Rivaroxaban, are you taking it right?

Author: Zhao Xia Xuanwu Hospital, Capital Medical University

Reviewer: Xia Jinggang, Chief Physician, Xuanwu Hospital, Capital Medical University

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Rivaroxaban is a new oral anticoagulant that can block the activity of coagulation factor Xa, thereby inhibiting the formation and development of blood clots.

What does rivaroxaban do?

1. For use in adult patients with non-valvular atrial fibrillation who have one or more risk factors, such as congestive heart failure, hypertension, age ≥75 years, diabetes, history of stroke or transient ischemic attack, to reduce the risk of stroke and systemic embolism.

2. For the treatment of deep vein thrombosis and pulmonary embolism in adults, in patients whose risk of recurrence of deep vein thrombosis and/or pulmonary embolism persists after completing at least 6 months of initial treatment, to reduce the risk of recurrence of deep vein thrombosis and pulmonary embolism.

3. For use in adult patients undergoing elective hip or knee replacement surgery to prevent venous thrombosis.

What are the advantages of rivaroxaban?

First , rivaroxaban does not require routine coagulation monitoring and dose adjustment, which can reduce the inconvenience of repeated blood draws and medical costs for patients.

Secondly , rivaroxaban has fewer interactions with other drugs and is not affected by food. Therefore, it can be taken with food or on an empty stomach or after a meal.

Third , rivaroxaban has a lower risk of bleeding, especially intracranial and fatal bleeding, compared with warfarin.

How should rivaroxaban be taken?

Rivaroxaban is available in three dosage forms: 10 mg, 15 mg and 20 mg, and the dosage required for different diseases is different.

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1. For adult patients with non-valvular atrial fibrillation to reduce the risk of stroke and systemic embolism: The recommended dose is 20 mg once a day, which is also the maximum recommended dose. For low-weight and elderly patients (>75 years old), the physician may use 15 mg once a day at the discretion of the patient. When the benefits of rivaroxaban in preventing stroke and systemic embolism outweigh the risk of bleeding, long-term treatment should be given.

2. Treatment of deep vein thrombosis and reduction of the risk of recurrence of acute deep vein thrombosis and pulmonary embolism: The recommended dose for the initial treatment of acute deep vein thrombosis is 15 mg twice a day for the first three weeks. The dose for maintenance treatment and to reduce the risk of recurrence of deep vein thrombosis and pulmonary embolism is 20 mg once a day. The duration of treatment is determined based on individual circumstances.

3. Prevention of venous thrombosis in adult patients undergoing elective hip or knee replacement surgery: The recommended dose is 10 mg of rivaroxaban taken orally once a day. If the wound has stopped bleeding, the first dose should be between 6 and 10 hours after surgery. For patients undergoing major hip surgery, the recommended course of treatment is 35 days. For patients undergoing major knee surgery, the recommended course of treatment is 12 days.

Is rivaroxaban affected by diet?

10mg specification : Drug absorption is not affected by diet, rivaroxaban is almost completely absorbed, and the bioavailability is 80%~100%.

15mg and 20mg specifications : Drug absorption is affected by diet. The bioavailability of the drug on an empty stomach is 66%, and the bioavailability can be as high as 100% when taken with a meal. Food can promote drug absorption and it needs to be taken with food. Compared with taking the drug on an empty stomach, the bioavailability of the drug on a full stomach increases by 39% and the peak concentration increases by 76%.

Key points: Rivaroxaban 10 mg can be taken before, during or after meals, while 15 mg and 20 mg must be taken with food.

How do patients who cannot swallow medicine take medicine?

1. Crush rivaroxaban before taking the medicine, mix it with water or applesauce and take it orally immediately. Eat immediately after taking the crushed 15mg or 20mg rivaroxaban.

2. For patients with indwelling gastric tubes, first determine the position of the gastric tube in the stomach, then crush rivaroxaban, mix it with 50 ml of water, and administer it through the gastric tube using a syringe. Immediately after administering the crushed 15 mg or 20 mg rivaroxaban, food should be given through enteral nutrition.

3. Crushed 10 mg, 15 mg, and 20 mg rivaroxaban tablets are stable in water or applesauce for up to 4 hours.

What should I do if I miss a dose of rivaroxaban?

1. If you miss a dose during the period of taking the medicine once a day, please take the daily dose of rivaroxaban immediately; continue to take the medicine once a day according to the previous dose the next day; do not double the dose within a day to make up for the missed dose. For example, if you usually take rivaroxaban 10mg once a day, you should take 10mg immediately after missing a dose on that day, and continue to take 10mg once a day the next day.

2. If you miss a dose during the two-time daily dose period, please take the daily dose of rivaroxaban immediately to ensure that you take the daily dose. For example, if you usually take rivaroxaban 15mg each time, twice a day, that is, a total of 30mg per day, take rivaroxaban immediately after you miss a dose on that day to ensure that the daily dose is 30mg, and continue to take 15mg each time, twice a day the next day.

While taking rivaroxaban, you also need to pay attention to the following:

1. Depending on different diseases and individual conditions, the dosage and usage of rivaroxaban may vary. Please follow the instructions of your doctor or pharmacist and do not increase, decrease or stop the medication on your own.

2. If an overdose occurs, seek medical attention immediately and observe for bleeding or other adverse reactions. There is currently no specific antidote, and symptomatic supportive treatment can be given according to the condition.

3. If vomiting occurs after taking the medicine, if tablets are found in the vomit within 2 hours of administration, they should be taken again. No additional dose is needed after 2 hours of administration.

4. While taking rivaroxaban, liver and kidney function and coagulation indicators should be monitored regularly. If any abnormalities are found, please contact your doctor or pharmacist in time.

5. Avoid using it with other anticoagulants, nonsteroidal anti-inflammatory drugs or antiplatelet drugs to avoid increasing the risk of bleeding. If it is necessary to use it together, please use it under the guidance of a physician or pharmacist.

6. Pay attention to prevent bleeding. If bleeding occurs, such as nose bleeding, gum bleeding, vomiting blood, black stool, hematuria, abnormal vaginal bleeding, increased menstrual flow, anemia, etc., please seek medical attention in time. Try to avoid injuries in life, use soft-bristled toothbrushes and electric shavers, keep bowel movements smooth, and avoid scratches.

7. If you need to undergo invasive examinations or surgeries such as tooth extraction, gastroscopy, or fiberbronchoscopy, please inform your doctor or pharmacist in advance that you are taking rivaroxaban. They may adjust your medication regimen based on the situation.

8. Rivaroxaban is contraindicated for pregnant and lactating women, patients with decompensated cirrhosis, and patients with severe renal insufficiency. Women of childbearing age should use effective contraceptive measures while using rivaroxaban. If pregnant, please contact a physician or pharmacist immediately. Lactating women should stop breastfeeding if they must take the drug.

9. Rivaroxaban tablets contain lactose and should not be taken by patients with hereditary lactose or galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption.

10. Rivaroxaban may cause dizziness or syncope. If such adverse reactions occur, you should not drive a vehicle or operate machinery to avoid accidents.

11. Medicines should be kept out of reach of children to prevent them from taking them by mistake.

Rivaroxaban is a safe and effective anticoagulant drug, but it also needs to be used correctly under the guidance of a doctor to promptly detect and deal with possible adverse reactions.