliquis ranges from 2.5 mg to 10 mg twice a day. If you have had hip or knee replacement surgery, you will likely take your first dose 12 to 24 hours after surgery. Typically, you will need to take Eliquis for 12 days after knee replacement surgery and for 35 days after hip replacement surgery.

The dose of Pradaxa ranges from 75 mg to 150 mg twice a day. If you have had hip surgery, your first dose will generally be 1 to 4 hours after surgery. You will likely continue treatment for 28 to 35 days following the surgery.

Can You Take Eliquis or Pradaxa if You Are Pregnant?

Eliquis gets classified as pregnancy category B, meaning that animal studies have not shown a risk of harm to the baby. However, there are no adequate studies done on humans. Other medications in pregnancy category B include Tylenol (acetaminophen) and prenatal vitamins.

Pradaxa gets classified as pregnancy category C, meaning that animal studies have shown a risk of harm to the baby, and there are no adequate studies conducted in humans. Pregnancy category C medications should only be used if the potential benefits to the mother outweigh the potential risk of harm to the baby.

What is the Difference Between Eliquis and Pradaxa?

Eliquis and Pradaxa are similar in many ways. You and your doctor will determine which is best for you based on factors, such as your health condition, other medications you are taking, side effects, or your pregnancy status.

If you have liver problems, your doctor may need to adjust your Eliquis dose. However, Pradaxa does not need adjustments for liver issues. If you have kidney problems, both Eliquis and Pradaxa would require dose adjustments.

The side effects of Eliquis and Pradaxa are similar, but people taking Pradaxa have had more issues with stomach side effects than those taking Eliquis.

If you are pregnant, Eliquis may be a safer choice than Pradaxa. However, either medication increases the risk of hemorrhaging during labor and delivery. Be sure to have a conversation with your doctor to decide if you need to stop these medications before you have your baby.

How Much Do Eliquis and Pradaxa Cost?

The average retail price for 60 Eliquis 5 mg tablets is about $570. The average retail price for 60 Pradaxa 150 mg capsules is around $550.

If you do not have insurance or your insurance does not cover your Eliquis or Pradaxa, you can use a prescription discount card to get the best prescription price at a pharmacy near you.

Rosanna Sutherby is a freelance medical writer who has been a practicing pharmacist in her community for close to 20 years. She obtained her Doctor of Pharmacy from Nova Southeastern University in Ft. Lauderdale, FL. She utilizes her clinical training in the pharmacy, where she helps patients manage disease states such as asthma, diabetes, heart disease, hypertension, and many others. Dr. Sutherby reviews and recommends drug regimens based on patients’ concurrent conditions and potential drug interactions.

References:

https://www.wellrx.com/news/is-a-noac-right-for-me-amp/

https://www.wellrx.com/WARFARIN%20SODIUM/drug-information/

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https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/202155s012lbl.pdf

https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/022512s028lbl.pdf

https://www.pdr.net/drug-summary/Eliquis-apixaban-3039#15

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https://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/symptoms-causes/syc-20354647