Xarelto -- 15mg or 20mg?: My cardio... - Atrial Fibrillati...

Atrial Fibrillation Support

32,397 members38,732 posts

Xarelto -- 15mg or 20mg?

Nanfranz profile image
12 Replies

My cardio prescribed 90 days of 20 mg Xarelto right from the start, and I assumed that 20mg is the one-size-fits-all dose. Months later, he gave me 6 weeks worth of free samples , and when I got home I noticed the strength was 15mg. When I asked him about this he said that 15mg was all the samples he had at that time but it would be adequate. This pleased me -- the less the better, I say! Then when I needed a refill prescription I reminded him that I'd been on the lower dose and he muttered that 20 mg might be better. Is he confused or am I? So my question is . . . on what do they base their choice of medication strength . And if the patient has paroxysmal afib with only short episodes which are unlikely to cause clots anyway, how do they know for certain if the chosen dose is an effective one? Anyone have any inside info on this? Thanks!

Written by
Nanfranz profile image
Nanfranz
To view profiles and participate in discussions please or .
Read more about...
12 Replies
Beancounter profile image
BeancounterVolunteer

Hi Nanfranz

20mg is the usual dose, and 15mg is only presecribed if you have indications of renal impariment, in a "normal" person it will be less effective.

With renal impairment, certainly in the UK, they might try one of the other anti-coagulants.

As regards risk with paroxysmal versus persistent AF, the first challenge is how do you know the episodes are short? AF can easily be present with no symptoms, and secondly would it not be a little like russian roulette?

Lastly remember that rivaroxaban must take WITH food, not before or after, but during eating for effectiveness.

Be well

Ian

Nanfranz profile image
Nanfranz in reply toBeancounter

Thanks for your helpful input, Ian! Just a word of explanation: I've worn various monitors over a couple of years but the most recent was a Zio Patch, which records every heartbeat for two weeks. Cardio had ordered this because he wanted to know if it would be safe to discontinue Xarelto for 2-3 days for foot surgery. So it was the monitor results which told him that the AF episodes are brief enough not to pose a threat of blood clots, and he gave the go-ahead for surgery. I have persistent ectopics which I'm very aware of (and which respond well to Flecainide) but am not often aware of the separate issue of paroxysmal AF, so it occurs to me now that by the time I'm all set for surgery the AF episodes might be longer-lasting than they were during the monitoring. The more I think about this the more iffy the cardio's opinion seems. Perhaps I'm overthinking all this? But anyway, thanks again for the explaining the two doses of Xarelto!

Frances

Jill13 profile image
Jill13

My cardiologist started me On 20 mg of xarelto but when I had hives for six months put me on Pradaxa but it upset my digestive system so back onto 15 mgs of xarelto which he said is OK for my persistent AF. By the way, hive cause was never established. ( Personally I don't think it was the Xarelto or any of my other meds)

I didn't know you should take it with food rather than before and does anyone know if it is

best in the morning at breakfast or in evening with main meal? Doctors don't always give all the answers which is why other people's comments on this forum are so valuable.

Tapanac profile image
Tapanac in reply toJill13

My friend takes her Rivaroxaban with her breakfast as she has porridge every morning, but I take mine with my evening meal because I don't always have breakfast. Yes you must take it with food. I worried because I don't always cook evening dinner (not a,ways possible is it) at the same time, but it is important to take roughly the same time every day. Sometimes I do vary between 6 and 7.30 and it has been ok

BobD profile image
BobDVolunteer

You have AF therefore you have a stroke risk. The amount or frequency of events is not relevant so pleased do not think that because you may have only short events you are at less risk.

Regarding taking the drug with food, I understand from the talk by a consultant pharmacists at HRC Patients Day that this must be done and that the food MUST contain fat. The timing is not important but best taken DURING a meat of substantial food rather than say with a breakfast banana.

Clareowenpearcy profile image
Clareowenpearcy in reply toBobD

Wow! Again I learned something new today. Never has my doctor mentioned the importance of how and when I should take Xeralto. I noticed on the pill container it said “take with food” so I do that however, the importance of fat I have never heard that before. Thank you for the great information. Cheers

Nanfranz profile image
Nanfranz in reply toBobD

Thanks, Bob. Your comments are always valuable. The cardio was the one who stated that since my AF episodes are "brief" (as shown in results of wearing a two-week Zio Patch monitor) it would be safe to discontinue Xarelto for 2-3 days for anticipated foot surgery. But I'm having second thoughts on this (see my above comments to Ian). And this morning I've discovered that the cardio has forgotten (for the second time) to call in a renewal prescription for Xarelto. But that's another story.

feejbee profile image
feejbee

That comment at Patients Day was a golden nugget for me. I knew Rivaroxaban should be taken with food .I take all pills at 6pm and have dinner around that time give or take and thought that would be ok. .I did not realise that it was up to 70 % less effective if you are not eating something while taking it .I think most people in the room didn't realise that either.

Fi

meadfoot profile image
meadfoot

I was reduced from 20mg to 15mg due to liver and kidney downturn. I take it with a meal inc fat as instructed by a haematologist consultant who I met on a hospital board.

gixxerboy profile image
gixxerboy

I used to be on 20mg maintenance dose ,but then dropped to 15mg which my consultant also stated was a maintenance dose..... scratch head now......I was informed to always take mine with the largest meal of the day which for me is teatime....

irene75359 profile image
irene75359

I am amazed (and grateful) for what I learn on this forum. My daughter will likely be on Apixaban for life - does this NOAC also have to be eaten with food containing fat?

Jill13 profile image
Jill13

Hello Nanfranz

My cardio put me on 20 mg Xarelto at first but later reduced it to 15 mg

I am 78 and I think it is less as you get older. I now have permanent AF but don’t feel it on digoxin and Cardizem. Anyone else have that information. I have porridge and milk for breakfast and have mine then. My. GP says the fat in the milk is important.

Not what you're looking for?

You may also like...

15mg Bisoprolol

I am in a dose of 15mg plus Amiodarine I have AF is comes amd goes my question is it seems a high...
NLGA profile image

Does anyone take 15mg Bisoprol daily?

I recently posted a question about taking a medication to shorten an AFib episode and received some...
Jomaur profile image

Rivaroxaban (Xarelto) vs apixaban

I recently posted about problems dealing with the side effects of apixaban, mainly lightheadedness...
Calypso76 profile image

Xarelto, need encouragement

Hi folks. I've been lurking here for some time and am really grateful for all your posts. I'm F,...
sibelius profile image

Worried about too larger a dose for Pill in Pocket for my weight. Got answer from EP today.

As researched I found that Flecainide should be dosed according to weight The EP confirmed this....

Moderation team

See all
Kelley-Admin profile image
Kelley-AdminAdministrator
jess-admin profile image
jess-adminAdministrator
Emily-Admin profile image
Emily-AdminAdministrator

Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.

Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.