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Side Effects of
Cholinergic Agonists


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Direct thrombin inhibitors are a class of medications that work by acting as anticoagulants (agents which prevent blood clotting). Argatroban is used for thinning the blood to preventing blood clots in patients who have low platelet levels, or in patients undergoing percutaneous coronary intervention (PCI). Direct thrombin inhibitors work by blocking the enzyme called thrombin (factor II).

The subclasses are called either bivalent or univalent, depending on whether they bind to two sites (bivalent) or one site (univalent) on thrombin. The bivalent thrombin inhibitors include hirudin, bivalirudin (Angiomax), lepirudin and desirudin. The univalent thrombin inhibitors include argatroban, melagatran, and dabigatran (Pradaxa). Pradaxa helps to prevent platelets in your blood from sticking together or forming clots. Pradaxa is used to treat blood clots in the veins of your legs (deep vein thrombosis, DVT) or lungs (pulmonary embolism, or PE) and reduce the risk of them occurring again. British Journal of Clinical Pharmacology “Direct thrombin inhibitors,” Oct 2011).

Serious Side Effects

Severe bleeding is the most serious side effect of direct thrombin inhibitors such as Pradaxa, as reported by the U.S. Food and Drug Administration – Drug Safety Communication (May 2014). Major or severe bleeding may occur, and regardless of location, may lead to disabling, life-threatening or even fatal outcomes. The FDA is currently collecting information on bleeding events.

Common Side Effects

Common side effects include: sour stomach, black, tarry stools, constipation, diarrhea, heartburn, indigestion, nausea, pain or burning in the throat, stomach upset, vomiting or vomiting blood or material that looks like coffee grounds, bleeding from the bladder, blurred vision, blood in the urine, dizziness, confusion, no blood pressure or pulse, fever, sweating, stopping of the heart, unconsciousness, or unusual tiredness or weakness. British Journal of Clinical Pharmacology “Direct thrombin inhibitors,” Oct 2011).

Understand Your Risk for Side Effects with the Rxight® Genetic Test

Communication with your physician is imperative when taking direct thrombin inhibitors or any other drug for the first time. One way to possibly prevent or lessen side effects is to consider the Rxight® genetic test from MD Labs. This simple yet comprehensive test allows your physician to determine what drugs you may take safely and what drugs you should not take, all according to your genetic makeup. Hundreds of drugs across over 50 pharmacological classes in addition to DTIs are analyzed.

How Does Pharmacogenetic Testing Work?

Pharmacogenetics came out of the completion of the human genome, and is an important medical field in its own right. Pharmacogenetic research showed that individuals may have variations in their genetic makeup that is specifically geared toward drug metabolism. With the Rxight® pharmacogenetic test from MD Labs your physician will be able to determine if a particular drug may cause side effects that could be avoided by prescribing another drug, for example, or if your dose should be changed from the recommended dose.

Contributors to this Article:
Michael Sapko, MD, PhD; Deborah Kallick, PhD, Medicinal Chemistry

Cholinergic Agonists Tested Include:

  • Cevimeline (Evoxac)
  • Tolterodine (Detrol)

Read more about Rxight® Genetic Testing For Medication Effectiveness