Researching New Medication

Published on 01 September 2014

There are now more medications available to help patients prevent a stroke. For the past 60 years, warfarin has been the go-to medication. It’s effective, but requires constant monitoring and the initial dosing can be challenging. This new breed of medications offers promise and a different set of challenges.

Anastasia Armbruster, Pharm.D., BCPS, and Katie Tellor, Pharm.D., BCPS, assistant professors of pharmacy practice at St. Louis College of Pharmacy, took a closer look at dabigatran (Pradaxa®). It is the first of three similar blood-thinning medications to be approved by the U.S. Food and Drug Administration.

“Dabigatran requires less monitoring so it might be easier for the patient,” Armbruster says. “It also takes less time to be fully effective so you’ll likely be released from the hospital sooner.”

Armbruster and Tellor also work as pharmacists at a hospital in the St. Louis area. As more physicians are prescribing dabigatran, Armbruster and Tellor started looking at how it affected their patients. The results were recently published in American Health & Drug Benefits. As a result of their research and their experiences in the hospital, Armbruster and Tellor found:

A kidney function test is important before beginning dabigatran.

“Physicians have to make a significant change in the way they think about prescribing dabigatran,” Tellor says. “Kidney function is less of a consideration with warfarin, but it’s one of the most important issues when prescribing dabigatran.”

Dabigatran works quickly.

“With warfarin, it takes a couple of days to build up enough of the active ingredient in patients’ bodies to start working,” Armbruster says. “With dabigatran, that build-up time is less than a day.”

Unlike warfarin, there are no maintenance tests.

“There has to be a lot of monitoring once patients start with warfarin,” Tellor says. “Once patients are stable, then they need to be tested as often as once a month for as long as they’re on the medication.”

Dabigatran has no known dietary restrictions and less medication interactions.

“We don’t worry about as many  medications affecting patients on dabigatran,” Armbruster says. “For patients on warfarin, their diet can affect things. Even if they’ve been on warfarin for years, the dosing may need to change.”

Price is an issue.

“Dabigatran is an expensive medication,” Tellor says. “Patients may not be able to afford its cost. It’s a big difference because a prescription for warfarin can be as low as $4.”

Armbruster and Tellor know their role as pharmacists is to help other members of the health care team understand these new medications and appropriate treatment.

“New medications like dabigatran offer an alternative, but they’re not perfect,” Armbruster says. “When they first came out, some health care professionals were thinking there’s no place for warfarin. That’s not true.”

Armbruster and Tellor also encourage patients or their caregivers to take an active role in their health by providing health histories and complete medication lists, as well as asking what’s going on during treatment.

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