Coumadin rash

Hi my dad is a black man 73 years old 6’2 around 189 lbs in overall very good health. My dad has developed dark ankles and feet with a rash. His ankles and feet recently in the kast few months became discolored like similar to diabetes skin. The rash feels dry and he says it doesnt itch. He takes coumadin, plant protein poweder, multivitamins, and collagen daily. No other medications I am aware of. His blood pressure and cholesterol are normal. Healthy and beautiful teeth. His skin is in good health too very bright.
In September he went to the hospital because he had a bloodcot in his lungs. The doc gave him medicine to slowly disentegrate it. Now he is on blood thinners. He doesn’t drink, he eats failry healthy (he likes cakes and pies). He drinks fresh juice that he juices and water. Mostly water. Before the bloodcot diagnosis he had the feet color problem along with swelling so he was wearing compression socks. Now his feet doesn’t get swollen and he no longer wears the socks.
He also still works (by choice) even though he is retired. He is a senior longshoreman working 12-16 hours shifts 1-3x a week, and happily doing so. He gardens tremendously. He has about 300 palm seedlings and also a small blueberry farm and 20 fig trees he tends to. He was a 20 year old daughter (my little sister) that he keeps up with both mentally and physically. How he has all the energy I haven’t a clue. So he is not in bad shape sitting around.
Here are his feet: https://imgur.com/a/3j89vcF
He asked me to find out what is going on. Is it from standing on his feet too long, along with other things? He probably needs to see a derm and blood work for soemthing specific? He goes to the doctors so I am assuming they have seen his feet.
Thanks!

When it rains it pours… just need to vent. Ive been on this journey tapering down on prednisone from 60mg when I was first diagnosed in December to now was at 5mg, hydroxychloroquine 200mg and also have APLS so finally figured out Coumadin levels. Was feeling soooo weird and down all of April and May (I think from the prednisone taper). I also have ADHD and take adderAll and felt just so tired, out of whack, and no caffeine or adderAll could wake me up. Then bam a rash developed on my leg last weekend and I thought it was just a weird lupus rash so I didn’t tell my rheum until Thursday and he said “I can’t see you today but that sounds like shingles. Go to the dermatologist or urgent care asap today to confirm”… the dermatologist barely even looked and said “YUP! He is 100% right, you have shingles!” I already had shingles when I was 5 (because I had chicken pox at 6 weeks old). My dermatologist put me on antivirals and methylprednisolone pack…. The pain last night was just unbearable, it felt like a million knives were stabbing my skin. Today is better… I’m just terrified that this pain will take a very long time to go away - I’ve read a lot of horror stories. :(

Hi all. I am currently on my medical journey... I was diagnosed with Lupus (SLE) in a problematic state during this past November (2022). I was undiagnosed/untreated for so long living in excruciating pain for the past 6 months (probably longer but my pain was at it's height during last 6 mos) and trusted all the wrong doctors who gaslit me/called me paranoid when I explained my pain... I finally met my miracle doctors (Rheumatologist & new Hematologist) in November - and was put on 60mg/day of prednisone immediately upon my diagnosis. My hands are also all getting cut up now from doing normal tasks (i.e., opening water bottles, opening door knobs, zippering jackets, etc.) and my hands have rashes, reactions all over. In beginning of Jan, my Rheum added hydroxychloroquine to my medications and tapered me down to 40mg of prednisone. I stayed pretty consistent with my eating since November b/c I simultaneously started Coumadin (while still doing Lovonox injections 2x/day) for my APLS (antiphospholipid syndrome). In the beginning, I was eating very, very clean and healthy but my appetite has definitely increased, and I've slipped and gave into junk over holiday season... I feel the MOON FACE now and can see how much my face, cheeks, and chin has multiplied and it's very upsetting for me. I feel like I look like a lollipop.... because my face is so swollen but my body stayed skinny... It makes me so upset.... I have been remaining very positive since my diagnosis and really motivated to get everything under control, and taking everything day by day, but I keep feeling like I am thrown to the wolves and overwhelmed at times. Also, the high dose of prednisone is making me feel so cyclical... One minute I am so happy and feel on top of the world and then something someone says can really IRK me and set me off - I feel a little crazy at times but my doctors are telling me it's normal for high dose of prednisone... On top of all that, I feel like I look like a swollen chipmunk...
So after reading that long winded paragraph (if you are still here then I sincerely thank you), I was wondering if anyone had any facial recommendations that I could get??? Or any recommendations at all to reduce my facial swelling??? I am really trying not to give in anymore to sweets at night.... but I always loved an ice cream after dinner - it was my favorite 1 treat!! Now, I just take it so overboard b/c I'm on prednisone and overeat it!!!
Really appreciate any advice that anyone has about moon face, in general! Thank you so much in advance.

6 months ago when I was in the hospital, I began to get a web like rash on my legs, low rbc, cold hands and feet, and swelling on my right side.
When I got my blood drawn on my right side, I would lose consciousness. I have no fear of needles or blood draws. I could have blood drawn from my left side without a problem.
Since my hospitalization, I continue to have trouble breathing when humidity levels are high.
I don’t know if the breathing problems are related to my Myasthenia Gravis or if I should be concerned about a clot.
I was diagnosed with a blood clotting autoimmune disorder, Antiphospholipid Syndrome, last week, based on a high level of Antiphospholipid antibodies and a high PTT test.
My mom had lupus, so also going through further testing for lupus based on the antiphospholipid test and additional symptoms of pelvic pain, lower back pain, stiff joints, and butterfly rash. Waiting on results.
Is there any testing that I should ask for from a hematologist? Should I see a pulmonologist?
My mom died of Lupus (prolonged Coumadin and steroid usage led to septic shock) and was misdiagnosed and untreated for a long time, making her condition worse.
That’s why I want to make sure that I’m getting the right tests and seeing the right specialists to get treated quickly.
I was perfectly healthy 7 months ago before having MG symptoms of extreme weakness, eventual temporary paralysis, and a droopy side of my face at the end of the day (eye and mouth).
Severe MG episodes also create low RBC and seems to provoke antiphospholipid syndrome. Usually, the episodes happen right before I get sick or when my immune system is weak.
I am seronegative but diagnosed with MG based on the ice test and positive response to Mestinon.
I am a 36 year old 5’7 179 lb white female in Florida, US.
I currently only take a baby aspirin, vitamin D, B12, Huperzine A, and CoQ10 every morning and mestinon as needed.
Photos of symptoms: https://app.box.com/s/5fajz9p5ydh0mg63v2tqlkvkv2nqqejv

This long post is pretty much a plea for advice from anyone who can help.
Photos of symptoms are attached below.
These are probably multiple conditions that randomly started all at once. I have never had any health problems before this.
My mom had similar episodes but doctors never figured out what had happened. MRIs were fine. She was later diagnosed with Lupus. She passed away at 53 due to sepsis from prolonged Coumadin.
About 2.5 months ago I started noticing a right droopy eyelid and non-injury related lower back pain.
A little after this time, my dog got tapeworm. He never had been bitten by a tick, but was positive, treated quickly, and got rid of it.
Shortly after, I started noticing that it was more difficult for me to walk him a block around our neighborhood. I was out of breath.
Additionally, my stools changed. There were pale white chunks, and what I know now, was mucus. When I showed the picture of mucus to a doctor, given the recent tapeworm with my dog, praziquantel was prescribed. I was (and still am) unable to use the restroom until every 6-8 days with very hard stools.
Around this time, being unable to walk short distances became worse. Weakness, for the first time in my life, became debilitating. I played goalkeeper and am a strong woman. My muscles are gone from my calves and my arms. Weakness is worse on the right side of my body. I began to struggle to open a car door or a heavy store door during this rime, about a month ago.
Additionally, around this time, my hands and feet became freezing cold. Even in 90 degree weather, I needed to wear gloves. No fever.
Gastro issues shortly after taking praziquantel did not improve, and I began noticing fiber strands in my stools even though I take fiber supplements.
We decided it was time to go to the ER, and, since Mayo is supposedly the best, we drove up from Tampa to Jacksonville to visit my better half’s family and to go to the ER due to circulation issues and weakness.
During this time, stool tests from Quest were still pending because they had a delay.
Bloodwork at Mayo all looked fine. ER doctor said that there was nothing wrong with me, bloodwork looked good. By this time, I could barely walk and my feet were beginning to drag on the ground.
I began noticing cuts in my gums.
Two days later, I collapsed. I don’t remember most of it. Somehow, even with constipation, I lost control of my bowels. The ambulance took me to the Mayo Clinic.
This time, the ER doctor said he suspected I was malingering, but ran my blood tests and noticed a calcium deficiency that was not there 2 days before. Everything else looked fine. I became upset at myself for not being able to make my body work, and went back home.
About 4 days later, my droopy eyelid became a lot worse. My face looked like someone else’s. Weakness was worse than ever. I began slurring words. I had a sore throat and fever that also started on this day.
We went back to the ER, but this time at UF Health. Positive for Covid after being negative the previous ER visits. I stayed there for 3 days. They decided these issues were due to malnutrition and loss of appetite. I began to get hives all over and swelling on my right side only at the time of discharge.
Covid symptoms quickly went away before discharge. I am vaccinated and have already had it twice before.
Stool tests came back negative for parasites. Negative for Lyme.
I had a fluctuating iron deficiency, fluctuating calcium levels, and high ALT levels.
Everything else looked fine.
This time, when released, I could not walk or hold my head up, I needed a wheelchair and learned airplane pillows are great for neck support.
Finally, a rheumatologist saw me and noticed my face was uneven. Then, a neurologist said these symptoms seemed like classic Myasthenia Gravis and ordered bloodwork. So far, bloodwork is negative but waiting on MUSK. She also ordered a EMG nerve test in mid August. She also diagnosed me with Raynaud’s.
Yesterday, my drooping eye and mouth came back (they come and go every day but were worse), I started to have trouble thinking, and I began slurring words with “R” in them. We went back to the ER and was discharged after feeling better halfway through the visit. Even though I have been eating and bloodwork is normal, again, they blamed malnourishment.
I have been going downhill for the past month. Work has been very patient, but I need to go to a business trip in the beginning of August. I can’t hold my head up, even on a good day, longer than 3 hours.
If I don’t get treated sooner than a month and a half, I will risk losing the that I love. And my insurance. ER visit costs are adding up.
All tests and bloodwork looks normal.
What can I do to get treated?
In Florida, the soonest that I can get the nerve test is mid August.
To be clear, I don’t care what I have, I just want a diagnosis to get treated. I wish the Mayo ER doctors were right and I was able to make this go away myself. It’s incredibly upsetting not being able to.
Gastro issues are still unaddressed, but only weakness is debilitating.
Brain MRI with and without contrast is normal.
I work remotely, have UnitedHealthcare PPO, and can travel out of state.
My PCP will not give urgent referrals and says I need to be prepared for not getting a diagnosis and learning to live with it. Which tells me he doesn’t believe anything is wrong. Since my droopy face is off and on, he has not seen it although I think there are pictures in my record. A link to photos is also attached to this post.
The neurologist said she will not give a blank referral outside of UF Health and no one can do the EMG nerve test sooner within the UF Health network. Am on a wait list, but it’s a 2 hour slot.
I am waiting on my mom’s death certificate to be mailed to me from a family member so I can provide her health history to rheumatology, in case there’s something helpful. She apparently also had an autopsy.
So far, autoimmune tests are negative for everything except Hashimoto’s, but Thyroid is fine.
ANA negative. My mom was also ANA negative but she had lupus symptoms, including the butterfly rash. I do not.
My only medication currently is Wellbutrin, which I have been on for about 4 years.
I am 36 years old. I can write this post now, but literally last night I could not even pick up a phone and text a sentence.
Symptom Photos

What's ciprofloxacin ?
Ciprofloxacin is a fluoroquinolone (flor-o-kwin-o-lone) antibiotic, it is used to treat unique kinds of bacterial infections. It's also used to treat humans who have been uncovered to anthrax or certain varieties of plague. Ciprofloxacin extended-launch is most effective accredited to be used in adults.
Fluoroquinolone antibiotics can motive severe or disabling facet consequences that might not be reversible.
Ciprofloxacin ought to be used only for infections that can not be treated with a more secure antibiotic.
Warnings
Ciprofloxacin can cause serious aspect results, which includes tendon troubles, nerve damage, extreme temper or conduct modifications, or low blood sugar.
Prevent the use of ciprofloxacin and phone your medical doctor at once if you have: headache, hunger, irritability, numbness, tingling, burning ache, confusion, agitation, paranoia, problems with reminiscence or awareness, thoughts of suicide, or sudden pain or motion problems in any of your joints.
In uncommon instances, ciprofloxacin may additionally reason damage in your aorta, that could cause dangerous bleeding or dying. Get emergency medical help if you have intense and steady pain on your chest, belly, or lower back.
You may no longer be able to use this medicinal drug if you have a muscle ailment. Tell your medical doctor if you have a history of myasthenia gravis.
Earlier than taking this remedy
You must not use ciprofloxacin if you are allergic to it, or if:
You also take tizanidine; or
You are allergic to other fluoroquinolones (levofloxacin, moxifloxacin, norfloxacin, ofloxacin).
Ciprofloxacin may also motive swelling or tearing of a tendon (the fiber that connects bones to muscle tissues within the frame), specially in the achilles' tendon of the heel. This will occur during treatment or several months when you stop taking ciprofloxacin. Tendon problems can be much more likely in youngsters and older adults, or folks that use steroid medicine or have had an organ transplant.
To make sure ciprofloxacin is safe for you, inform your medical doctor when you have ever had:
Arthritis or problems with your tendons, bones or joints (specially in children);
Diabetes, low blood sugar;
Nerve troubles;
An aneurysm or blood flow problems;
Coronary heart problems, or a coronary heart attack;
Muscle weak point, myasthenia gravis;
Liver or kidney disorder;
A seizure, head injury, or brain tumor;
Problem swallowing tablets;
Lengthy qt syndrome (in you or a family member); or
Low stages of potassium in your blood (hypokalemia).
Do not deliver this remedy to a child without clinical recommendation.
It isn't always known whether or not this medicine will harm an unborn child. Inform your health practitioner in case you are pregnant.
You must now not breastfeed even as taking ciprofloxacin and for 2 days after your ultimate dose. Ask your physician approximately breastfeeding if you take this remedy for anthrax exposure.
How should i take ciprofloxacin?
Take ciprofloxacin exactly as prescribed by way of your physician. Follow all instructions on your prescription label and study all medicine publications or coaching sheets.
Take ciprofloxacin on the same time every day, without or with food.
Shake the oral suspension (liquid) for 15 seconds before you measure a dose. Use the dosing syringe furnished, or use a medicinal drug dose-measuring device (not a kitchen spoon). Do not provide ciprofloxacin oral suspension thru a feeding tube.
Swallow the prolonged-launch pill entire and do no longer weigh down, chew, or wreck it.
Drink masses of drinks even as you are taking this medicine.
Use ciprofloxacin for the full prescribed duration of time, even in case your signs and symptoms speedy improve. Skipping doses can growth your threat of infection that is resistant to medication. Ciprofloxacin will not treat a viral infection which includes the flu or a commonplace cold.
Do now not share this remedy with any other person.
Store at room temperature away from moisture and heat. Do now not permit the liquid remedy to freeze. Throw away any unused liquid after 14 days.
What to avoid
Do now not take ciprofloxacin with dairy products which include milk or yogurt, or with calcium-fortified juice. You could consume or drink those merchandise along with your food, however do not use them by myself while taking this medicinal drug.
Antibiotic drugs can reason diarrhea, which can be a sign of a new infection. When you have diarrhea that is watery or bloody, call your health practitioner before the usage of anti-diarrhea medicine.
Ciprofloxacin may want to make you sunburn extra without difficulty. Keep away from sunlight or tanning beds. Put on shielding apparel and use sunscreen (spf 30 or better) while you are exterior. Inform your physician when you have severe burning, redness, itching, rash, or swelling after being inside the solar.
Keep away from using or unsafe interest till you know how ciprofloxacin will have an effect on you. Your reactions may be impaired.
Ciprofloxacin facet outcomes
Get emergency clinical help when you have signs of an hypersensitive reaction to ciprofloxacin (hives, difficult respiratory, swelling to your face or throat) or a excessive skin response (fever, sore throat, burning to your eyes, skin pain, red or crimson pores and skin rash that spreads and reasons blistering and peeling).
Ciprofloxacin can motive severe aspect results, which includes tendon troubles, harm for your nerves (which may be permanent), serious mood or conduct adjustments (after simply one dose), or low blood sugar (that can cause coma).
Stop taking this remedy and make contact with your health practitioner at once if you have:
Low blood sugar - headache, starvation, irritability, dizziness, nausea, rapid heart charge, or feeling shaky;
Nerve damage signs and symptoms - numbness, tingling, burning pain on your fingers, hands, legs, or ft:
Extreme temper or conduct adjustments - anxiousness, confusion, agitation, paranoia, hallucinations, reminiscence troubles, problem concentrating, thoughts of suicide; or
Symptoms of tendon rupture - surprising ache, swelling, bruising, tenderness, stiffness, movement problems, or a snapping or popping sound in any of your joints (rest the joint until you receive hospital therapy or commands).
In uncommon instances, ciprofloxacin may additionally purpose damage for your aorta, the main blood artery of the frame. This will result in dangerous bleeding or demise. Get emergency scientific help if you have excessive and constant pain on your chest, belly, or returned.
Additionally, prevent using this medication and speak to your health practitioner immediately when you have:
Severe belly ache, diarrhea this is watery or bloody;
Rapid or pounding heartbeats, fluttering for your chest, shortness of breath, and unexpected dizziness (like you would possibly pass out);
Any skin rash, regardless of how mild;
Muscle weak spot, respiration issues;
Little or no urination;
Jaundice (yellowing of the pores and skin or eyes); or
Multiplied pressure within the skull - extreme complications, ringing on your ears, dizziness, nausea, imaginative and prescient troubles, ache at the back of your eyes.
Commonplace ciprofloxacin facet consequences may include:
Nausea, vomiting, diarrhea, stomach ache;
Headache; or
Extraordinary liver characteristic tests.
Remedies
Bladder infection
Ciprofloxacin
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Ciprofloxacin
Widely wide-spread name: ciprofloxacin (oral) [ SIP-roe-FLOX-a-sin ]
Brand names: cipro, proquin xr
Drug elegance: quinolones
Medically reviewed through kaci durbin, md. Closing updated on sep 30, 2021.
Makes use of
Warnings
Earlier than taking
Aspect consequences
Interactions
Dosage
Faq
What's ciprofloxacin?
Ciprofloxacin is a fluoroquinolone (flor-o-kwin-o-lone) antibiotic, it's far used to deal with one-of-a-kind varieties of bacterial infections. It's also used to treat humans who've been exposed to anthrax or positive varieties of plague. Ciprofloxacin prolonged-launch is simplest permitted to be used in adults.
Fluoroquinolone antibiotics can reason critical or disabling side outcomes that might not be reversible.
Ciprofloxacin ought to be used only for infections that can not be dealt with with a more secure antibiotic.
Warnings
Ciprofloxacin can purpose critical facet consequences, which includes tendon issues, nerve damage, serious temper or behavior changes, or low blood sugar.
Stop the usage of ciprofloxacin and get in touch with your physician at once if you have: headache, starvation, irritability, numbness, tingling, burning pain, confusion, agitation, paranoia, troubles with memory or attention, thoughts of suicide, or surprising pain or motion troubles in any of your joints.
In uncommon instances, ciprofloxacin may additionally reason damage on your aorta, that may result in dangerous bleeding or loss of life. Get emergency medical help when you have severe and steady pain on your chest, stomach, or again.
You can now not be able to use this remedy when you have a muscle disorder. Inform your doctor when you have a history of myasthenia gravis.
Earlier than taking this medication
You have to no longer use ciprofloxacin in case you are allergic to it, or if:
You furthermore mght take tizanidine; or
You're allergic to different fluoroquinolones (levofloxacin, moxifloxacin, norfloxacin, ofloxacin).
Ciprofloxacin may also reason swelling or tearing of a tendon (the fiber that connects bones to muscle tissues inside the frame), particularly within the achilles' tendon of the heel. This will manifest in the course of remedy or numerous months after you prevent taking ciprofloxacin. Tendon problems can be more likely in youngsters and older adults, or people who use steroid medicine or have had an organ transplant.
To make sure ciprofloxacin is safe for you, tell your health practitioner if you have ever had:
Arthritis or problems with your tendons, bones or joints (specifically in youngsters);
Diabetes, low blood sugar;
Nerve troubles;
An aneurysm or blood circulate problems;
Heart troubles, or a heart assault;
Muscle weak point, myasthenia gravis;
Liver or kidney ailment;
A seizure, head harm, or brain tumor;
Problem swallowing capsules;
Lengthy qt syndrome (in you or a member of the family); or
Low ranges of potassium in your blood (hypokalemia).
Do now not deliver this remedy to a baby with out medical advice.
It is not regarded whether this medicinal drug will harm an unborn baby. Tell your medical doctor in case you are pregnant.
You have to not breastfeed at the same time as taking ciprofloxacin and for 2 days after your final dose. Ask your physician approximately breastfeeding if you take this medicinal drug for anthrax publicity.
How need to i take ciprofloxacin?
Take ciprofloxacin precisely as prescribed through your health practitioner. Comply with all guidelines for your prescription label and examine all medicinal drug courses or education sheets.
Take ciprofloxacin at the equal time every day, without or with meals.
Shake the oral suspension (liquid) for 15 seconds before you measure a dose. Use the dosing syringe furnished, or use a medication dose-measuring device (no longer a kitchen spoon). Do not deliver ciprofloxacin oral suspension through a feeding tube.
Swallow the prolonged-release pill entire and do no longer crush, chunk, or break it.
Drink plenty of beverages while you're taking this medication.
Use ciprofloxacin for the whole prescribed length of time, even in case your signs and symptoms speedy improve. Skipping doses can boom your chance of contamination this is immune to medicine. Ciprofloxacin will not deal with a viral infection together with the flu or a commonplace cold.
Do not percentage this remedy with some other individual.
Store at room temperature far from moisture and heat. Do now not permit the liquid medicinal drug to freeze. Throw away any unused liquid after 14 days.
Exact ciprofloxacin dosage records
What happens if i leave out a dose?
If you take regular drugs or oral suspension: take the drugs as soon as you could, however bypass the ignored dose if your subsequent dose is due in less than 6 hours.
If you take extended-launch capsules: take the medication as quickly as you can, but skip the missed dose in case your next dose is due in much less than 8 hours.
Do no longer take doses at one time.
What occurs if i overdose?
Are looking for emergency medical interest or name the poison assist line at 1-800-222-1222.
What to keep away from
Do now not take ciprofloxacin with dairy merchandise inclusive of milk or yogurt, or with calcium-fortified juice. You can devour or drink these products together with your meals, however do no longer use them by myself when taking this medicine.
Antibiotic drugs can cause diarrhea, which may be a sign of a new contamination. When you have diarrhea that is watery or bloody, call your physician earlier than the usage of anti-diarrhea medicinal drug.
Ciprofloxacin could make you sunburn greater easily. Keep away from daylight or tanning beds. Put on protective apparel and use sunscreen (spf 30 or better) while you are outside. Inform your health practitioner when you have excessive burning, redness, itching, rash, or swelling after being in the solar.
Keep away from using or hazardous interest until you understand how ciprofloxacin will affect you. Your reactions could be impaired.
Ciprofloxacin aspect effects
Get emergency medical help when you have symptoms of an hypersensitive reaction to ciprofloxacin (hives, tough respiration, swelling for your face or throat) or a extreme skin response (fever, sore throat, burning on your eyes, pores and skin ache, pink or crimson pores and skin rash that spreads and causes blistering and peeling).
Ciprofloxacin can cause serious facet outcomes, inclusive of tendon troubles, damage for your nerves (which can be everlasting), severe mood or conduct adjustments (after just one dose), or low blood sugar (that may result in coma).
Stop taking this medication and call your physician immediately if you have:
Low blood sugar - headache, starvation, irritability, dizziness, nausea, speedy heart charge, or feeling shaky;
Nerve damage signs and symptoms - numbness, tingling, burning pain to your arms, palms, legs, or ft:
Serious temper or behavior modifications - anxiousness, confusion, agitation, paranoia, hallucinations, memory issues, problem concentrating, mind of suicide; or
Signs of tendon rupture - surprising pain, swelling, bruising, tenderness, stiffness, movement problems, or a snapping or popping sound in any of your joints (relaxation the joint till you receive medical care or instructions).
In rare instances, ciprofloxacin may additionally purpose harm on your aorta, the principle blood artery of the body. This will lead to risky bleeding or death. Get emergency clinical help if you have severe and constant ache to your chest, belly, or returned.
Additionally, prevent the usage of this medicine and get in touch with your physician right away when you have:
Intense stomach ache, diarrhea this is watery or bloody;
Speedy or pounding heartbeats, fluttering to your chest, shortness of breath, and sudden dizziness (like you would possibly skip out);
Any pores and skin rash, regardless of how moderate;
Muscle weak point, respiratory troubles;
Little or no urination;
Jaundice (yellowing of the pores and skin or eyes); or
Expanded stress in the cranium - extreme headaches, ringing to your ears, dizziness, nausea, imaginative and prescient troubles, ache behind your eyes.
Not unusual ciprofloxacin facet effects may additionally include:
Nausea, vomiting, diarrhea, belly pain;
Headache; or
Strange liver function checks.
This isn't a entire list of side outcomes and others may additionally occur. Name your doctor for medical advice about aspect outcomes. You could document side outcomes to fda at 1-800-fda-1088.
Ciprofloxacin side outcomes (more detail)
What other tablets will affect ciprofloxacin?
A few drug treatments can make ciprofloxacin a lot much less effective when taken at the identical time. If you take any of the subsequent medicines, take your ciprofloxacin dose 2 hours earlier than or 6 hours after you take the opposite medicinal drug.
The ulcer medicine sucralfate, or antacids that contain calcium, magnesium, or aluminum (along with maalox, milk of magnesia, mylanta, pepcid entire, rolaids, tums, and others);
Didanosine (videx) powder or chewable tablets;
Diet or mineral supplements that incorporate calcium, iron, magnesium, or zinc.
Tell your health practitioner about all your different drugs, particularly:
Clozapine, cyclosporine, methotrexate, phenytoin, probenecid, ropinirole, sildenafil, or theophylline;
A blood thinner (warfarin, coumadin, jantoven);
Heart remedy or a diuretic or "water pill";
Oral diabetes medicinal drug;
Merchandise that comprise caffeine;
Remedy to treat melancholy or mental infection;
Steroid remedy (such as prednisone); o
Nsaids (nonsteroidal anti inflammatory tablets) - aspirin, ibuprofen (advil, motrin), naproxen (aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others;
https://www.arshinepharma.com/info/uses-side-effects-and-precautions-for-taking-71254389.html

I really need ya'lls help. I have the heterozygous gene for fvl and my grandmother has the Homozygous gene. I'm here posting on behalf of her. She has been struggling with fvl for many years. She has struggled to find a treatment that works for her. Everything she has been on so far has caused an allergic reaction or she has developed an allergic reaction over time. To be clear I am NOT asking for medical advice but I am asking if there is a medication you have been on for your fvl that her doctors haven't given her yet so she can ask her doctor about it.
So, what have you tried that isn't on her list?
Here is the list of medications she has tried:
Coumadin (caused full body blistered rash after being on it from 1988-2007)
Aspirin therapy until 2007
Xarelto (for two years and she ended up with a DVT)
Pradaxa (DVT)
Eliquis (Blood clot in right leg)
Hospital gave her a Heparin Drip when she had her most recent DVT with no reaction
Lovenox 7.5 injection (Severe itching body rash.)
Fondaparinux 7.5 Injection is what she is currently taking BUT it is not doing enough and they want her on something else too.
Side note if anyone knows how to get a lower price on the Arixtra (Fondaparinux) injections please let me know.
Thank you all in advance

Hi all, the last few months have been a roller-coaster for me and my health. I'm so grateful to have found this subreddit and wanted to share my story. 30 year old male, a bit of baggage but not morbidly obese. USA, New York.
In early February, I began to experience a pain in my calf that quickly reminded me of a condition that I had once before, cellulitis, a common just under the skin infection. The pain was minimal and I decided I'd keep an eye on it for a few days just to rule out a rash or other minor injury. As the week progressed, the pain got worse and spread alarmingly fast to the point where my whole leg was hurting. I decided I would go to the walk in clinic right by work at the end of the week. You know, get it looked at, get some antibiotics and call it a day.
I had a casual attitude when I went to the walk in on Friday after work with my girlfriend. We were looking forward to the weekend and just wanted to get this done with. I checked in, described my complaint to the nurse and waited for the doctor. The doctor looked over my leg and was concerned that it was a blood clot and told me he could not assist me at the clinic and would not charge me, and advised me to go to an ER asap. This angered me as like most Americans I have no insurance or are under insured simply due to cost.
My girlfriend was panicking knowing the severity of the blood clot and I was just getting angrier and angrier at the thought of having to pay an ER bill that I cannot afford. We went to the hospital that was closest to my apartment and we went to triage. Still agitated, angry, and anxious my blood pressure rose to 188/140. The highest I've ever seen it. I began taking BP medication shortly after following up with a cardiologist but that's another story. Luckily this was before covid and my girlfriend was able to stay with me in the hospital, this was not how we were expecting our valentine's day to end.
Luckily the wait was short, and I was seen. I described my complaints, and what had happened at the walk in. They sent me for an ultrasound where they had found an extensive, but only superficial, blood clot running down my right leg. Just great. I explained to the hospital that I have a very tight budget and cannot afford expensive treatment. They had me stay overnight because they would be able to get me a free 45 day supply of xarelto in the morning. Their patient advocate or whoever arranges deals with pharma companies had left for the day. It was nice at least to have my girlfriend stay with me for the night, but again, not how we planned our valentine's day to go.
The next day the hospital set me free with the 45 days of xarelto and told me to follow up with a vascular surgeon asap. I was in a fair amount of pain for the next week as my clot was still hard. I went to my family doctor who had seen me previously and recommended a doctor not too far away. She set me up with some medication to help with the pain and I was on my way. I called a few other vascular surgeons to try to price out who would be the cheapest, but they all cost about the same, so I made an appointment with the doctor my family doctor recommended. It was $250 for imaging, and another $250 for consultation, I wasn't happy, but luckily I was blessed to have some savings built up coming out of the holidays.
The day of the appointment with the vascular surgeon came and I was first seen by the imaging tech who took a very long time with my leg, I remember it being longer than the hospital by a good amount. Soon enough, we were done, and I was left to clean up the mess left on me by the tech with the ultrasound jelly. My girlfriend and I waited in a room for the doctor for a very long time while we could hear him speaking to someone like he was conducting an interview or having some sort of business sales pitch meeting. He came in, very briefly only to say, paraphrased "yep, superficial blood clot, take your meds, see you in a month or so". I felt like $500 went down the toilet for something I already knew. Not to mention, he was upset that my family doctor prescribed me pain medication over a superficial blood clot, but I kept my comments to myself, he doesn't get to decide the amount of pain that I'm in.
A week later, my clot softened and I continued my xarelto. Unfortunately in early March I would be let go from my job due to circumstances from the coronavirus pandemic. Long story short, I work in large events, no events, no income. It was a silver lining, because I could now apply for my state's medicaid. I applied, but unfortunately my policy would not start until May 1st. My xarelto would run out in early April. So I found myself between a rock and a hard place. I could not afford rent, another $500 doctor's appointment, and more xarelto, so I decided to wait until may to follow up with a vascular surgeon who was in my medicaid network. This would ultimately be a poor decision, but one I had no choice in making.
I had been self isolating since I was laid off and lived alone, my girlfriend lived with her mother only 5 minutes away. I did my best to stay active both mentally and physically.
In mid-late April, I decided to follow a YouTube video cardio workout and did it to the best of my ability. I felt really out of shape, but what worried me was that my heart rate climbed into the 160s for what would otherwise be mild cardio for me. For a week my heart rate would continue to climb while resting, and I felt like total crap. Then it happened, my leg hurt, and I knew it was the clot. I got the earliest appointment I could with the same vascular surgeon, and waited for the day with much anticipation. The pain was much greater than the superficial clot to the point where I was popping percoset like candy with no real relief.
I went back to the vascular surgeon and after another $500 I was told that I now had a dvt. He told me to keep taking my xarelto and to see him in a month. I had to explain to him that the hospital only gave me a 45 day supply and I could not afford more. He gave me a week's worth of samples, and said he'd write a prescription for me when my medicaid kicked in. He also advised me to see a hematologist when my medicaid kicked in. I went back home with my girlfriend staying at my apartment as the pain was so bad I needed help to get around and to be driven to my appointments.
Two days later the pain was so bad, my appetite was nonexistent, and my physical health was quickly deteriorating that we called back the vascular surgeon to see what we should do. My resting heart rate at this point was almost 100bpm, about 30bpm higher than normal, and even getting out of bed made my heart rate shoot to the 140s. His partner, another vascular surgeon called me back and advised me to double the amount of xarelto that I was taking and to follow up in a couple of days for an office visit.
Once again, I went to the office, paid my $500, and now this time they checked the ultrasound at my groin (for the first time, despite me saying I felt pain there) and saw clots there too. So I'm all backed up from my ankle to my groin at this point. He wanted to then perform a thrombectomy, but my medicaid wouldn't cover it. He advised me to go to a specific hospital he did rounds at, go to the er, and he would perform the surgery then. This made me feel very uncomfortable, while I absolutely hate the American Healthcare system, this felt off to me. I told him I was very worried about my increasing heart rate and fatigue through this and he literally said "I'm not concerned about your heart rate", words that I would remember. I thanked him and said we'll consider it. I had my hematologist appointment the next day and wanted her opinion.
The next day we went to the hematologist, I explained the whole story up to that point, and she had a look of horror on her face that I honestly could not begin to describe, even through her mask I could see it in her eyes and body language, especially when I told her that the vascular surgeon said "I'm not concerned about your heart rate". She advised me that I might have a PE and urged me to go to the ER asap. She also said while ethically she cannot tell me what to do with my other doctors that I was right to consider other opinions. At this point, my medicaid had started and I was not opposed to going to the ER.
I live in the NYC metro area, and unfortunately we are the epicenter for covid in the country. My girlfriend and I debated which hospital we should go to as some were supposedly better than others for dealing with the covid situation, especially for patients not in hospital for covid. The hospital we chose just so happened to be the one the vascular surgeon did rounds at. We called his office to say the effect of "nevermind, it's off, we're going to the ER now." this was on a Saturday.
I went to the hospital, had the CT scan and was told I had PE in both lungs. The doctors were astounded that I did not have any issues breathing, but took it as a good sign that it was caught relatively early. Unfortunately when I went off the xarelto originally the clot must not have fully been reabsorbed, got worse, spread to my deep veins and broke off to my lungs.
I was in the hospital for 6 days as they immediately started a heparin drip and began to bridge me to Coumadin. I started to feel better literally the second day in the hospital with the heparin in my system. I could walk without much pain. My appetite returned, and I was in much better spirits.
On Sunday night at 11pm the vascular surgeon called the night nurse and advised her to have me ready for surgery tomorrow. This was a shock to me, we never talked since the office visit and I had called the office to say "nevermind". I was very upset, I had a returned appetite and would ultimately miss both breakfast and lunch until the vascular surgeon made his rounds. I tried to be as respectful as I could but I was livid. After seeing me the next afternoon, walking and with reduced swelling he said that he no longer thought I needed a thrombectomy, and that I should continue my anticoagulant treatment. He also had no idea that I had PE or that I started Coumadin.
That was the last I saw of him. Thankfully, I was able to order a late lunch from the hospital cafeteria. I spent the next few days in the hospital as they finished bridging me to Coumadin and I was in a therapeutic inr range. I was discharged into the care of my hematologist who I would see for the next several days daily for inr tests.
The one thing that bothered me was after the heparin drip stopped, I got a severe pain in my calf that lasted for almost a week. Luckily it is manageable now and getting better by the day.
I'm seeing my hematologist weekly as we hone in on a dosage of Coumadin that's right for me. Through her, I was able to confirm that I inherited one copy of my mother's factor V Leiden, but have no other abnormal clotting factors. I've begun to see a new vascular surgeon who listened to everything I had to say, was noticeably taken back by the actions of my former vascular surgeon, and was happy to hear that I am on an affordable treatment even should I lose my medicaid. She's worried about Post-thrombotic syndrome later down the road, but said a thrombectomy at this time would be a bit more than aggressive, considering I'm already on an effective treatment.
That's my story and I just wanted to share with you all. I'm happy to have found this subreddit with others who have gone through this. As of now my leg is getting better by the day, but is still tender. The worst is feeling like I'm walking on gravel after being on my leg for more than a few minutes. I get occasional pangs in my chest, but still no difficulty with breathing. I'm worried what will happen when I eventually lose my medicaid but I know Coumadin is cheap as dirt out of pocket, although I don't know how much inr testing will be. PE was one of the factors that contributed to my girlfriend's father passing away so I don't want to play around with my heath, but I still need to pay the bills.
I also want to thank my amazing girlfriend u/OnyxPanthyr for being there for me in such a scary time of my life. When I was broken physically and mentally you were my caregiver and aided me without hesitation. Something I hope to make up to you some day.
Thank you!

Antiphospholipid Syndrome

source

NORD gratefully acknowledges Robert A. S. Roubey, MD, Adjunct Professor of Medicine, Division of Rheumatology, Allergy and Immunology, Dept. of Medicine and Thurston Arthritis Research Center, The University of North Carolina at Chapel Hill, for assistance in the preparation of this report.

Synonyms of Antiphospholipid Syndrome

• antiphospholipid antibody syndrome
• APS
• APLS
• Hughes syndrome
• lupus anticoagulant syndrome

Subdivisions of Antiphospholipid Syndrome

• primary antiphospholipid syndrome
• secondary antiphospholipid syndrome
• catastrophic antiphospholipid syndrome

General Discussion

Antiphospholipid syndrome (APS) is a rare autoimmune disorder characterized by recurring blood clots (thromboses). Blood clots can form in any blood vessel of the body. The specific symptoms and severity of APS vary greatly from person to person depending upon the exact location of a blood clot and the organ system affected. APS may occur as an isolated disorder (primary antiphospholipid syndrome) or may occur along with another autoimmune disorder such as systemic lupus erythematosus (secondary antiphospholipid syndrome).
APS is characterized by the presence of antiphospholipid antibodies in the body. Antibodies are specialized proteins produced by the body's immune system to fight infection. In individuals with APS, certain antibodies mistakenly attack healthy tissue. In APS, antibodies mistakenly attack certain proteins that bind to phospholipids, which are fat molecules that are involved in the proper function of cell membranes. Phospholipids are found throughout the body. The reason these antibodies attack these proteins and the process by which they cause blood clots to form is not known.

Signs & Symptoms

The specific symptoms associated with antiphospholipid syndrome are related to the presence and location of blood clots. Blood clots can form in any blood vessel of the body. Clots are twice as likely to form in vessels that carry blood to the heart (veins) as in vessels that carry blood away from the heart (arteries). Any organ system of the body can become involved. The lower limbs, lungs and brain are affected most often. APS also causes significant complications during pregnancy.
The severity of APS varies, ranging from minor blood clots that cause few problems to an extremely rare form (catastrophic APS) in which multiple clots form throughout the body. However, in most cases, blood clots will only develop at one site.
When blood clots affect the flow of blood to the brain a variety of issues can development including serious complications such as stroke or stroke-like episodes known as transient ischemic attacks. Less frequently, seizures or unusual shaking or involuntary muscle movements (chorea) may occur.
Blood clots in large, deep veins are referred to as deep vein thrombosis (DVT). The most common site of DVT is the legs, which can become painful and swollen. In some cases, a piece of the blood clot may break off, travel in the bloodstream, and become lodged in the lungs. This is referred to as pulmonary embolism. Pulmonary embolism may cause breathlessness, a sudden pain the chest, exhaustion, high blood pressure of the pulmonary arteries, or sudden death.
Skin rashes and other skin diseases may occur in people with APS. These include blotchy reddish patches of discolored skin, a condition known as livedo reticularis. In some cases, sores (ulcers) may form on the legs. Lack of blood flow to the extremities can cause loss of living tissue (necrotic gangrene), especially in the fingers or toes.
Additional abnormalities that may occur in individuals with APS include clot-like deposits on the valves of the heart (valvular heart disease) which can permanently damage the valves. For example, a potential complication is mitral valve regurgitation (MVR). In MVR, the mitral valve does not shut properly allowing blood to flow backward into the heart. Affected individuals may also experience chest pain (angina) and the possibility of a heart attack (myocardial infarction) at an early age but these problems are not thought to be related to valvular heart disease.
Some affected individuals can develop low levels of blood platelets (thrombocytopenia). Thrombocytopenia associated with antiphospholipid antibodies is usually mild and only rarely causes easy or excessive bruising and prolong bleeding episodes. Affected individuals are also at risk for autoimmune hemolytic anemia, a condition characterized by the premature destruction of red blood cells by the immune system.
Some individuals have reported symptoms that resemble multiple sclerosis including numbness or a sensation of pins and needles, vision abnormalities such as double vision, and difficulty walking, but it is not known if these problems are related to APS. Some data show an association of APS with cognitive dysfunction, but the mechanism is not known.
In women, APS can cause complications during pregnancy including repeated miscarriages, fetal growth delays (intrauterine growth retardation), and preeclampsia. Preeclampsia is a condition characterized by high blood pressure, swelling and protein in the urine. Symptoms associated with preeclampsia vary greatly, but may include headaches, changes in vision, abdominal pain, nausea and vomiting.
CATASTROPHIC ANTIPHOSPHOLIPID SYNDROME (CAPS) Catastrophic antiphospholipid syndrome, also known as CAPS or Asherson’s syndrome, is an extremely rare variant of APS in which multiple blood clots affect various organ systems of the body potentially causing life-threatening multi-organ failure. The specific presentation, progression and organs involved vary from person to person. CAPS may develop in a person with primary or secondary APS or in individuals without a previous diagnosis of APS. In some cases, infection, trauma, or surgery appears to trigger the condition.

Causes

Antiphospholipid syndrome is an autoimmune disorder of unknown cause. Autoimmune disorders are caused when the body natural defenses (antibodies, lymphocytes, etc.) against invading organisms attack perfectly healthy tissue. Researchers believe that multiple factors including genetic and environmental factors play a role in the development of APS. In rare cases, APS has run in families suggesting that a genetic predisposition to developing the disorder may exist.
The antibodies that are present in APS are known as antiphospholipid antibodies. These antibodies were originally thought to attack phospholipids, fatty molecules that are a normal part of cell membranes found throughout the body. However, researchers now know that these antibodies mostly target certain blood proteins that bind to phospholipids. The two most common proteins affected are beta-2-glycoprotein I and prothrombin. The exact mechanism by which these antiphospholipid antibodies eventually lead to the development of blood clots is not known.

Affected Populations

APS affects males and females, but a large percentage of primary APS patients are women with recurrent pregnancy loss. Some estimates suggest that 1 in 5 cases of recurrent miscarriages or deep vein thromboses are due to APS. As many as one-third of cases of stroke in people under 50 years of age may be due to APS. Secondary APS occurs mainly in lupus, and about 90% of lupus patients are female.

Related Disorders

Symptoms of the following disorders can be similar to those of antiphospholipid syndrome. Comparisons may be useful for a differential diagnosis.
Several rare genetic disorders are characterized by the formation of blood clots (thromboses). These disorders may be collectively referred as the thrombophilias and include protein C deficiency, protein S deficiency, antithrombin III deficiency, and factor V Leiden. (For more information on these disorders, contact the National Alliance for Thrombosis and Thrombophilia.)
Some individuals with APS may be misdiagnosed as having multiple sclerosis (MS) because of the development of similar neurological symptoms. Multiple sclerosis is a chronic disease of the brain and spinal cord (central nervous system) that may be progressive, relapsing and remitting, or stable. The pathology of MS consists of small lesions called plaques that may form randomly throughout the brain and spinal cord. These patches prevent proper transmission of nervous system signals and thus result in a variety of symptoms including eye abnormalities, impairment of speech, and numbness or tingling sensation in the limbs and difficulty walking. The exact cause of multiple sclerosis is unknown. (For more information on this disorder choose “Multiple Sclerosis” as your search term in the Rare Disease Database.)
Lupus (systemic lupus erythematosus) is a chronic, inflammatory autoimmune disorder that can affect various organ systems. In autoimmune disorders, the body’s own immune system mistakenly attacks healthy cells and tissues causing inflammation and malfunction of various organ systems. In lupus, the organ systems most often involved include the skin, kidneys, blood and joints. Many different symptoms are associated with lupus, and most affected individuals do not experience all of the symptoms. The initial symptoms may include arthritis, skin rashes, fatigue, fever, pleurisy, and weight loss. In some cases, lupus may be a mild disorder affecting only a few organ systems. In other cases, it may result in serious complications.

Diagnosis

A diagnosis of antiphospholipid syndrome is made based upon a thorough clinical evaluation, a detailed patient history, identification of characteristic physical findings (at least one blood clot or clinical finding), and a variety of tests including simple blood tests.
The most common blood tests used to detect antiphospholipid antibodies are anticardiolipin antibody immunoassays (which, despite the name, detect mainly antibodies to beta-2-glycoprotein I), anti-beta-2-glycoprotein antibody immunoassays, and lupus anticoagulant tests (coagulation assays that detect subsets of anti-beta-2-glycoprotein I antibodies and anti-prothrombin antibodies). Positive tests should be repeated because antiphospholipid antibodies can be present in short intervals (transiently) due to other reasons such as infection or drug use. Borderline negative tests may need to be repeated because individuals with APS have initially tested negative for the antiphospholipid antibodies.

Standard Therapies

Treatment
Individuals with APS who do not have symptoms may not require treatment. Some individuals may undergo preventative (prophylaxis) therapy to avoid blood clots from forming. For many individuals, daily treatment with aspirin (which thin the bloods and prevents blood clots) may be all that is needed.
Individuals with a history of thrombosis may be treated with drugs that preventing clotting by thinning the blood. These drugs are often referred to as anticoagulants and may include heparin and warfarin (Coumadin). New oral blood thinners (dabigatran, rivaroxaban, and apixaban) have recently been approved to treat other blood clotting conditions. Studies are needed to determine whether these drugs are appropriate for preventing recurrent blood clots in patients with APS. Individuals with repeated thrombotic events may require lifelong anticoagulant therapy.
Importantly, affected individuals are strongly encouraged to avoid or reduce risk factors that increase the risk of a blood clot forming. Such risks include smoking, the use of oral contraceptives, high blood pressure (hypertension), or diabetes. During pregnancy, women at a high risk for pregnancy loss are treated with heparin, sometimes in combination with low dose aspirin. In some cases, heart valve damage may be severe and require surgical replacement.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. Government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office: Tollfree: (800) 411-1222 TTY: (866) 411-1010 Email: prpl@cc.nih.gov
For information about clinical trials sponsored by private sources, contact: www.centerwatch.com
For information about clinical trials conducted in Europe, contact: https://www.clinicaltrialsregister.eu/

Supporting Organizations

• APS Foundation of America
  • PO Box 801
  • La Crosse, WI 54602-0801
  • Phone: (608) 782-2626
  • Email: [apsfa@apsfa.org](mailto:apsfa@apsfa.org)
  • Website: http://www.apsfa.org
• Genetic and Rare Diseases (GARD) Information Center
  • PO Box 8126
  • Gaithersburg, MD 20898-8126
  • Phone: (301) 251-4925
  • Toll-free: (888) 205-2311
  • Website: http://rarediseases.info.nih.gov/GARD/
• Hughes Syndrome Foundation
  • Conybeare House
  • Guy's Hospital
  • London, SE1 9RT United Kingdom
  • Phone: (207) 188-8217
  • Email: [info@hughes-syndrome.org](mailto:info@hughes-syndrome.org)
  • Website: http://www.hughes-syndrome.org
• Lupus Foundation of America, Inc.
  • 2000 L Street NW
  • Suite 710
  • Washington, DC 20036 USA
  • Phone: (202) 349-1155
  • Toll-free: (800) 558-0121
  • Email: [info@lupus.org](mailto:info@lupus.org)
  • Website: http://www.lupus.org
• National Blood Clot Alliance
  • 8321 Old Courthouse Road, Suite 255
  • Vienna, VA 22182
  • Phone: (703) 935-8845
  • Toll-free: (877) 466-2568
  • Email: [info@stoptheclot.org](mailto:info@stoptheclot.org)
  • Website: http://www.stoptheclot.org/
• National Stroke Association
  • 9707 E. Easter Lane
  • Suite B
  • Centennial, CO 80112 USA
  • Phone: (303) 649-9299
  • Toll-free: (800) 787-6537
  • Email: [info@stroke.org](mailto:info@stroke.org)
  • Website: http://www.stroke.org

References

TEXTBOOKS Hogan WJ, Nichols WL. Antiphospholipid Syndrome. NORD Guide to Rare Disorders. Lippincott Williams & Wilkins. Philadelphia, PA. 2003:2.
Rand JH, Wolgast L. “The Antiphospholipid Syndrome” in Kaushansky K, Lichtman MA, Prchal JT, Levi MM, Press OW, Burns LJ, Caligiuri M. Eds. Williams Hematology. 9th ed. McGraw-Hill Companies. New York, NY; 2016:2233-2252.
JOURNAL ARTICLES Andreoli L, Bertsias GK, Agmon-Levin N, et al. EULAR recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis. 2016 Jul 25. pii: annrheumdis-2016-209770. doi: 10.1136/annrheumdis-2016-209770. [Epub ahead of print]; https://www.ncbi.nlm.nih.gov/pubmed/27457513
Rodríguez-Pintó I, Moitinho M, Santacreu I, Shoenfeld Y, Erkan D, Espinosa G, Cervera R. CAPS Registry Project Group (European Forum on Antiphospholipid Antibodies). Catastrophic antiphospholipid syndrome (CAPS): Descriptive analysis of 500 patients from the International CAPS Registry. Autoimmun Rev. 2016 Sep 15. pii: S1568-9972(16)30205-1. doi: 10.1016/j.autrev.2016.09.010. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/27639837
Chaturvedi S, McCrae KR. The antiphospholipid syndrome: still an enigma. Hematology Am Soc Hematol Educ Program. 2015;2015:53-60.
Chighizola CB, Raschi E, Borghi MO, Meroni PL. Update on the pathogenesis and treatment of the antiphospholipid syndrome. Curr Opin Rheumatol. 2015; 27:476-482.
Krilis SA, Giannakopoulos B. Laboratory methods to detect antiphospholipid antibodies. Hematology Am Soc Hematol Educ Program 2014:321-328.

Years Published

1994, 1995, 1996, 2001, 2002, 2007, 2011, 2016
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What is Nexium?
Nexium (esomeprazole magnesium) is a proton pump inhibitor that decreases the amount of acid produced in the stomach.
Nexium is used to treat symptoms of gastroesophageal reflux disease (GERD) and other conditions involving excessive stomach acid such as Zollinger-Ellison syndrome. It is also used to promote healing of erosive esophagitis (damage to your esophagus caused by stomach acid).
Nexium may also be given to prevent gastric ulcer caused by infection with Helicobacter pylori (H. pylori), or by the use of nonsteroidal anti-inflammatory drugs (NSAIDs).
What you need to know before you take Nexium
Do not take Nexium:
If you are allergic to esomeprazole or any of the other ingredients of this medicine (listed in section 6).
If you are allergic to other proton pump inhibitor medicines (e.g. pantoprazole, lansoprazole, rabeprazole, omeprazole).
If you are taking a medicine containing nelfinavir (used to treat HIV infection).
Do not take Nexium if any of the above apply to you. If you are not sure, talk to your doctor or pharmacist before taking Nexium.
Warnings and precautions
Talk to your doctor or pharmacist before taking Nexium:
If you have severe liver problems.
If you have severe kidney problems.
If you have ever had a skin reaction after treatment with a medicine similar to Nexium that reduces stomach acid.
If you are due to have a specific blood test (Chromogranin A).
Nexium may hide the symptoms of other diseases. Therefore, if any of the following happen to you before you start taking Nexium or while you are taking it, talk to your doctor straight away:
You lose a lot of weight for no reason and have problems swallowing.
You get stomach pain or indigestion.
You begin to vomit food or blood.
You pass black stools (blood-stained faeces).
If you have been prescribed Nexium “on demand” you should contact your doctor if your symptoms continue or change in character.
Taking a proton pump inhibitor like Nexium, especially over a period of more than one year, may slightly increase your risk of fracture in the hip, wrist or spine. Tell your doctor if you have osteoporosis or if you are taking corticosteroids (which can increase the risk of osteoporosis).
If you get a rash on your skin, especially in areas exposed to the sun tell your doctor as soon as you can, as you may need to stop your treatment with Nexium. Remember to also mention any other ill-effects like pain in your joints.
How should I take Nexium?
Use Nexium exactly as directed on the label, or as prescribed by your doctor.
Take each dose with a full glass (8 ounces) of water.
Nexium should be taken at least one hour before a meal.
Do not crush or chew a delayed-release capsule. However to make swallowing easier, you may open the capsule and sprinkle the medicine into a spoonful of pudding or applesauce. Swallow right away without chewing. Do not save the mixture for later use.
The capsule can be given through a nasogastric (NG) feeding tube. Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions.
Esomeprazole is usually given for 4 to 8 weeks only. Your doctor may recommend a second course of treatment if you need additional healing time.
Use this medicine for the full prescribed length of time, even if your symptoms quickly improve.
Call your doctor if your symptoms do not improve or if they get worse while you are taking this medicine.
This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using esomeprazole.
Some conditions are treated with a combination of esomeprazole and antibiotics. Use all medications as directed.
Store at room temperature away from moisture and heat.
Nexium side effects
Get emergency medical help if you have signs of an allergic reaction ro Nexium: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have:

• severe stomach pain, diarrhea that is watery or bloody;
• seizure (convulsions);
• kidney problems - urinating more or less than usual, blood in your urine, swelling, rapid weight gain;
• low magnesium - dizziness, fast or irregular heart rate, tremors (shaking) or jerking muscle movements, feeling jittery, muscle cramps, muscle spasms in your hands and feet, cough or choking feeling; or
• new or worsening symptoms of lupus - joint pain, and a skin rash on your cheeks or arms that worsens in sunlight.
• Taking esomeprazole long-term may cause you to develop stomach growths called fundic gland polyps. Talk with your doctor about this risk.

If you use esomeprazole for longer than 3 years, you could develop a vitamin B-12 deficiency. Talk to your doctor about how to manage this condition if you develop it.
Common Nexium side effects may include:

• headache, drowsiness;
• mild diarrhea;
• nausea, stomach pain, gas, constipation; or
• dry mouth.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
See also:
Nexium side effects (in more detail)
What other drugs will affect Nexium?
Tell your doctor about all your current medicines. Many drugs can affect esomeprazole, especially:

• cilostazol;
• clopidogrel;
• diazepam;
• digoxin;
• erlotinib;

iron-containing medicines (ferrous fumarate, ferrous gluconate, ferrous sulfate, and others);

• methotrexate;
• mycophenolate mofetil;
• rifampin;
• tacrolimus;
• warfarin (Coumadin, Jantoven);
• antifungal medication - ketoconazole, voriconazole; or
• HIV/AIDS medication - atazanavir, nelfinavir, saquinavir.

This list is not complete and many other drugs may interact with esomeprazole. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.
See also:
Nexium drug interactions (in more detail)
Further information
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Nexium only for the indication prescribed.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Xarelto (rivaroxaban) blocks the activity of certain clotting substances in the blood. Xarelto is used to prevent or treat a type of blood clot called deep vein thrombosis (DVT), which can lead to blood clots in the lungs (pulmonary embolism). A DVT can occur after certain types of surgery.
Xarelto is also used in people with atrial fibrillation (a heart rhythm disorder) to lower the risk of stroke caused by a blood clot. Xarelto may also be used for purposes not listed in this medication guide.
Xarelto is a prescription medicine used to reduce the risk of stroke and blood clots in people with atrial fibrillation, not caused by a heart valve problem. For patients currently well managed on warfarin, there is limited information on how Xarelto and warfarin compare in reducing the risk of stroke.
Xarelto is also a prescription medicine used to treat deep vein thrombosis (DVT) and pulmonary embolism (PE), and to reduce the risk of blood clots happening again in people who continue to be at risk for DVT or PE after receiving treatment for blood clots for at least 6 months.
Xarelto is also a prescription medicine used to reduce the risk of forming a blood clot in the legs and lungs of people who have just had knee or hip replacement surgery.

How Should i take Xarelto?

• Take XARELTO exactly as prescribed by your doctor.
• Do not change your dose or stop taking XARELTO® unless your doctor tells you to.
• Your doctor may change your dose if needed.
• If you take XARELTO for

Atrial Fibrillation:

• Take XARELTO 1 time a day with your evening meal.
• If you miss a dose of XARELTO, take it as soon as you remember on the same day. Take your next dose at your regularly scheduled time.
• Blood clots in the veins of your legs or lungs:
• Take XARELTO 1 or 2 times a day as prescribed by your doctor.
• For the 15-mg and 20-mg doses, XARELTO should be taken with food.
• For the 10-mg dose, XARELTO may be taken with or without food.
• Take your XARELTO dose(s) at the same time each day.
• If you miss a dose:
• If you take the 15-mg dose of XARELTO 2 times a day (a total of 30 mg of XARELTO in 1 day): Take XARELTO as soon as you remember on the same day. You may take 2 doses at the same time to make up for the missed dose. Take your next dose at your regularly scheduled time.
• If you take XARELTO 1 time a day: Take XARELTO as soon as you remember on the same day. Take your next dose at your regularly scheduled time.​
• Hip or knee replacement surgery:
  • Take XARELTO 1 time a day with or without food.
  • If you miss a dose of XARELTO, take it as soon as you remember on the same day. Take your next dose at your regularly scheduled time.
• If you have difficulty swallowing the XARELTO tablet whole, talk to your doctor about other ways to take XARELTO.
• Your doctor will decide how long you should take XARELTO.
• Your doctor may stop XARELTO for a short time before any surgery, medical or dental procedure. Your doctor will tell you when to start taking XARELTO again after your surgery or procedure.
• Do not run out of XARELTO. Refill your prescription for XARELTO before you run out. When leaving the hospital following a hip or knee replacement, be sure that you have XARELTO available to avoid missing any doses.
• If you take too much XARELTO, go to the nearest hospital emergency room or call your doctor right away.

This Medication Work

Rivaroxaban belongs to the family of medications called anticoagulants.Anticoagulants prevent harmful blood clots from forming in the blood vessels by reducing the ability of the blood to clot. Rivaroxaban is used to prevent blood clots for people who have had total hip replacement or knee replacement surgery. It is used to treat blood clots for people who have had a deep vein thrombosis (DVT; a blood clot in the major arteries, particularly the leg) or pulmonary embolism (blood clot in the lung), and to prevent these clots from happening again.
Rivaroxaban is also used to prevent stroke or blood clots in people with atrial fibrillation.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

Uses

Rivaroxaban is used to prevent blood clots from forming due to a certain irregular heartbeat (atrial fibrillation) or after hip or knee replacement surgery. It is also used to treat blood clots (such as in deep vein thrombosis-DVT or pulmonary embolus-PE) and to prevent the blood clots from forming again.
Rivaroxaban is an anticoagulant that works by blocking certain clotting proteins in your blood.

How to use Xarelto

Read the Medication Guide provided by your pharmacist before you start taking rivaroxaban and each time you get a refill. If you have any questions, ask your doctor or pharmacist.
Take this medication by mouth as directed by your doctor. If you are taking this medication to prevent blood clots after knee or hip replacement surgery, the dose is usually taken once a day. If you are taking this drug to prevent strokes and blood clotsthat may form due to an irregular heartbeat, the dose is usually taken once a day with the evening meal. If you are taking rivaroxaban to treat blood clots, the dose is usually taken twice a day for the first 3 weeks, and then once a day. Carefully follow your doctor’s directions. Do not increase your dose, take it more often, or stop taking it unless you are told to do so by your doctor.
The 10 milligrams tablet may be taken with or without food. The 15 milligrams and 20 milligramstablet should be taken with food. If you have any questions about how to take rivaroxaban, ask your doctor or pharmacist.
If you are unable to swallow whole tablets, you may crush the tablet and mix it with applesauce. Eat the entire mixture right away. Do not prepare a supply for future use.
If you are giving this medication through a tube into the stomach (nasogastric or gastric tube), ask your health care professional for detailed instructions on how to properly mix and give it.
The dosage and length of treatment is based on your medical condition and response to treatment.
Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.

Who should NOT take this medication?

Do not take rivaroxaban if you:

• are allergic to rivaroxaban or any ingredients of the medication
• are bleeding actively or have a high risk of bleeds
• are pregnant or breast-feeding
• are taking certain medications such as ketoconazole, itraconazole, voriconazole, posaconazole, or ritonavir
• are taking other anticoagulants (blood thinners, e.g., warfarin, heparin, low molecular weight heparin, apixaban)
• have a body lesion at risk of bleeding, including bleeding in the brain within the last 6 months, or bleeding in your stomach or gut
• have liver disease associated with an increased risk of bleeding

side effects

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• bleeding
• bruising
• constipation
• decreased energy
• diarrhea
• fluid buildup in legs, ankles
• headache
• increased menstrual bleeding
• nausea
• stomach ache
• vomiting

Although most of these side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:

• bleeding or oozing from the surgical wound
• confusion
• decreased urine production
• fast heartbeat
• itchy skin or skin rash
• signs of anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness,shortness of breath)
• signs of bleeding (e.g., bloody nose that lasts for more than 5 minutes, blood in urine, coughing blood, cuts that don’t stop bleeding, gums that bleed for longer than 5 minutes when brushing teeth, bleeding into the rectum or from hemorrhoids, excessive menstrual bleeding)
• signs of infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
• signs of low blood pressure (e.g., dizziness, lightheadedness, fainting)
• stiff, sore, hot, or painful joints
• symptoms of unidentified bleeding (e.g., weakness, paleness, dizziness, headache, unexplained swelling)
• unexpected bruising or bleeding after surgery

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of bleeding in the stomach (e.g., bloody, black, or tarry stools, spitting up of blood, vomiting blood or material that looks like coffee grounds)
• signs of a serious allergic reaction (i.e., hives, difficulty breathing, or swelling of the face and throat)
• signs of severe skin reactions (e.g., blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort).

warnings

Increased bleeding risk: If you have conditions that are associated with an increased risk of bleeding (e.g., bleeding problems; uncontrolled very high blood pressure; a problem with the blood vessels in the back of the eye called retinopathy; current or past ulcer of the stomach or intestines; or recent stroke, recent surgery of the brain, spinal column, or eye), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Kidney disease: If you have kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Lactose: This medication contains lactose. People with certain rare problems associated with lactose or galactose intolerance (e.g., Lapp lactase deficiency, glucose-galactose malabsorption) should not take this medication.
Liver disease: If you have liver disease or decreased liver function, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.
Spinal or epidural injection or catheters: If you have a spinal or epidural catheter, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Surgery: Inform all health care professionals involved in your care that you are taking rivaroxaban. Rivaroxaban may need to be stopped temporarily before dental or surgical procedures to reduce your risk of bleeding heavily during or after the procedure.
Pregnancy: This medication should not be used during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: Rivaroxaban may pass into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. This medication is not recommended to be taken while breast-feeding.
Children: The safety and effectiveness of using this medication have not been established for children less than 18 years of age.
Seniors: The side effects of this medication may be more noticeable in seniors. People who are over 65 years old should discuss with their doctor how this medication may affect them and whether any special monitoring is needed.

Before taking this medicine

You should not use Xarelto if you are allergic to rivaroxaban, or if you have:

• an artificial heart valve; or
• active or uncontrolled bleeding.

Xarelto can cause a very serious blood clot around your spinal cord if you undergo a spinal tap or receive spinal anesthesia (epidural). This type of blood clot could cause long-term paralysis, and may be more likely to occur if you have:

• you have a genetic spinal defect;
• you have a spinal catheter in place;
• you have a history of spinal surgery or repeated spinal taps;
• you have recently had a spinal tap or epidural anesthesia;
• you are taking an NSAID – Advil, Aleve, Motrin, and others; or
• you are using other medicines to treat or prevent blood clots.

Xarelto may cause you to bleed more easily, especially if you have:

• a bleeding disorder that is inherited or caused by disease;
• hemorrhagic stroke;
• uncontrolled high blood pressure;
• stomach or intestinal bleeding or ulcer; or
• if you take certain medicines such as aspirin, enoxaparin, heparin, warfarin (Coumadin, Jantoven), or clopidogrel (Plavix), or certain antidepressants.

To make sure you can safely take Xarelto, tell your doctor if you have kidney or liver disease.
It is not known whether Xarelto will harm an unborn baby. However, this medicine could cause bleeding complications during childbirth. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.
It is not known whether rivaroxaban passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are using Xarelto.

How should I take rivaroxaban?

Take Xarelto exactly as prescribed by your doctor. Xarelto is taken either once per day or two times per day, depending on the reason you are using this medication. Follow all directions on your prescription label. Your doctor may occasionally change your dose. Do not take this medicine in larger or smaller amounts or for longer than recommended. Carefully follow your doctor’s dosing instructions.
For atrial fibrillation: Take the Xarelto 15-milligram or 20-milligram tablet once per day with your evening meal.
For blood clots in your legs or lungs: Xarelto is usually taken with food 1 or 2 times per day, at the same time each day.

Xarelto dosing information

The recommended dose of Xarelto for the treatment of DVT and/or PE is 15 mg taken orally twice daily with food for the first 21 days. After this initial treatment period, the recommended dose of Xarelto is 20 mg taken orally once daily with food, at approximately the same time each day.
The recommended dose of Xarelto for reduction in the risk of recurrence of DVT or PE is 20 mg taken orally once daily with food at approximately the same time each day.
In patients taking Xarelto for prevention of deep vein thrombosis (DVT), which could result in pulmonary embolism (PE) following certain surgical procedures, the recommended daily dose is 10 milligrams taken once a day, with or without food. The initial dose should be taken at six to 10 hours after surgery once the patient has been stabilized (or body functions have returned to normal).
Treatment with Xarelto should continue in patients who are taking the drug following a hip replacement surgery for a recommended duration of 35 days. For patients undergoing knee replacement surgery, Xarelto should be continued for 12 days following surgery. A patient’s doctor will ultimately decide how long his or her patient should continue to take Xarelto following surgery.
Sometimes a patient’s doctor may ask them to stop taking Xarelto for a short time prior to certain surgeries, medical or dental procedures. The doctor will also inform the patient when it is considered safe to resume treatment with the blood thinner medication.

Overdose

It is possible to overdose on Xarelto (rivaroxaban) by consuming large amounts of the drug. If an overdose is suspected, patients are urged to seek immediate treatment as potentially life-threatening bleeding complications can occur. Due to Xarelto’s high plasma protein binding, the drug is not dialyzable, meaning dialysis cannot be used to remove the medication from the patient’s blood. Since there is currently no specific antidote available to reverse bleeding in patients taking Xarelto, activated charcoal may be used to reduce absorption of the drug.
Mild cases of overdose may not result in any symptoms. Since there is currently no easy or overall effective way to treat a Xarelto overdose that results in bleeding, treatment is likely to be largely symptomatic and supportive, minimizing complications that occur rather than preventing them.
Usual Adult Dose of Xarelto for Deep Vein Thrombosis Prophylaxis after Hip Replacement Surgery:
Prevention of venous thromboembolism in patients undergoing hip or knee replacement surgery: 10 mg orally once a day starting 6 to 10 hours after surgery.
Duration of therapy is 35 days for hip replacement surgery and 12 days for knee replacement surgery.
Usual Adult Dose for Deep Vein Thrombosis Prophylaxis after Knee Replacement Surgery:
Prevention of venous thromboembolism in patients undergoing hip or knee replacement surgery: 10 mg orally once a day starting 6 to 10 hours after surgery.
Duration of therapy is 35 days for hip replacement surgery and 12 days for knee replacement surgery.
Usual Adult Dose for Atrial Fibrillation:
Nonvalvular Atrial Fibrillation: 20 mg orally, once daily with the evening meal.
Usual Adult Dose of Xarelto for Deep Vein Thrombosis:
Treatment of DVT and PE: Initial dose: 15 mg orally twice daily with food, for first 21 days. Maintenance dose: 20 mg orally once daily with food, for remaining treatment.
Usual Adult Dose for Pulmonary Embolism:
Treatment of DVT and PE: Initial dose: 15 mg orally twice daily with food, for first 21 days. Maintenance dose: 20 mg orally once daily with food, for remaining treatment.
Usual Adult Dose for Deep Vein Thrombosis – Recurrent Event:
Reduction in the Risk of Recurrence of DVT and of PE: 20 mg orally once daily with food.
Usual Adult Dose of Xarelto for Pulmonary Embolism – Recurrent Event:
Reduction in the Risk of Recurrence of DVT and of PE: 20 mg orally once daily with food.

Dental Procedures and Xarelto

Due to concerns related to bleeding risks, it is sometimes suggested that patients discontinue the use of Xarelto prior to undergoing certain dental procedures. The European Heart Rhythm Association issued a 2015 consensus guideline (updating a prior 2013 guideline), suggesting that certain procedures, such as the extraction of one to three teeth, periodontal surgery, abscess incisions or implant positioning, do not necessarily require patients to discontinue the use of Xarelto.
A 2015 narrative review concluded that with “limited dental surgery” continuing the regular dose of Xarelto or postponing the timing of the daily dose to either follow the dental treatment or skipping one daily dose altogether, may be the most conservative and beneficial options for the patient taking Xarelto. The author of the narrative pointed out that clinical trials would need to be conducted to confirm the findings.
Another narrative issued the same year confirmed the advice offered by the first narrative author, but also addressed the need to consider other supplements or drugs the patient may be taking together with Xarelto that could increase the patient’s risk for bleeding and resultant complications.
With the inclusion of a 2013 systematic review as well, the overall recommendation was to advise patients not to take Xarelto one to three hours prior to dental treatment. All of the authors acknowledged that no clinical studies or guidelines have been published to directly address the treatment management considerations of patients taking Xarelto while undergoing various dental procedures, so any recommendations made are purely subjective.
The general consensus, according to the American Dental Association (ADA), seems to be that with the newer target-specific anticoagulant medications, no change to the treatment regimen is required for patients undergoing dental treatments. But the ADA suggested that in order to be cautious, dental practitioners should consult a patient’s physician to assess the safety for each individual patient, and that when suggesting any modification to a patient’s medication regimen prior to dental surgery, that it be done in conjunction with consultation of the patient’s primary care doctor.

Other Blood Thinners

Warfarin, marketed under the brand names Coumadin and Jantoven, has been the primary anticoagulant (blood thinner) drug available to patients since its approval. However, since 2010, the FDA has approved four new oral anticoagulant drugs, including, in order, Pradaxa (dabigatran), Xarelto (rivaroxaban), Eliquis (apixaban) and Savaysa (edoxaban).
All four of these anticoagulants work to effectively reduce a patient’s overall risk of stroke associated with atrial fibrillation (AF); but they can also cause bleeding, and only two of the blood thinner drugs (warfarin and Pradaxa) currently have antidotes available to reverse this adverse effect.
Across the board the FDA concluded that all four anticoagulants in the new generation of blood thinners are equivalent to, or more effective than, warfarin in preventing strokes. Still, the existence or lack of an antidote may be a game-changer for some patients when considering which medication to take.
Other benefits of this new wave of blood thinners over the tried-and-true warfarin include fewer interactions with food and other drugs, a more rapid onset, freedom from the need to undergo periodic blood testing, and a substantially reduced risk of bleeding into the brain resulting in hemorrhagic stroke (a type of stroke that is not caused by blood clots that go into the brain, such as those found in AF patients).

Xarelto In Certain Populations

Certain individuals considering taking Xarelto may be at an increased risk for resulting complications. These individuals can include patients who have ever had bleeding problems, patients who have liver or kidney problems, or patients with other medical conditions.
The drug’s overall safety and efficacy has not been adequately studied in pregnant women, and dosing for pregnant women has not yet been established. Women with high-risk pregnancies may be at an increased risk of bleeding and premature delivery since there is no antidote for resulting hemorrhages. In animal studies, maternal bleeding and maternal and fetal death occurred during labor and delivery at a dose of 40 milligrams/kg of Xarelto. Therefore, Xarelto should be used during pregnancy only if the potential benefit justifies the potential risk to mother and fetus.

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.
Some products that may interact with this drug include: mifepristone, certain antidepressants (including SSRIs such as fluoxetine, SNRIs such as desvenlafaxine/venlafaxine).
Other medications can affect the removal of rivaroxaban from your body, which may affect how rivaroxaban works. Examples include cobicistat, conivaptan, certain azole antifungals (itraconazole, ketoconazole, posaconazole), rifamycins (such as rifampin), HIV protease inhibitors (such as lopinavir, ritonavir), St. John’s wort, drugs used to treat seizures (such as carbamazepine, phenytoin, phenobarbital), among others.
Aspirin can increase the risk of bleeding when used with this medication. However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually at dosages of 81-325 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.

What Does Xarelto Treat?

Xarelto (rivaroxaban) is indicated to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (an irregular heartbeat) by preventing the formation of blood clots. It is also used as a treatment and maintenance drug for deep vein thrombosis (DVT) (a blood clot that forms in a vein deep in the body, usually in the lower leg or thigh), which may lead to pulmonary embolism (PE) (a sudden blockage in an artery of the lung) in patients having knee or hip replacement surgery.

Nonvalvular Atrial Fibrillation

Atrial fibrillation (AF) is the most common type of arrhythmia, or irregular heartbeat. If a patient has an arrhythmia, it means there is a problem with the speed or rhythm of their heartbeat. “Nonvalvular” means AF is not caused by a heart valve problem.
The cause of AF has to do with a disorder in the heart’s electrical system. A test called an electrocardiogram (EKG) can assist in the diagnosis of AF by showing the electrical waves of a patient’s heart. Complications of the condition can include an increased risk of stroke, chest pain, heart attack or heart failure, which can lead to death. Treatment of AF may include medications and/or other procedures designed to restore the heart’s normal rhythm.

Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)

Deep vein thrombosis (DVT) is a condition in which a blood clot forms in a vein deep within the body. DVT typically occurs in the large veins in the lower legs and thighs, but it can also occur in other deep veins, such as in the arms and pelvis (also called the pelvic region located between the abdomen and the thighs). If the vein swells, it is referred to as thrombophlebitis. DVT is most common in individuals over 60. However, blood clots can occur at any age.
Blood clots, including a DVT, can affect blood flow causing changes in skin color (redness), leg pain, swelling of the leg (edema), and skin that feels warm to the touch or is tender over the affected vein.
Other serious problems can result in patients if a DVT breaks loose and travels through the bloodstream to the lung. A sudden blockage in an artery in the lung is called a pulmonary embolism (PE). PE can cause permanent damage to the affected lung, low oxygen levels in a patient’s blood and damage to other organs in the body due to a lack of oxygen supply. In instances where the clot is large or there are multiple clots present, PE can even result in death.
About 50 percent of individuals who have PE are unaware that they are affected by the potentially life-threatening condition. Symptoms can include shortness of breath, chest pain or coughing up blood. The goal of treatment is to break up any existing clots and to prevent new clots from forming.

No Antidote for Bleeding

Currently, no antidote exists for reversal of bleeding associated with the use of Xarelto (rivaroxaban). Unlike with warfarin, vitamin K is not an effective reversal agent with Xarelto. Partial reversal has been seen in healthy clinical trial volunteers after the administration of prothrombin complex concentrates (PCCs). PCC, or Factor IX complex as it’s also known, is a medicine used to treat and prevent bleeding associated with a blood-clotting disorder called hemophilia B. The use of other medications with blood-clotting factors, or procoagulant reversal agents, have not been evaluated with Xarelto.
In December 2015, the New England Journal of Medicine (NEJM) published data from a study conducted by Portola Pharmaceuticals, the makers of a proposed antidote for Xarelto. Portola was hoping to launch the drug following FDA approval in 2016. In early 2015, the FDA designated the company’s lead candidate Andexxa (andexanet alfa) “a breakthrough therapy,” meaning early evidence indicated that it was representative of a substantial improvement over existing therapies, and that it would assist in the acceleration of the development and review of other drugs for serious or life-threatening conditions.

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: bloody/black/tarry stools, pink/dark urine, unusual/prolonged bleeding.

Notes

Do not share this medication with others.
Laboratory and/or medical tests (such as hematocrit/hemoglobin, red blood cell count) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

This is taken from the Medication Guide I received with my prescription. It has a date of last edited in January 2017. Read the guide every time you get another prescription, as things may update. Remain in contact with your healthcare provider on all side effects and problems. This is not a replacement for talking to your healthcare provider. This is not a comprehensive list. I am not liable for anything related to your health, this is just a list with information, please consult your healthcare provider or call 911 if it's an emergency.
I have requested to be a moderator of this subreddit and hope to make this on a wiki page, but of course /redditrequest is super backed up.
Common side effects:

• Nausea (Most commonly reported)
• Sleepiness
• Weakness
• Dizziness
• Feeling anxious
• Trouble Sleeping
• Sexual problems
• Sweating
• Shaking
• Not feeling hungry
• Dry mouth
• Constipation
• Infection
• Yawning

Other side effects in children and adolescents:

• Increased thirst
• Abnormal increase in muscle movement or agitation
• Nose bleed
• Difficult Urination
• Heavy menstrual periods
• Possible slowed growth rate and weight change. Child's height and weight should be monitored during treatment with escitalopram

Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of escitalopram. For more information, ask your healthcare provider or pharmacist.
CALL YOUR DOCTOR FOR MEDICAL ADVICE ABOUT SIDE EFFECTS. YOU MAY REPORT SIDE EFFECTS TO THE FDA AT 1-800-FDA-1088 (1-800-332-1088).
Serious side effects (Call your healthcare provider immediately if you experience these symptoms, especially if they are new, worse, or worry you and 911 if it's an emergency:
1 - Suicidal thoughts or actions
Escitalopram and other antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, or young adults within the first few months of treatment or when the dose is changed.
Depression or other serious mental illnesses are the most important causes of suicidal thoughts or actions.
Watch for these changes and call your healthcare provider right away if you notice:

• New or sudden changes in mood, behavior, actions, thoughts, or feelings, especially if severe.
• Pay particular attention to such changes when escitalopram is started or when the dose is changed.

Keep all follow-up visits with your healthcare provider and call between visits if you are worried about symptoms. Call your healthcare providor right away if you have any of the following symptoms, or call 911 if an emergency:

• Attempts to commit suicide
• Acting on dangerous impulses
• Acting aggressive or violent
• Thoughts about suicide or dying
• New or worse depression
• New or worse anxiety or panic attacks
• Feeling agitated, restless, angry, or irritable
• Trouble sleeping
• An increase in activity or talking more than what is normal for you
• Other unusual changes in mood or behavior

2 - Serotonin Syndrome. This condition can be life-threatening and may include:

• Agitation, hallucinations, coma, or other changes in mental status
• Coordination problems or muscle twitching (overactive reflexes)
• Racing heartbeat, high or low blood pressure
• Sweating or fever
• Nausea, vomiting, or diarrhea
• Muscle rigidity

3 - Severe allergic reactions:

• Trouble breathing
• Swelling of the face, tongue, eyes, or mouth
• Rash, itchy welts (hives), or blisters, alone or with fever or joint pain

4 - Abnormal Bleeding:
Escitalopram and other antidepressant medicines may increase your risk of bleeding or bruising, especially if you take the blood thinner warfarin (Coumadin, Jantoven), a non-steroidal anti-inflammatory drug (NSAIDs, like ibuprofen or naproxen), or aspirin.
5 - Seizures or Convulsions
6 - Manic episodes

• Greatly increased energy
• Severe trouble sleeping
• Racing thoughts
• Reckless behavior
• Unusually grand ideas
• Excessive happiness or irritability
• Talking more or faster than usual

7 - Changes in appetite or weight
Children and adolescents should have height and weight monitored during treatment.
8 - Low salt (sodium) levels in the blood
Elderly people may be at greater risk for this. Symptoms may include:

• Headache
• Weakness or feeling unsteady
• Confusion, problems concentrating, problems thinking, and problems with memory

9 - Visual Problems

• Eye pain
• Changes in vision
• Swelling or redness in or around the eye

Only some people are at risk for these problems. You may want to undergo an eye examination to see if you are at risk and receive preventative treatment if you are.
Other notes or questions
Do not stop escitalopram without first talking to your healthcare provider. Stopping escitalopram too quickly may cause serious symptoms including:

• Anxiety, irritability, high or low mood, feeling restless or changes in sleep habits
• headache, sweating, nausea, dizziness
• electric shock-like sensations, shaking, confusion

What is escitalopram?
Escitalopram is a prescription medicine used to treat depression. It is important to talk with your healthcare provider about the risks of treating depression and also the risks of not treating it. You should discuss all treatment choices with your healthcare provider.
Escitalopram is also used to treat:

• Major Depressive Disorder (MDD)
• Generalized Anxiety Disorder (GAD)

Talk to your healthcare provider if you do not think that your condition is getting better with escitalopram treatment.
Who should not take escitalopram?
Do not take escitalopram if you:

• are allergic to escitalopram oxalate or citalopram hydrobromide or any of the ingredients in escitalopram. If you need more information about the ingredients in this medicine ask your pharmacists for a complete list.
  
• take monoamine oxidase inhibitor (MAOI). Ask your healthcare provider or pharmacist if you are not sure if you take an MAOI, including the antibiotic linezolid.
  
  • Do not take an MAOI within 2 weeks of stopping escitalopram unless directed to do so by your physician.
  • Do not start escitalopram if you stopped taking an MAOI in the last 2 weeks unless directed to do so by your physician.
  • People who take escitalopram close in time to an MAOI may have serious or even life-threatening side effects. Get medical help right away if you have any of these symptoms:
    • High fever
    • Uncontrolled muscle spasms
    • Stiff muscles
    • Rapid changes in heart rate or blood pressure
    • Confusion
    • Loss of consciousness (pass out)
• take the antipsychotic medicine pimozide (Orap) because taking this drug with ecsitalopram can cause serious heart problems
  

What should I tell my healthcare provider before taking escitalopram? Ask if you are not sure.
Before starting escitalopram, tell your healthcare provider if you:

• Are taking certain drugs such as:
  • Triptans used to treat migraine headache
  • Medicines used to treat mood, anxiety, psychotic, or thought disorders including tricyclics, lithium, SSRIs, SNRIs, or antipsychotics
  • Tramadol
  • Over-the-counter supplements such as tryptophan or St. John's Wort
• Have liver problems
• Have kidney problems
• Have heart problems
• Have had seizures or convulsions
• Have bipolar disorder or mania
• Have low sodium levels in your blood
• Have a history of a stroke
• Have high blood pressure
• Have or had bleeding problems
• Are pregnant or plan to become pregnant. It is not known if escitalopram will harm your unborn baby. Talk to your healthcare provider about the benefits and risks or treating depression during pregnancy
• Are breast-feeding or plan to breast-feed. Some escitalopram may pass into your breast milk. Talk to your healthcare provider about the best way to feed your baby while taking escitalopram.

Tell your healthcare provider about all the medicines that you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Escitalopram and some medicines may interact with each other, may not work as well, or may cause serious side effects.
Your healthcare provider or pharmacist can tell you if it is safe to take escitalopram with your other medicines. Do not start or stop any medicine while taking escitalopram without talking to your healthcare provider first.
If you take escitalopram you should not take any other medicines that contain escitalopram oxalate or citalopram hydrobromide including: Celexa.
How should I take escitalopram?

• Take escitalopram exactly as prescribed. Your healthcare provider may need to change the dose of escitalopram until it is the right dose for oyu.
• Escitalopram may be taken with or without food.
• If you miss a dose of escitalopram, take the missed dose as soona s you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of escitalopram at the same time.
• If you take too much escitalopram, call your healthcare provider or poison control center right away, or get emergency treatment.

What should I avoid while taking escitalopram?
Escitalopram can cause sleepiness or may affect your ability to make decisions, think clearly, or react quickly. You should not drive, operate heavy machinery, or do other dangerous activities until you know how escitalopram affects you. Do not drink alcohol while using escitalopram.
How should I store escitalopram?

• Store escitalopram at 77ºF (25ºC); excursions permitted to 59 - 86ºF (15 - 30ºC).
• Keep escitalopram bottle closed tightly.
• Keep escitalopram and all medicines out of the reach of children

General information about escitalopram
Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not use escitalopram for a condition for which it was not prescribed. Do not give escitalopram to other people, even if they have the same condition. It may harm them. This Medication Guide summarizes the most important information about escitalopram. If you would like more information, talk with your healthcare provider. You may ask your healthcare provider or pharmicist for information about escitalopram that is written for healthcare professionals.
What are the ingredients in escitalopram?
Active ingredients: escitalopram oxalate
Inactive ingredients: If you need more information about the inactive ingredients in this medicine ask your pharmacists for a complete list.

Formally introducing myself...
New to posting to this group, but I up-vote and read everything here and have laughed and cried with those of you who post and comment here.
Recently re-started my transition back to my identity, I am a 42 year old MtF.
Back in 2008 (34) I fully transitioned and was full time, with birth-certificate, IDs, bank all changed to match who I am. I Transitioned on the same employer and all was good for about a year, after which I had one of those co-workers who rallied the other women to oust me. Jan 2009 I found myself unemployed and was offered a job in the mid-west, I am from California. This job afforded me the option to have an employer only know me, it was amazing to say the least and I was sorta living a stealth life.
Skipping a few years, April 2012 I had mis-managed my expectations of what transitioning was I had not fulled explored what I really wanted and that lead to serious depression and weight gain. Due to my lack of motivation, taking too much E via IM, and depression, not to mention I donated blood the day before I had my clot.
I ended with a Superficial thrombophlebitis (below the skin blood clot) behind my right knee and my doc took me off estrogen completely and added coumadin and weekly blood tests to manage this new medical condition I had inflicted upon myself.
He wouldn't prescribe estrogen for fear of another clot and all I had was Spiro. As the months rolled by, I began to feel like a ball of yarn was unraveling and was concerned as my body was reverting to some middle state of not quite female, but not male either.
I decided to de-transition. Looking back, it was a bad call. But It was what I felt was required to meet society's expectations and I did not feel comfortable having this androgynous/male look about me.
As the years rolled on, I had several re-starts with spiro with that same doc who worked with me when I had my blood clot, but he didn't like the idea of estrogen. I could either DIY (dangerous) or do without. I ended up just dealing with her constant voice of wanting to transition and I just got more depressed and angry, my wife knew my struggles and would do what she could to help, but It wasn't something she could help with.
I eventually found another doc this past August and he was OK with dosing estrogen patch's with blood thinners. To which I have agreed to and started the this August with Xarelto. But the patch's were not to be. I ended up with skin rash's that caused red blisters to form days after applying them.
He would not do any other form of estrogen even with the blood thinners. I ended up going my own way (read between the lines) and have continued with the blood thinners, I may not like the situation, but I'm not stupid either. I have been on IM estrogen since November and haven't felt this good or happy in years. I'm smiling once again.
I know all the crap and ugly side this change can manifest and bring into our lives, Looking back I know now how I good I had it back then and how selfish I was. I had fully transitioned at 34 and didn't appreciate what I had, I got greedy with my expectations and the clot showed me what greed can do (that's my inner karma speaking).
I have supportive friends, co-workers and family members, and I am not going to fall into another trap of being unappreciative like I was previously. I am not full-time yet, but I suspect I will be in the next few months. My body remembered what estrogen was and has picked up where it left off.
In time I will share a before-after photo, and I look forward to sharing my thoughts and offering whatever I can offer here.
Jennifer

Hello everyone. I'm new to /migraines, but I consider myself very familiar with the plight of migraine sufferers. I wanted to take a moment a post this story because the experiences we've had over the last several months have been nothing short of devastating, yet the ultimate result has been damn near miraculous. If this story helps at least one person out there who's suffering, posting it here would have been worth it.
A little background on us: I (34/m) and my wife (27/f) have been together for the past three years (married for 2). Before I met my wife, I hadn't the slightest clue about migraines (I always thought is was just a bad headache that some people experienced). But since being with my wife, I've learned quite a bit in a short amount of time.
About her migraines: My wife used to suffer from excruciating migraines (w/ aura) every 1-2 months. They started when she was 19 (1-2 per year), but only got more frequent and intense as she got older). When a migraine would come, she was pretty much out of commission for the next 48-72 hours (trying her best to sleep it off, throwing up from the pain / dry-heaving every hour) and there would be little I could do to help. She had tried all the standard medications (pain killers, sumatriptans) and nothing would really help that much (We found that Cambia helped lessen some of the pain, but you could only take it once every 24 hours, and the follow up migraine would be just a bad). Without any other options, we pretty much accepted it as the new status quo.
More specifics on my wife:

• Big health nut, would run/work out daily
• History of superficial blood clots in her legs
• No drugs or smoking
• Very very limited with Alcohol
• Has a heart condition called a Patent Foramen Ovale (which affects nearly a 1/3 of the population)

When bad turned to worse: Out of the blue, my wife started to have difficulty breathing out of no where. She's a health-nut, so the idea of her not being able to breath due to exertion or stress was laughable. But nonetheless, ER visit after ER visit would result with Dr's discharging my wife with the standard "You've got anxiety" nonsense. This continued on for about a month until finally, someone had the sense to look deeper beyond the standard scans and eventually found that she had been suffering from fairly large Pulmonary Embolisms in three locations in her lungs and DVT's in one of her legs (feel free to direct message me and I can provide the details on why it took so long to find it). So immediately, they started her up on blood thinners (an inject-able one to start) and her symptoms started to get better.
Unfortunately, the symptoms started to get worse once they put her on the standard oral anti-coagulants and we eventually spent the next 6 months bouncing from doctor-to-doctor, hospital-to-hospital, to find out what was wrong. Eventually, we found that she actually had a condition where standard blood thinning treatments do not work and that she would need to be on a higher dose of Coumadin to help quell the mini-blood clots she was throwing off (Antiphospholipid syndrome). She's now back to 80% of her original form and we are expecting a full recovery over the next couple of months (there's been a bunch of damage that she has to heal from.
So where's the Migraine connection? One of the clues that helped us get an eventual diagnosis was the fact that, despite all of the stress and craziness of these last 8 months, her migraines have all but disappeared. For someone who used to suffer from a migraine every 1-2 months, going 8 months without one is insane. The only thing that we could point to that was different is the fact that she's been on some form of anti-coagulation therapy since the blood clots were found a month into the whole ordeal. The theory goes that, although the original level of blood thinners weren't enough to quell the blood-clot formation (Let me stress that only Coumadin should be considered for APS patients), it kept the migraines at bay (and continues to do so today).
The bottom line is that, for lack of a better phrase, my wife has 'sticky blood' that affected her in many different ways... many of which we thought were not-connected until we came across APS. Turns out, it was the APS that was causing her migraines as well as the other symptoms. Treating her properly for APS essentially wiped out the root cause of her migraines.
So look, I know that migraines manifest in people many different ways and that there is no catch-all cure for them. But if you have the following symptoms, you may want to look into APS:

• Migraines (with aura)
• History of blood clots (superficial or deep vein thrombosis)
• Lacy red rash after getting out of a hot/cold shower
• Dizziness when standing up after kneeling (Orthostatic Hypertension or POTS)
• Poor memory
• History of miscarriages

As I mentioned before, feel free to comment or contact me directly if you wish for more information on this. Again, it's only been 8 months since the migraines have disappeared. They could come back, but with this answer in hand, we remain very optimistic that they are now held at bay and limited in their frequency.
Feel better.

At least that's what the doctors say it is. I'm pretty healthy. I'm on Coumadin and lovenox. I just found out four days ago. It's been awful. I'm terrified of needles and I've been poked more times that when I was pregnant. (18 times now) I even had two IVs. I'm miserable right now. It hurts to breath. I wish I could walk to my kitchen without feeling like death. I'm only allowed 400mg of Tylenol a day. Lovenox is awful and I hate it. I also have a rash where my IVs were from the tape. It's been a tough few days. Anyone is a similar position from depo or Hormonal BC?