Xarelto -- 15mg or 20mg?

[Nanfranz]

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!

[Beancounter Volunteer]

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 in reply to Beancounter]

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]

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 in reply to Jill13]

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 Volunteer]

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 in reply to BobD]

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 in reply to BobD]

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]

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]

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]

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]

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]

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.