Rivaroxaban

Sounds like 'RIV-a-ROX-a-ban'

Rivaroxaban is an anticoagulant. It is used to treat and prevent clots in your blood. Find out how to take it safely and possible side effects. Rivaroxaban is also called Xarelto.

What is rivaroxaban?

Rivaroxaban is an anticoagulantAnticoagulants are often referred to as ‘blood thinners’ but they actually 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.

When is rivaroxaban used?

  • If you have atrial fibrillation (irregular heart beat), which increases your risk of stroke. Read more about atrial fibrillation and stroke.
  • 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: 

Dose

  • Rivaroxaban tablets are available in different strengths: 10 mg, 15 mg and 20 mg.
  • Your doctor or pharmacist will tell you the strength that is right for you. 
  • Your dose of rivaroxaban will depend on what it is being used for.
Dose of rivaroxaban

To prevent stroke in people with atrial fibrillation 20 mg once a day
To prevent clots after knee or hip surgery 10 mg once a day
To treat and prevent recurrent DVT or PE 15 mg 2 times a day for 3 weeks, and then 20 mg once a day
  • Your dose may be lower if you have other health conditions such kidney problems.
  • If you have had knee or hip surgery, you will need to take rivaroxaban for 2–5 weeks.
  • If you are taking it for other reasons, you will need to take it for longer.
  • Don't stop taking rivaroxaban until your doctor tells you to.
  • Stopping too early can put you at greater risk of getting blood clots or stroke. 

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.  

How to take rivaroxaban

  • Know your tablet strength: Rivaroxaban tablets are available in different strengths: 10 mg, 15 mg and 20 mg. If you are not sure which tablet strength you are 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 2 TIMES 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.  
  • Tell your healthcare provider: It is important to let health professionals know that you are taking rivaroxaban, such as your dentist, pharmacist, surgeon, podiatrist or nurse. You may need to stop using this medicine for several days before having surgery, dental appointments or medical tests.

Testing and monitoring

When you first start taking rivaroxaban, you will need blood tests to check how well your kidneys and liver are working.

  • This will help your doctor make sure it is safe for you and the dose is correct.
  • Regular blood testing to check the level of rivaroxaban is not needed.

Precautions before starting rivaroxaban

  • Do you have stomach problems such as an ulcer?
  • Are pregnant, planning to become pregnant or breastfeeding?
  • Have you have had any surgery recently (other than hip or knee surgery)?
  • Do you have high blood pressure (hypertension)?
  • Do you have any medical problems that may increase your risk of bleeding?
  • Do you have problems with the blood vessels in your eyes (known as vascular retinopathy)?
  • Do have any problems with your liver or kidneys?
  • Do you have a long-term lung condition called bronchiectasis?
  • Are you taking any other medicines? Tell your doctor or pharmacist about any medicines you are taking (including over the counter medicines), herbal and complementary medicines.

If so, it’s important that you tell your doctor or pharmacist before you start rivaroxaban. Sometimes a medicine isn’t suitable for a person with certain conditions, or it can only be used with extra care.

What are the side effects of rivaroxaban?

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 troublesome.

Increased risk of bleeding

Taking rivaroxaban means that blood takes longer to form clots, and this can increase your risk of bleeding. The benefits of using anticoagulants usually outweigh the risks of bleeding and your doctor will consider this before starting treatment.

You might bleed or bruise more easily while you are 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. 

Did you know that you can report a side effect to a medicine to CARM (Centre for Adverse Reactions Monitoring)? Report a side effect to a product


Signs of severe bleeding

If you have any of the following signs of bleeding, contact your doctor immediately or phone Healthline on 0800 611 116 for free 24-hour advice:

  • become pale, very weak and tired, or short of breath
  • any bleeding from your gums
  • cuts or nosebleeds that won’t stop (longer than 10 minutes)
  • 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 or vomit that looks like coffee grounds.

Interactions with other medicines

Rivaroxaban should not be taken with some other medicines and herbal supplements. Tell your doctor or pharmacist about all medicines you are taking (including over-the-counter medicines), herbal and complementary medicines or recreational drugs. Your doctor or pharmacist will be able to check for any interactions. 

The following may increase your risk of bleeding and should be avoided:

  • over-the-counter anti-inflammatories such as diclofenac (eg, Voltaren Rapid), ibuprofen (eg, Nurofen), naproxen (eg, Naprogesic)
  • herbal extracts such as garlic, ginkgo or ginseng.

If you are already taking other medicines that act on your blood, such as aspirin or clopidogrel, ask your doctor about the use of these with rivaroxaban. Sometimes the combination can be dangerous.

Learn more

The following links provide further information on rivaroxaban. Be aware that websites from other countries may contain information that differs from New Zealand recommendations.

Rivaroxaban (te reo Māori) NZ Formulary Patient Information
Xarelto® Medsafe Consumer Information Sheet, NZ
Rivaroxaban Patient Info, UK

References

  1. Rivaroxaban: a fully-subsidised oral anticoagulant. BPAC, NZ, 2018
  2. An update on managing patients with atrial fibrillation BPAC, NZ, 2017
  3. Rivaroxaban NZ Formulary

Additional resources for healthcare professionals

Oral anticoagulants NZ Formulary
Xarelto® Medsafe, NZ
Anticoagulation update PHARMAC, NZ, 2018

Credits: Sandra Ponen, Pharmacist. Reviewed By: Maya Patel, Pharmacist, Auckland Last reviewed: 07 Oct 2021