Lovenox and Toradol

[DottyCece]

I am on life long anticoagulant therapy for MVR and Atrial Fib.  Recently, I had a total knee replacement.  Lovenox was used to bridge before and after surgery.  I have used Lovenox many times in the last three years for various procedures etc.  I have never had a problem. But, this time, Lovenox was started the day after surgery and coumadin on the day of surgery.  Within two days I began to bleed into the knee...four units of blood replacement were required not to mention all the other complications.  Anyway, they also gave me torodol for the pain (I believe 48 hours worth  Could there have been an interaction between toradol and lovenox to cause the bleeding?  It has caused very high INRs for me in the past.  They are saying that I now have a sensitivity to lovenox.  What would be my alternatives to bridge if and when I need it?  Or, is it simply the toradol interaction?

[CCF-M.D.-MJM]

Hi Dotty,

Sorry to hear about the complication.  Hopefully it didn't set  you back that much.

Toradol inhibits platelet activity and can make you more prone to bleeding.  In rarer circumstances, toradol can also adversely influence kidney function. Lovenox is cleared from the body via the kidneys.  If you had kidney problems, lovenox levels can go to high.  These are the only two interactions I know for these drugs.

The only other alternative is sub cutaneous herparin, but this is far less reliable than lovenox.

I don't think this one instance proves that you had an interaction or that you are overly sensitive to lovenox.  That being said, lovenox should always be used cautiously and like an other medications is not devoid of side effects and complications.

I hope this helps and that you are recovering quickly.  Good luck.

[MaryRoe]

I am reading this with interest.  I have been putting off having knee surgery (torn meniscus) as I am on Plavix for stent placement and Heart doctor said No surgery till I have been on Plavix for a year to keep stents open.   OS doctor wants me off Plavix for 7 days before knee surgery. )-: He said he will give me one injection of Lovenox the day of surgery and for the next three days after surgery and start me back on Plavix the day after surgery. I am now wondering if this is a good idea.

I asked about Torodol as I love that drug as I have no side effects and it works well.  (was given this when I had a Brachial Plexus Injury for 5 days only) He told me that he rarely uses this med and if I cannot take other pain meds, I would have to resort to Advil which I said I would.  When I was in the ER room with A-fib and pain some months ago, they wanted to give me Morphine.  I said NO!  Give me a shot of Torodol.  They would not give me this. )-: I declined the Morphine and had nothing.  

Dotty what you went thru is so scary. I hope you are doing better now.  Maybe I should live with the painful knee.  There has to be a formula for people like us that have A-FIB and are on blood thinners as far as surgical procedures go.

[Konopka1955]

Hi Dotty,  I'm sorry to hear about your problem with surgery and lovenox.  :-(  I hope your knee surgery itself went well and your able to get back to your normal acitivities.  

I was wondering Dotty,  if you know anything about 'coreg' not being available to patients.  I went to go and fill my 'coreg' prescription yesterday at my new pharmacy and they said - coreg - will not be sold any longer ..   Something to do with a 'patent'..  

Does anyone know about this?  I can't find anything.  The pharmacist said he would call my doctors office..  I take coreg for heart failure - I thought toprol was a substitute drug if a patient couldn't take coreg.  I don't know..    I'm waiting to hear from my CHF doctors office.  I called his office as well and I left a message as well - I only have 4 pills left of coreg.  I had a terrible time adjusting to this drug and after mos and mos I finally started to feel decent the last few weeks and now I hear I can't get it !!!!  This can't be true..  The pharmacist must be wrong.  

Konopka

[mmfd]

That is very interesting about the Coreg.  I googled it and came up with nothing related to what you were told.  I think that drug has a while to go before the generic comes out.  The pharmacist has to be wrong!  One thought though.........are you on Medicare and signed up for a drug card?  Maybe that drug isn't on your plan's formulary??  It is expensive!  Hope you are able to get your script refilled.

[tickertock]

I dont understand what going on with Coreg that's strange. Coreg is the brand name of the generic drug carvedilol, it is also marketed in the UK under Eucardic made by Roche as far as I remember. I would check this out with another pharmacy.

[Konopka1955]

Hi,  No I'm not on Medicare.  I did a google check and found nothing also.  But, when I asked why it wasn't being sold - the pharmacist said something about "patent".  I have a very good insurance plan - but I did just go there for my first visit for prescriptions - maybe they didn't have me under the right prescription plan.  But they said it was a 'patent' problem.  I'm still trying to find somthing on this.  I wonder if the CCF docs have heard anything about this?  I guess from what I've been told that Toprol XL is the next best drug for heart failure.  Does anyone here take Toprol XL and has it been shown to decrease the size of your heart?

Konopka

[tickertock]

Unless something has changed the patent for Coreg in the United States doesn't expire until March 5, 2007. Good luck with other options if this is still not the case.

Maybe the generic substitution carvedilol is now available, I doubt thats the case in the U.S, though. Maybe your doctor has to rewrite your script for carvedilol , unless generic substitution was ticked on your refill which probably was not the case.Once again Good luck.

[MaryRoe]

Call your doctor's office NOW and tell them what is happeening and if they have some samples of this drug.  I have about 30 samples here that were given to me and even at the very lowest dose, I could not handle it.  I was on Topol XL 50mg twice a day and it was not getting my heart rate down.  I know Coreg is suppose to be good but it is not for everyone.  I am on Zebeta (brand name) I forgot the generic name and this is the only med so far that has decreased my Heart Rate.  I do not have CHF although I suspect I do or some type of Myopathy. My doc was surprised that I responded so well to Zebeta as he said it is way down the list.  Also, call another drug store and speak to a pharmacist...not their assistant. Good Luck.

[Konopka1955]

Hi,  I called my CHF clinic and they called the pharmacist. I had not heard back by 4:30 p.m. so when I got home I called the pharmacist and now they say - I guess there was some sort of fire at the plant that manufacturer's this drug - so they need to find another manufacturer.  My pharmacist now has enough supply for me to last one month.  I guess the company needs to find another manufacturer until such time as they can get their plant up and running again.  I don't know -that's what they are telling me now.  So I guess I'm ok for another 30 days - why they didn't know this yesterday - I don't know - they should have checked their shelves or their other stores.  Perhaps they didn't anticipate a call from my CHF clinic !!!  Maybe I should have stayed with my previous pharmacist - but it was a local store pharmacist and I didn't think they could handle the more complicated meds I've been taking.  They don't seem to tell me about contraindications - which I think they should.  I've had previous pharmacist tell me and explain it all to me and even call my PCP office to verify the prescription.  

Plus, the worse thing is I heard my old pharmacist tell this elderly man that they didn't have his drug and to check again tomorrow.  The poor man was so upset as I guess this was his third day coming into the pharmacy and walked out without his drug.  I thought - I would never want them to just brush me aside like that - as they did him. He even asked if the prescription could be forwarded to a pharmacy that had the drug.  They just kind of shrugged him off and it was like:  Check in tomorrow - NEXT !!!  The poor man - I was tempted to speak up and say - you find this man the drug he needs and do it now !!!  But, I just thought - its time to move on out of that pharmacy.  So I did.  I'm not sure I picked a good new pharmacy though.  I guess time will tell.  They now say they can supply me with coreg for another 30 days !!!  I still don't know why they didn't say that yesterday.  I have foudn in the past a Pharmacist can be such an important person to your drug regimen and its best to have a more up to date one.  

Sorry,  if I pushed any panic buttons.  But I would call your pharmacy and check on their coreg supply and get a refill if you can.  I'm going to do a search and see if I can find something on the web that backs up what this woman at my new pharmacy told me about their supplier.  

Konopka

[MaryRoe]

Well this is better news now.  Do you have an RX plan that you can send away for a 90 day supply and pay only one co-pay?  I send off an RX for 6 months supply and they send me a 90 day supply for one co-pay of 10.00.  I also use Walgreens and have gotten to know all three pharmacists there and they are great.  They really work with you and one time they forgot to put something in my bag and called me and had a driver deliver it to my door.  If something is not there they call around for me or else it is in the next day. Get to know your pharmacist and ask lots of questions and the paper they give you on side effecs etc. etc. is very limied.  Ask for the the little white long sheet that the pharmaceutical company sends to the drug stores.   You are entitled to see this.  

You have every right to panic.  You need your meds to survive. You are entitled....and do not hesitate to ask for samples from your doctor's office.

~~~~~~~~~~~~~~~~~Go Longhorns~~~~~~~~~~~~~~

[Konopka1955]

Thanks - I'm going over at lunch time to pick up my coreg.  Your right - I do have a plan that I can get a 90 day supply.  Only problem is I have to send away for that.  I only have 4 days left of coreg.  So, I kind of feel I have to take this refill.  But next month - I'll call them a week ahead of time and if they can't fill it - I'll call the mail order service and see if they can.  I'm almost tempted to just go back to my old pharmacy..  What a mess.  I think I'll call my old pharmacy and see if they know anything about this.  I kind of wish - my new pharmacy had coumadin in stock as that's what I've been taking and they offered me warfarin.  I don't think I like what's going on here.  I see lots of my meds getting switched.

Thanks
Konopka

[DottyCece]

I was only able to get a 20 day supply of coreg.  The pharmacist doesn't know what will happen.  Hopefully, they will develop a plan within the next few days and get back on line. All these things have to be approved by the FDA so who knows how long this will be.