Rivaroxaban

💊 What is Rivaroxaban used for?

• •To reduce the risk of major cardiovascular events (cardiovascular death, heart attack, and stroke) in adults with coronary artery disease (CAD). The label says it is used in combination with aspirin.
• •To reduce the risk of major thrombotic vascular events (heart attack, ischemic stroke, acute limb ischemia, and major amputation of a vascular cause) in adults with peripheral artery disease (PAD), including adults who recently had a lower extremity revascularization procedure for symptomatic PAD. The label says it is used in combination with aspirin.

How it works

Rivaroxaban is a factor Xa inhibitor. The label says it lowers blood clotting and helps prevent clots from forming. Because it is a blood thinner, it also increases the risk of bleeding.

How it is usually taken

• •The label says it is taken by mouth twice daily.
• •It may be taken with or without food.
• •In coronary artery disease or peripheral artery disease, the label says it is taken together with aspirin, which is taken once daily.
• •Follow the instructions from your prescriber or pharmacist about how to take it.

Comes as

• •2.5 mg tablets: light yellow, round, film-coated tablets marked with "2.5" on one side.

⚠️ Rivaroxaban side effects

🛑 Who should not take Rivaroxaban, and who should be careful

The label says not to take it if

• 🚨You currently have active pathological (abnormal) bleeding. The label says not to take it in this case.
• 🚨You are allergic to rivaroxaban or any of its ingredients. The label lists severe allergic reactions, such as anaphylaxis, as a contraindication.
• 🚨You have an artificial heart valve. The label says rivaroxaban use is not recommended for people with prosthetic heart valves.
• 🚨You have triple positive antiphospholipid syndrome. The label says rivaroxaban use is not recommended in this condition.
• 🚨The label says rivaroxaban tablets are not recommended for pediatric patients.

Tell your doctor before taking it if

• •Tell your doctor about all medical conditions, including bleeding problems, liver or kidney problems, and antiphospholipid syndrome (APS).
• •Tell your doctor if you are pregnant or plan to become pregnant.
• •Tell your doctor about all medicines you take, including aspirin, NSAIDs, and other blood thinners.
• •The label says it is not for people with artificial heart valves.
• •Tell your doctor if you currently have unusual bleeding.

🔀 Rivaroxaban with other medicines, food and alcohol

The label says to discuss these with your doctor or pharmacist

• •Aspirin, NSAIDs (especially long-term use), clopidogrel, warfarin, heparin, enoxaparin, and other anticoagulants can increase bleeding risk. The label says to avoid using other anticoagulants with rivaroxaban unless the benefit outweighs the risk.
• •SSRIs and SNRIs (antidepressants) can increase bleeding risk when taken with rivaroxaban.
• •The label says to avoid combined P-gp and strong CYP3A inhibitors, such as ketoconazole and ritonavir.
• •The label says to avoid combined P-gp and strong CYP3A inducers, such as carbamazepine, phenytoin, rifampin, and St. John's wort.
• •In patients with renal (kidney) impairment, the label says rivaroxaban should not be used with combined P-gp and moderate CYP3A inhibitors, such as erythromycin, unless the potential benefit justifies the potential risk.
• •The label says clarithromycin, a strong CYP3A inhibitor, does not require precautions with rivaroxaban based on pharmacokinetic data.
• •Always tell your doctor or pharmacist about every medicine you take, including over-the-counter products and supplements.

Alcohol and food

The label says it may be taken with or without food. The label text provided does not mention alcohol.

🤰 Rivaroxaban in pregnancy and breastfeeding

Pregnancy

The label says it is not known if rivaroxaban will harm an unborn baby. The label advises using it with caution in pregnant patients because of the potential for bleeding related to pregnancy and possible emergency delivery. The label says the anticoagulant effect cannot be reliably monitored with standard lab tests. Tell your doctor right away if you become pregnant during treatment. The label also says people who can become pregnant should discuss pregnancy planning with their doctor.

Breastfeeding

The label does not say.

🗓️ Storage, missed doses and taking too much

Storage

The label says to store at 20°C to 25°C (68°F to 77°F). Keep out of the reach of children.

If a dose is missed

The label does not say.

If too much is taken

The label says an overdose may lead to bleeding. If bleeding complications from an overdose occur, the label says to stop rivaroxaban and start appropriate treatment. The label says activated charcoal may be considered to reduce absorption. Rivaroxaban is not removed by dialysis. Plasma products may partly reverse lab measures of its effect. The label says no specific agent is available to reverse its effect.

🗒️ Questions to ask about Rivaroxaban

• Why am I being prescribed rivaroxaban together with aspirin?
• What bleeding signs should I watch for, and when should I call you?
• What should I do if I need a spinal procedure, epidural, or spinal anesthesia while taking this medicine?
• What should I do if I need to stop this medicine for surgery or another reason?
• Are any of my other medicines, including over-the-counter pain relievers, likely to increase my bleeding risk?
• Can I take this medicine if I become pregnant or plan to become pregnant?
• What is my plan if I have a bleeding problem or fall and hit my head?

❓ Rivaroxaban: frequently asked questions