Xarelto

    Xarelto (rivaroxaban) Dosage and Side Effects

    XARELTO is used for:

    • Prevention of blood clots after major hip or knee surgery
    • Prevention of blood clots in your brain (stroke) and in other blood vessels in your body if you have atrial fibrillation
    • Treatment and prevention of blood clots in the veins of your legs or lungs

    Warnings and Precautions

    Do not stop taking XARELTO without first talking to your doctor. If you stop taking XARELTO, blood clots may cause a stroke or other complications. This can be fatal or lead to severe disability.

    As with other blood thinners, taking XARELTO may result in serious or life-threatening bleeding from any site, including internal organs.

    Take special care when using XARELTO:

    • if you have an increased risk of bleeding, as could be the case with conditions such as
      • bleeding disorders
      • very high blood pressure, not controlled by medical treatment
      • active ulcer or a recent ulcer of your stomach or bowel
      • a problem with the blood vessels in the back of your eyes (retinopathy)
      • recent bleeding in your brain (stroke, intracranial or intracerebral bleeding) problems with the blood vessels in your brain or spinal column
      • problems with the blood vessels in your brain or spinal column
      • a recent operation on your brain, spinal column or eye
      • a chronic disease of the airways in your lungs causing widening, damage and scarring (bronchiectasis), or a history of bleeding into your lungs
      • if you are older than 75 years of age

    For the treatment and prevention of blood clots in the veins of your legs or lungs, XARELTO is not recommended if your doctor determines that:

    • you are not able to maintain an adequate blood pressure
    • you are taking drugs to break down your blood clots
    • you have been scheduled for emergency surgical removal of blood clots from your lung

    Tell your doctor before you take XARELTO, if any of these apply to you. Your doctor may decide to keep you under closer observation.

    • If you are having surgery for any reason including an operation that involves a catheter or injection into your spinal column (e.g., for epidural or spinal anesthesia or pain reduction):
      • it is very important to take XARELTO before and after the procedure/injection or removal of a catheter exactly at the times you have been told by your doctor
      • tell your doctor immediately if you get numbness or weakness of your legs, or problems with your bowel or bladder after the end of anesthesia, because urgent care is necessary

    Lactose is a nonmedicinal ingredient in XARELTO. Do not take XARELTO if a doctor has told you that you have one of the following rare hereditary diseases:

    • Galactose intolerance
    • Lapp lactase deficiency
    • Glucose-galactose malabsorption

    XARELTO is not recommended if you have severe kidney disease. Your doctor will know how to determine your kidney function.

    XARELTO is not recommended if you have an artificial heart valve.

    XARELTO is not recommended in children younger than 18 years old.

    Pregnancy and breastfeeding:

    If there is a chance that you could become pregnant, use a reliable contraceptive while you are taking XARELTO. If you become pregnant while you are taking XARELTO, immediately tell your doctor, who will decide how you should be treated.

    Side Effects

    Like all medicines, XARELTO can cause side effects, although not everybody gets them.

    As XARELTO acts on the blood clotting system, most side effects are related to signs of bruising or bleeding. In some cases bleeding may not be obvious, such as unexplained swelling.

    Patients treated with XARELTO may also experience the following side effects:

    Nausea, vomiting, stomach ache, constipation, diarrhea, indigestion, and decreased general strength and energy.

    Interactions with this medication

    Tell your doctor or pharmacist if you are taking:

    • anticoagulants (blood thinners) such as warfarin, heparin or low molecular weight heparin (LMWH) including enoxaparin, fondaparinux, bivalirudin, apixaban, dabigatran, or antiplatelet agents, such as clopidogrel, ticlopidine, prasugrel, ticagrelor
    • oral medications to treat fungal infections such as ketoconazole, itraconazole, posaconazole
    • medications for HIV/AIDS such as ritonavir [NORVIR] and lopinavir/ritonavir [KALETRA]
    • anti-inflammatory and pain relieving medicines including nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., naproxen [NAPROSYN] or acetylsalicylic acid [ASPIRIN])
    • some antibiotics such as clarithromycin
    • rifampicin
    • anticonvulsants (to control seizures or fits) such as phenytoin, carbamazepine, phenobarbital

    If you take XARELTO with NSAIDs or antiplatelet agents such as ASA or clopidogrel you are at an increased risk for bleeding. The use of XARELTO with prasugrel or ticagrelor is not recommended.

    Please tell your doctor or pharmacist if you are taking or have recently taken any other medication, including medications obtained without a prescription as well as vitamins and herbal supplements, such as St. John's Wort. Know the medicines you take. Keep a list of them and show it to your doctor and pharmacist when you get a new medicine.

    Proper Use of this medication

    If you are currently taking warfarin (another blood thinner taken by mouth) or receive other anticoagulant treatment given by injection, and your doctor has decided XARELTO is appropriate for you, make sure you ask your doctor exactly when and how best to switch and start taking XARELTO.

    Always follow your doctor's instructions. Do not stop taking XARELTO without talking to your doctor first, because XARELTO helps prevent the development of blood clots.

    Swallow the tablet preferably with water. Try to take the tablet at the same time every day to help you to remember it.

    Prevention of blood clots after major hip or knee surgery:

    Usual dose: 10 mg once a day with or without food.

    Take the first tablet 6 to 10 hours after your operation. Then take a tablet every day until your doctor tells you to stop.

    If you have had a major hip operation, you will usually take XARELTO for 35 days.

    If you have had a major knee operation, you will usually take XARELTO for 14 days.

    Prevention of blood clots in your brain (stroke) and in other blood vessels in your body if you have atrial fibrillation:

    Usual dose: 20 mg once a day with food.

    To be sure that you get the full benefit from XARELTO, it is important to take the 20 mg tablets with food.

    If your kidneys are not working properly, your doctor may prescribe 15 mg once a day with food.

    To be sure that you get the full benefit from XARELTO, it is important to take the 15 mg tablets with food.

    This is long-term treatment and you should continue to take XARELTO until your physician says otherwise.

    The recommended maximum daily dose is 20 mg.

    Treatment and prevention of blood clots in the veins of your legs or lungs:

    Day 1 to 21: 15 mg, 1 tablet twice a day (one 15 mg tablet in the morning and one in the evening) with food.

    From Day 22 onwards: 20 mg, 1 tablet once a day with food.

    This is long-term treatment and you should continue to take XARELTO until your physician says otherwise.

    Swallow the tablet preferably with water.

    Overdose:

    Taking too much XARELTO increases the risk of bleeding.

    In case of drug overdose, contact a health care practitioner, hospital emergency department or regional Poison Control Centre immediately, even if there are no symptoms.

    Missed dose:

    If you are prescribed XARELTO 10 mg, 15 mg or 20 mg once a day and you have missed a dose, take it as soon as you remember. Take the next tablet on the following day at the usual time and then carry on taking a tablet once a day as normal. Do not take a double dose to make up for a forgotten tablet.

    If you are prescribed XARELTO 15 mg twice a day and you have missed a dose, take it as soon as you remember. Do not take more than two 15 mg tablets on one day. If you forget to take a dose you can take two 15 mg tablets at the same time to get a total of two tablets (30 mg) on one day. On the following day you should carry on taking one 15 mg tablet twice a day.

    Other related products

    The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.