Taming the cost of anticoagulants
DEAR DR. ROACH: I’m 83 and was recently diagnosed with atrial fibrillation. My doctor put me on Eliquis. I have had no problems with it, except the cost! Is there something comparable that is less expensive? -- D.C.
ANSWER: Apixaban (Eliquis) is one of the new oral anticoagulant drugs, often abbreviated “NOACs.” They are effective and have similar or lower bleeding risk than the older treatment, warfarin, but apixaban does not have an antidote in case of severe bleeding, as I recently addressed in a column.
I did not address cost. The average retail price for a month’s worth of apixaban is $484, which is a huge burden for many people if their insurance doesn’t cover it or only partially covers it. Many insurers have a particular NOAC they will cover, and it may be that your prescriber can switch you to the preferred drug. There are drug-assistance programs through the manufacturer; visit its website at www. bmspaf.org.
If that still doesn’t help, then you can take warfarin, which is very inexpensive. However, the drug’s level has to be monitored via blood tests on an ongoing basis.
DEAR DR. ROACH: I’m an 80-year-old woman with Parkinson’s disease. It took eight years and four doctors to get a diagnosis. Now I can’t taste anything, and I have lost 12 pounds in one year because it is so hard to eat. I sometimes vomit. I just started a Parkinson’s medication two weeks ago. I also take fluticasone nasal spray. -- B.R.
ANSWER: Loss of sense of taste is a common problem in Parkinson’s disease. Twentyseven percent of people with PD had impaired sense of taste in a recent study. Loss of sense of smell can cause poor taste sensation; however, that was not the case in this study on Parkinson’s patients. In contrast, there are reports of people on fluticasone nasal spray losing sense of smell.
In both cases, I would recommend evaluation by an ear, nose and throat physician to be sure there is not a separate problem. Unfortunately, if the loss of taste is due to Parkinson’s, it usually is permanent. Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com. (c) 2017 North America Syndicate Inc. All Rights Reserved