XARELTO (Rivaroxaban)

What is this medication?

XARELTO (Rivaroxaban)
Direct oral anticoagulant; Factor Xa Inhibitor

XARELTO (Rivaroxaban) is officially indicated for atrial fibrillation, coronary artery disease, or peripheral artery disease.  It is also prescribed off-label for heparin induced thrombocytopenia, superficial vein thrombosis, venous thromboembolism, deep vein thrombosis, or pulmonary embolism. 

ALERT: WARNING
Premature discontinuation increases the risk of thrombotic events:
Premature discontinuation of any oral anticoagulant, including rivaroxaban, increases the risk of thrombotic events. If anticoagulation with rivaroxaban is discontinued for a reason other than pathological bleeding or completion of a course of therapy, consider coverage with another anticoagulant.

Spinal/Epidural hematomas:
Epidural or spinal hematomas have occurred in patients treated with rivaroxaban who are receiving neuraxial anesthesia or undergoing spinal puncture. These hematomas may result in long-term or permanent paralysis. Consider these risks when scheduling patients for spinal procedures. Factors that can increase the risk of developing epidural or spinal hematomas in these patients include use of indwelling epidural catheters; concomitant use of other drugs that affect hemostasis, such as nonsteroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors, or other anticoagulants; a history of traumatic or repeated epidural or spinal punctures; or a history of spinal deformity or spinal surgery. The optimal timing between the administration of rivaroxaban and neuraxial procedures is not known.

Monitor patients frequently for signs and symptoms of neurological impairment. If neurological compromise is noted, urgent treatment is necessary.

Consider the benefits and risks before neuraxial intervention in patients who are anti-coagulated or are to be anti-coagulated for thromboprophylaxis.

How does this medication work? 

XARELTO (Rivaroxaban) reversibly inhibits factor Xa which is responsible for catalyzing the conversion of prothrombin to thrombin as part of both the intrinsic and extrinsic coagulation pathways.  Thrombin activates platelets and catalyzes the conversion of fibrinogen to fibrin.  Blocking factor Xa thereby results in inhibited platelet activation and fibrin clot formation.

How should I take this medication? 

Oral: Take 2.5-20mg once or twice daily depending on the condition it is being used for.

How to Take: Follow instructions provided by physician/pharmacy label, take consistently at same times each day unless otherwise directed.  Doses greater than or equal to 15mg should be taken with food, doses lower than this could be with or without.

Note: Do not stop this medication suddenly or without involvement of your physician.  Prematurely stopping this medication can cause increased risk of a thrombotic event such as stroke so generally if changing medications, a bridging schedule is required.  If the medication is to be discontinued follow your physician’s instructions, the exception to this is if a major bleed is occurring in which case it must be stopped immediately, and emergency medical attention is required.  If a dosage is missed the general recommendation is to take the dosage as soon as you remember and then to continue your normal dosing schedule the following day.   Confirm with your physician if you are wanting to use any NSAIDs such as ibuprofen, ASA, or naproxen.  Do not self-select over the counter items such as these without asking a medical professional due to risk of ulceration and a severe hemorrhage.

What should I watch for while using this medication?

Before starting XARELTO (Rivaroxaban), make sure your physician is aware of any allergies or medications you currently take, if you have kidney disease, if you have liver disease, if you have valvular disease, if you have had bariatric surgery, if you have a bleeding disorder or active pathological bleed (such as an ulcer), or if you are pregnant or breastfeeding.

What if I miss a dose?

If you miss a dose of medication, try to take it as soon as possible. However, if it is almost time for your next dose, take only that scheduled dose. Do not take double or extra doses.

How should I store this medication?

Keep out of the reach of children at all times. Store at room temperature, 59 to 86° F (15 to 30° C). Protect from light. Keep the container tightly closed.  Properly dispose of any unused medication after the expiration date.

What are the possible side effects of using this medication? 

The main side effects are bruising and hemorrhage (bleeding) both minor and major.  Patient should monitor for weakness, dizziness, unexplained edema, black tarlike stool, what appears to be coffee grounds in vomit, major unexplained bruising, minor cuts that do not stop bleeding, blood when brushing teeth etc.  These are signs of over anticoagulation or an internal bleed in which case immediate medical attention is required.

Note this is not a complete list of side effects for XARELTO (Rivaroxaban), only common ones.