Rivaroxaban

Sounds like 'ri-va-rox-ah-ban'

Key points about rivaroxaban

  • Rivaroxaban is used to prevent blood clots from forming and stop existing clots from growing bigger.
  • It’s used for conditions including deep vein thrombosis (DVT), pulmonary embolism (PE) and atrial fibrillation (to prevent stroke). It’s also used to prevent DVT and PE after hip or knee surgery.
  • Rivaroxaban is also called Xarelto.
  • Find out how to take it safely and possible side effects.
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Rivaroxaban belongs to a group of medicines called anticoagulants. Anticoagulants work by interrupting the clot-forming process and increasing the time it takes for blood clots to form. This helps prevent blood clots from forming and stops existing clots from growing bigger. Read more about anticoagulants

When is rivaroxaban used?

  • For people with atrial fibrillation, because atrial fibrillation increases the risk of stroke. A stroke happens when a blood clot forms in your heart and travels to your brain (usually due to an irregular heart rhythm known as atrial fibrillation atrial fibrillation).
  • After hip or knee surgery when your risk of blood clots is increased.
  • To treat and prevent recurrent deep vein thrombosis (DVT) or pulmonary embolism. Read more about DVT and pulmonary embolism.

The following video from the Bay of Plenty DHB is about the use of rivaroxaban in atrial fibrillation.

Video: Rivaroxaban for use in AF

 


(Bay of Plenty DHB, NZ)

  • In Aotearoa New Zealand rivaroxaban comes as tablets which are available in different strengths: 10 mg, 15 mg and 20 mg.
  • Your dose of rivaroxaban will depend on what it's being used for.
  • Your doctor or pharmacist will tell you the strength that's right for you.
  • How long you will need to take rivaroxaban for will depend on why you're taking it. Some people only need it for a few weeks (eg, after surgery), or for a few months (eg, for deep vein thrombosis). Others may need to take it for the rest of their lives (people with atrial fibrillation).
  • Always take your rivaroxaban exactly as your doctor has told you. The pharmacy label will tell you how much rivaroxaban to take, how often to take it and any special instructions.

  • Know your tablet strength: Rivaroxaban tablets are available in different strengths: 10 mg, 15 mg and 20 mg. If you're not sure which tablet strength you're taking, ask your pharmacist.
  • Timing: Take your rivaroxaban dose at the same times each day. Rivaroxaban is best taken with food. If you are taking 10 mg once daily, you can take the tablet with or without food.    
  • Swallow your tablets with a glass of water: If you can't swallow the tablet, you can crush it and mix it with a little water or apple puree, just before taking it.
  • Missed dose: Missing doses increases your risk of getting blood clots. If you forget to take your dose, follow these instructions or contact your pharmacist or doctor.
    • If you're taking rivaroxaban ONCE A DAY: Take the missed dose as soon as you remember on the same day. 
    • If you're taking rivaroxaban TWICE A DAYTake the missed dose as soon as you remember. If needed, you can take your first dose with your second dose of the day. Continue your regular dose twice daily the next day.  

When taking rivaroxaban, it's important to use the medicine safely and correctly. The benefits of rivaroxaban need to be carefully balanced with possible side effects. Not enough anticoagulation can lead to a blood clot or stroke, but too much anticoagulation can lead to serious bleeding.

Here are some things to know when you're taking rivaroxaban. Other things may be important as well, so ask your healthcare provider what you should know about.

  • Rivaroxaban increases your risk of bleeding: Avoid contact sports, tattoos, piercings and deep massage. It's also important to look out for signs of bleeding and report them to your healthcare provider. Signs include bleeding gums, red or black bowel motions (poo) and if you'ree bruising easily.
  • Avoid injury: To reduce your risk of severe bleeding, avoid cuts and grazes by taking care when brushing your teeth (use a soft toothbrush) and shaving (consider using an electric razor) and protecting yourself when gardening, sewing or playing sports. You may be advised to avoid contact sports because of the risk of excessive bleeding.
  • Tell all healthcare providers that you're taking rivaroxaban (eg, your doctor, dentist, pharmacist or podiatrist). You may need to stop taking your anticoagulant before surgery, dental care and some tests.
  • Other medicines: Rivaroxaban can interact with some medicines and herbal supplements, so check with your doctor or pharmacist before starting rivaroxaban and before starting any new products. This includes over-the-counter anti-inflammatories including diclofenac (eg, Voltaren Rapid), ibuprofen (eg, Nurofen) and naproxen (eg, Naprogesic).
  • Pregnancy: Rivaroxaban isn’t given to pregnant women. If you're taking it and could become pregnant, you should make sure you use contraception. If you're on rivaroxaban and find out you're pregnant (or you're planning a pregnancy) talk to your doctor or anticoagulant clinic about stopping or changing your prescription.

Like all medicines, rivaroxaban can cause side effects, although not everyone gets them.

Common side effects include nausea (feeling sick), indigestion, tummy cramps and headache. These may go away with time. Tell your doctor if they bother you. 

You might bleed or bruise more easily while you're taking rivaroxaban.

  • Be careful when shaving, clipping fingernails, brushing and flossing your teeth, or playing sports.
  • Avoid new tattoos and piercings as these can cause bruising and bleeding.
  • If you have a fall or hurt your head or body, get medical attention immediately, even if you feel okay.
  • Some types of bleeding are more serious than others. If bleeding concerns you, is heavier than usual or takes an unusually long time to stop, you should talk to your healthcare provider quickly.

Signs of severe bleeding

Contact your healthcare provider urgently if you have any of the following signs of bleeding:

  • Becoming pale, very weak and tired, or short of breath.
  • Any bleeding from your gums.
  • Cuts or nosebleeds that won’t stop.
  • Blood in your stools (poo) – black, tarry stools.
  • Blood in your urine (pee) – pink, red or brown-coloured urine.
  • Heavy periods (menstrual bleeding).
  • Coughing up blood.
  • Vomiting up something that looks like coffee grounds.

Brochures

rivaroxaban factsheet

Rivaroxaban factsheet

Healthify He Puna Waiora and PHARMAC, NZ, 2020

5 questions to ask about your medications

5 questions to ask about your medications

Health Quality and Safety Commission, NZ, 2019

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Credits: Sandra Ponen, Pharmacist, Healthify He Puna Waiora. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Angela Lambie, Pharmacist, Auckland

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