Rivaroxaban

Rivaroxaban can be taken by adults aged 18 and over.

Rivaroxaban is not suitable for some people. Tell your doctor if you:

• have had an allergic reaction to rivaroxaban or any other medicines in the past
• are trying to get pregnant or you are already pregnant – rivaroxaban can be harmful to your baby
• have liver problems
• are taking any other medicines that affect blood clotting, such as warfarin
• Have any injuries that are currently bleeding a lot (such as a wound or a stomach ulcer), are taking the herbal remedy St John’s wort (often taken for depression).
• have antiphospholipid syndrome, a condition that affects the immune system and makes you more likely to get blood clots

 

Pregnancy and breastfeeding

Rivaroxaban is not normally recommended during pregnancy or while breastfeeding.

Important advice– Tell your doctor if you are trying to get pregnant, are already pregnant or breastfeeding.

It is very important to take Rivaroxaban as your doctor has told you.

It is usual to take it once a day just after you have eaten a meal or snack.

It is important to take Rivaroxaban with some food to help your body absorb the whole dose. Try to take it at the same time every day.

People who are taking Rivaroxaban to treat DVT or a pulmonary embolism may need to take it twice a day for the first few weeks. Your doctor will tell you if you need to do this.

If you have trouble swallowing pills, speak to your doctor or pharmacist.

You can crush Rivaroxaban tablets and mix them with water or apple purée. Swallow this mixture, then eat some food straight away.

 

How much will I take?

Your dose of Rivaroxaban depends on why you are taking it:

• For people with a heart condition called atrial fibrillation – the usual dose is 20mg a day. But your doctor might prescribe a lower dose if you have kidney disease and are at a higher risk of bleeding.
• For people who have had a blood clot (DVT or pulmonary embolism) – the usual dose is 20mg a day. You might need to take a dose of 15mg twice a day for the first few weeks of taking rivaroxaban. If you have kidney disease and are at a higher risk of bleeding, your doctor may prescribe a lower dose.
• For people who have had an operation to replace a hip or knee joint – the usual dose is 10mg a day.
• For people who have had a heart attack or have a heart condition called unstable angina – the usual dose is 2.5mg twice a day.

If you are unsure what dose you need to take, check with your doctor or pharmacist.

 

What if I forget to take it?

What you need to do depends on the dose you normally take.

• If you normally take 10mg, 15mg or 20mg once a day – take a dose as soon as you remember, unless it is nearly time for your next one. Take your next dose at the usual time and then carry on as normal. Never take more than 1 dose in a single day.
• If you normally take 15mg twice a day – take a dose as soon as you remember. You can take 2 x 15mg tablets at the same time to get a total of 2 doses in 1 day. Never take more than 2 doses in 1 day.
• If you normally take 2.5mg twice a day – take a dose as soon as you remember, unless it is nearly time for your next one. Do not take a double dose to make up for a missed one. Take your next dose at the usual time, and then carry on as normal.

It is very important that you remember to take rivaroxaban every day. If you forget doses often, it may help to set an alarm to remind you.

You could also ask your pharmacist for advice on other ways to help you remember to take your medicine. If you are worried, contact your doctor or pharmacist.

What if I take too much?

Ask your doctor or pharmacist for advice straight away, as overdose puts you at risk of bleeding.

 

How long will I take it for?

How long you need to take rivaroxaban will depend on why you are taking it.

If you have had an operation to replace your knee or hip joint, you will probably take rivaroxaban for 2 to 5 weeks.

If you have had a blood clot (DVT or pulmonary embolism), you will normally take rivaroxaban for at least 3 months. Depending on what caused the blood clot, you might need to take it for longer.

If you have a heart problem like atrial fibrillation or have had a heart attack, you might need to take rivaroxaban long term or even for the rest of your life.

While you are taking rivaroxaban, be careful when you do activities that might cause an injury or a cut or bruising.

Occasionally, you can have serious bleeding from taking rivaroxaban.

This can be dangerous and needs urgent medical attention.

Contact your doctor or go to the hospital straight away if:

• you have red pee or black poo
• you get bruises that happen for no reason, or bruises that are larger than you would expect or keep growing in size
• you get nosebleeds that last longer than 10 minutes
• you have blood in your vomit or you are coughing up blood
• you get severe headaches
• you have any bleeding from a cut or injury that will not stop or slow down

These are symptoms of serious bleeding.

If you experience serious bleeding, stop taking Rivaroxaban.

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

Very rarely, Rivaroxaban can lead to bleeding in the brain. This can cause a very severe headache, fits (seizures), changes to your eyesight, numbness or tingling in your arms or legs, and make you feel very tired, weak or sick.

If you suddenly get any of these symptoms, contact your doctor immediately. This is an emergency.

 

Common side effects

These common side effects happen in more than 1 in 100 people.

They are usually mild and do not last long, but talk to your doctor or pharmacist if these side effects bother you or do not go away:

• tiredness and lack of energy, shortness of breath, noticeable heartbeats (heart palpitations) and pale skin – these can be signs of anaemia 
• feeling dizzy or lightheaded
• a mild rash
• feeling or being sick (nausea or vomiting)

 

Serious allergic reaction

In rare cases, Rivaroxaban can cause a serious allergic reaction (anaphylaxis)

• You get a skin rash that may include itchy, red, swollen, blistered or peeling skin
• You are wheezing
• You get tightness in the chest or throat
• You have trouble breathing or talking
• Your mouth, face, lips, tongue, or throat start swelling.

These symptoms suggest you could be having a serious allergic reaction and may need immediate treatment in the hospital.

These are not all the side effects of Rivaroxaban.

For a full list, see the leaflet inside your medicines packet.

 

How to cope with side effects

What to do about:

• signs of anaemia – talk to your doctor, who may arrange a blood test.

• feeling dizzy or lightheaded – if rivaroxaban makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so you do not faint, then sit until you feel better. If the dizziness does not go away or keeps happening, speak to your doctor. They may arrange a blood test to see if you have anaemia.

• a mild rash – it may help to take an antihistamine, which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you. If the rash does not go away within a few days, speak to your doctor.

• feeling or being sick (nausea or vomiting) – stick to simple meals and do not eat rich or spicy food. If you are vomiting, try having small, frequent sips of water to avoid dehydration.

 

Cautions with other medicines

Some medicines and supplements can interfere with rivaroxaban.

This can lead to serious side effects. Tell your doctor if you are taking these medicines before starting rivaroxaban:

• any other anticoagulant, such as warfarin or enoxaparin
• drugs to treat fungal or bacterial infections, such as fluconazole, erythromycin or clarithromycin
• drugs to treat HIV, such as ritonavir
• drugs to treat epilepsy, such as carbamazepine or phenytoin
• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin

 

Can I take Rivaroxaban with everyday painkillers?

You can take paracetamol while you are taking rivaroxaban.

Do not take aspirin or ibuprofen while you are taking rivaroxaban unless a doctor has said it is okay to. They increase the chance of bleeding.

 

Mixing Rivaroxaban with herbal remedies and supplements

Do not take St John’s wort, the herbal remedy for depression, while you are taking rivaroxaban.

It can increase your risk of side effects.

Important

Tell your doctor or pharmacist if you are taking any other medicines, including herbal remedies, vitamins or supplements.

How does Rivaroxaban work?

Rivaroxaban is a type of medicine known as an anticoagulant. It makes your blood clot more slowly.

Blood clotting (thickening) is a complicated process involving substances called clotting factors.

Clotting factors are made by the liver and help stop bleeding. They work with blood cells called platelets that trigger the clotting process to make sure your blood clots properly.

Rivaroxaban works by stopping a clotting factor called factor Xa from working. This thins your blood so it takes longer to clot.

 

How long does it take to work?

Rivaroxaban works within a few hours of taking it.

 

Is it safe to take it for a long time?

Rivaroxaban is safe to take for a long time.

There do not seem to be any lasting harmful effects from taking it for many months and years.

 

What will happen if I stop taking it?

Do not stop taking rivaroxaban without talking to your doctor.

If you stop taking rivaroxaban, the rate at which your blood clots will return to what it was before you started taking it, usually within a day or two of stopping.

This means you may be at increased risk of serious problems like strokes, heart attacks, DVT or pulmonary embolism.

 

Are there any other similar medicines?

There are several other anticoagulants available as tablets or capsules.

They include apixaban, dabigatran, edoxaban and warfarin.

There are also anticoagulants that you take by injecting them. These include heparin, enoxaparin, dalteparin and tinzaparin.

Not all medicines that prevent blood clots are suitable for everyone.

Talk to your doctor or pharmacist to find out why you have been recommended a particular medicine.

 

Can I drink alcohol with it?

You can drink alcohol while taking rivaroxaban as long as you stick to the guidelines of no more than 14 units a week for men and women.

A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.

Drinking heavily, especially binge drinking lots of alcohol in one go, is dangerous while taking rivaroxaban.

The alcohol can increase rivaroxaban’s effect and make you more likely to bleed.

 

Is there any food or drink I need to avoid?

There are no foods or drinks you need to avoid while taking rivaroxaban.

 

Will I need to stop rivaroxaban before surgery?

Because of the risk of bleeding, your dose of rivaroxaban may need to be lowered or stopped a few days before you have an operation.

Tell the surgeon that you are taking rivaroxaban and show them your anticoagulant alert card.

 

Will I need to stop rivaroxaban before dental treatment?

You can still go to your dentist as usual. But tell your dentist that you are taking rivaroxaban, and show them your anticoagulant alert card, before you have any treatment. This is especially important if you need to have a tooth out.

Most people do not need to change their rivaroxaban dose, but your dentist may contact your doctor for advice before starting the dental treatment.

 

Can I have vaccinations?

You can have vaccinations while taking rivaroxaban. Before you have them, be sure to show your anticoagulant alert card to the nurse or doctor.

It is important to tell them that you are taking rivaroxaban.

 

Will it affect my contraception?

Rivaroxaban does not affect any type of contraception, including the combined pill and emergency contraception.

 

Will it affect my fertility?

There is no firm evidence to suggest that taking rivaroxaban will reduce fertility in either men or women. But talk to your doctor first if you are a woman and trying to get pregnant.

This medicine is not usually recommended in pregnancy.

 

Can I drive or ride a bike?

Most people can drive or ride a bike while taking rivaroxaban. But if taking rivaroxaban makes you feel dizzy or lightheaded, do not drive or cycle until it goes away.

 

Can I have a tattoo or piercing?

It is not usually recommended to have a body piercing or tattoo while you are taking rivaroxaban because of the increased risk of bleeding and infection.

If you still want to go ahead, talk to your doctor about your specific risks in case you need antibiotics.

And let the tattooist or piercer know beforehand that you’re taking a blood-thinning medicine.

 

Can I take recreational drugs with it?

It is thought that cannabis can increase your risk of serious bleeding.

It is not clear how other recreational drugs like cocaine and heroin affect rivaroxaban. They could be potentially dangerous.

 

Can lifestyle changes help?

You can reduce your risk of having a blood clot by making changes to your lifestyle, such as:

• not smoking
•  eating well
• getting regular exercise 
• keeping to a healthy weight or losing weight if you need to