Rich Z (WebSlave)

Originally Posted by WebSlave

No, the tablets are NOT scored.

I guess I need to contact my cardiologist and just tell him I want to have the dosage reduced and get the 5mg pills. This bruising I am getting is just not normal. I got this bruise on my left forearm on the 19th just by bracing my arm on part of the generator to get some leverage to remove the sparkplugs, and I STILL have that darn discoloration that makes me look like some sort of leper or something. Makes me scared to death to do anything because just what used to be an inconsequential bump against something is no longer inconsequential.

And these aren't just surface skin bruises, neither. These go right to the muscle, which really aches for quite a while. Something is just not RIGHT.

This is the way, yes.

It is good that you shared what you shared.

Originally Posted by nickolasanastasiou

S

If a tablet has an enteric coating, you are not supposed to split or crush it. Is the tablet scored? If it is not scored, then it is not intended to be split and the active pharmaceutical ingredient is not guaranteed to be equally distributed throughout the tablet, in which case half of the tablet is less likely to contain half of the dosage, making dosing irregular and unpredictable.

I agree, and 5 mg tablets are available.

Originally Posted by WebSlave

I guess I need to contact my cardiologist .

This. For any medication changes, or changes to your treatment plan. Because of interactions, your cardiologist should be aware of all the medications you are takng and the dosage. In addition, please discuss with your cardiologist *any* changes to his/her prescription before the change is made. For instance, for many medications, a generic substitution of a medication does not make much of a difference. This is not always true of cardiac medications.

Haven't heard anything back from my cardiologist yet. What I said was that I was halving the does of Prasugrel he prescribed by cutting the pills in half. I said if that was not appropriate, then I was insisting on a new prescription of the 5 mg dose tablets of this drug. And I described the bruising issues I have been having and did not want that to continue any longer.

One change I have decided on was to switch taking those three heart meds (Prasugrel, 51mg aspirin, and Ramipril) from the morning to the evening hours. That way any lingering bruising problems might be reduced if the prasugrel has been in my system overnight and maybe reduce the negative symptoms when I do yard work during the day and get myself roughed up in the process.

Ran Connie to an appointment with our new PCP today, but this would have been a very good day to be working outside. Temps have cooled down and a nice breeze all day long. So a destructive hurricane elsewhere in Florida seems to have produced a rather pleasant day or two here. Of course, with a strong breeze, there is always the chance of tree limbs coming down out of the trees and taking me down. Even one of those large unopened pine cones hitting me on the head would probably kill me. They are quite dense and heavy. I guess one of the few things the squirrels did good around here was keeping those pine cones down quite a bit. But, unfortunately, that isn't good enough reason for excusing them from stealing all our pears this year and most of them the last few years. And I sure don't want them taking our citrus fruits later on when they ripen.

Oh well, maybe I can do some yard work tomorrow. Got to get the yard back in shape after neglecting it this entire Spring and Summer. Still have to be careful of the bruising potential, though. I don't think halving my dose of Prasugrel will remove the problem, but should at least reduce it. And Connie should be going back onto her chemo treatments next week, too, so that might put me having to stay close by when she needs me. I do have a walkie talkie I can carry with me if needed.

Life has just become so EXHAUSTING lately....

Send another message to my cardiologist about that Presugrel dosage. Haven't heard anything back.

Yesterday I did yard work for a few hours. And wound up doing an involuntary test of my new found bruising capability. I was carrying a large branch back to a pile, and holding it vertically, the upper part just broke off and landed on my left forearm, pointy end first. Yowch! Small puncture and scrape mark, but enough of an impact that I thought for sure I was going to get one of those spectacularly ugly bruises I have been getting. Well, it has been over 24 hours now, and nothing. Just a little redness at the impact site, but not a trace of any bruising whatsoever. So 5 mg of that medication seems to be the ticket to get rid of that excessively easy bruising, anyway. Whether or not it is enough to do what it is supposed to do for the stents in my coronary arteries is a question yet to be answered.

Anyway, as I phrased it to my cardiologist, unless I hear otherwise, THIS is what I plan to do with that Prasugrel. Excessively easy bruising is NOT a good sign of health for anyone, and in my mind it means something bad is going on with my vascular system. It's not like doctor's never make mistakes or anything, is it?

The trouble with that is the drug might be doing nothing protective at all right now, as its intended delivery system is compromised.

Originally Posted by nickolasanastasiou

The trouble with that is the drug might be doing nothing protective at all right now, as its intended delivery system is compromised.

Well, I reached out to my cardiologist. Twice. I am having trouble coming up with a good reason why he hasn't said so to me, if that is the case.

I am still taking the 51mg of aspirin every day. That also acts as a blood thinner, doesn't it?

It helps prevent clotting, yes, but it may not be enough on its own. I am hoping your cardiologist gets back to you asap.

I would be very surprised to hear back from him over the weekend.

Meanwhile, using my Google-Foo:

If you're already using prasugrel or clopidogrel, take these precautions:

Call your doctor immediately if you notice any signs of excessive bleeding that can't be explained: severe, prolonged, or unusual bleeding; pink or brown urine; red or black stools; bruises or purple skin spots; and coughing up or vomiting blood or clots. But don't stop taking the medication without your doctor's OK.
Tell every doctor or dentist you see that you're taking the drug, especially if you're about to undergo an invasive procedure.
Use an electric razor or be extra careful when shaving.
Take prasugrel with particular caution if you're of Korean descent, because some research suggests that the drug may have a stronger effect.
If you're taking clopidogrel or a smaller than recommended dose of prasugrel, consider asking your doctor if you should be tested for adequate platelet inhibition.

And of particular interest:

Potential prasugrel users should know about another research observation: After four months, prasugrel users seemed to experience an increased risk of cancerous tumors than clopidogrel users. That may have occurred either by chance or because higher bleeding rates lead to more scrutiny and detection of cancer. The FDA did not include cancer among the risks listed in the package insert, though it briefly mentioned the possibility elsewhere. But it did order the manufacturer to continue work on another clinical trial, already under way, to assess the drug's cancer-causing potential.

Emphasis added by me.

Source: https://www.consumerreports.org/cro/...some/index.htm

While this is all on my mind, any of you who have NOT read this book really should do so:

The Real Anthony Fauci by Robert F. Kennedy Jr.

I am about half way through it and already I have to wonder why a certain someone isn't swinging by a necktie made or rope from a branch of the nearest oak tree.

Well, from my accidental experiment the other day, NO bruise resulted from that limb impacting my forearm. Just a little scab from that puncture and a little discolored from the abrasion. That large bruise I got from when I worked on the generator has pretty nearly evaporated now. What was interesting was that the bruise started out rather small and got larger over time. That is just odd, IMHO.

I noticed with the recommended dosage for Prasugrel, there are only two tablets available, 5mg and 10mg. 10mg is recommended for everyone over 132 lbs (60kg). So that means I am getting the same 10mg dose (at my current 154 lbs) as someone that weighs 300 lbs.

I have pretty much proven that the initial dose of 60mg (6 tablets) right after my second stent placement was an obvious overdose, causing me to urinate blood afterwards for about a half a day.

Prasugrel is also not recommended for patients 75 years or older. Well, I am 72, so that is darn close. I am thinking that really bad bruising is a sign that something is just not right. Wish the cardiologist would get back to me, but something tells me he is just going to state that I should continue with HIS recommended 10mg per day, as is.

As for me compromising the pill by cutting it in two? Beats me. I have yet to find online any first hand accounts of someone doing that, and/or what any specific negative results may come from it. I just need to stop that bruising i have been experiencing. It is telling me that something is WRONG in my body, and I just do not want to ignore that sign. I did read something a few nights ago where it was stated that crushing a Prasugrel tablet while taking it would speed up the delivery, but I didn't save the link, nor can I find it again. Reading through this sort of stuff is VERY dry, and a sure cure for insomnia.

Several months ago I had a sharp chest pain that I ignored and some people came down on me about it. So yeah, I had a heart attack soon afterwards. Point taken. So yes, I should have taken that advice and paid attention to that warning. Well, I think this abnormal bruising is in the same sort of category. And I am trying to NOT ignore it. Normally I just do not get bruises, at all, so this (rightfully, I think) worries me. This Prasugrel has made me feel FRAGILE. So are doctors ALWAYS correct in what they prescribe? Should I just ignore these worrisome signs and just blindly accept what my cardiologist recommended for me? Yeah, bruising is normal for this drug, but how much is "normal"? I am getting my darn muscles bruised, which will ache for weeks afterwards. For me, that is not at all normal. But is it considered acceptable as a tradeoff for the benefits of this drug?

Spent all day today with Connie at the new cancer treatment center to resume her chemo treatments. She got to use her new port that was surgically installed and that actually seemed to go very well.

Meanwhile, I got a phone message from the local Walgreen's to tell me that I had a prescription to pick up. 5mg Prasugrel tablets.