Xarelto in the evening?

[Polly159]

Was reading on another thread that xarelto should be taken in the evening for best effect. Have re-read the info leaflet (I'm in the UK) and it makes no mention of this? Any comments/advice?

[Jalia]

Typo??😂 I was wondering how carrots came into it. Sorry can't help, I'm on warfarin .

[Polly159 in reply to Jalia]

Ha! (Btw, the typo for warfarin (on my keyboard) is saffron!

[Jalia in reply to Polly159]

Just a different shade of orange then !😁

[BobD Volunteer]

There was an urgent bulletin about a month ago that said some people with AF had strokes because they were not taking rivaroxaban with a proper meal. Many had been taking it in the morning with a cup of tea/coffee and maybe a slice of toast but this was not sufficient. A full meal which should contain some fat was needed for the drug to be absorbed into the body and without this people were going unprotected. If you have a Full English that is fine but if you unable to eat first thing as many appear to be (never a problem for me lol) then have you dose with your dinner whenever that is.

Although we have been telling members about this need for quite a long time this was the first offical notification I have seen and yes this forum is UK based and lead.

[Polly159 in reply to BobD]

Very helpful - can you point me in the direction if the article? Morning I have 2 weetabix with full fat milk - probably not enough? Have also, to lose weight fine on a mainly veg/salad diet........May be add egg, cheese, lentils etc seems a really important thing to get right.

[Polly159 in reply to Polly159]

Should also say how valuable this forum is for information and support.

[BobD Volunteer in reply to Polly159]

It was an admin post from Rachel so you couod call AF Association office line and ask if you can't search for it.

[Buffafly in reply to BobD]

If you go to Rachel's profile you'll find the link - I tried to post a link but it didn't work.

[Buffafly in reply to Buffafly]

healthunlocked.com/api/redi...

This one works - don't be put off by the redirect notice!

[Gillybean123 in reply to BobD]

Good Morning BobD, these comments on Xarelto didn't know about the fat content. If a boiled egg is enough and I take mine at night within two hours of my dinner. There would be enough fat content in my meal wouldn't there. There can't be much fat in a boiled egg. I know that I know that 2.5 and 10mg is with or without food. But 15 and 20mg definitely with food. Is it one of those tablets that stays in the system for so many hours or is it a prolonged one that is in your system all the while. Thanks Gill. P.s. hope you are feeling well and that life is good considering!

[BobD Volunteer in reply to Gillybean123]

Thanks Gill, getting there! I can only report what has been printed but I would say that it does need to be taken with food not two hours afterwards. I understand that it is the digestion of the food (and the fat in particular) which helps absorbtion.

[Gillybean123 in reply to BobD]

Will start taking it with my dinner then. Thanks Gill.

[Auriculaire in reply to BobD]

One wonders if bile is involved. Would that hinder those who had had gallbladder removal? Just a thought. You would think if so there would be info about this.

[goldey in reply to BobD]

Bob, can you please post the link to that Urgent Bulletin someone posted a month or so ago? I have been trying to find it again, because it was what led me to find the big definitive study that proved that the Xeralto was active for 12-14 hours. Nobody believed me when I posted about that study, so I need to find it again so I can pass it along to everybody. thanks so much!!

[Tux18 in reply to BobD]

Wow , this is very important information about taking Xarelto with full meal. I knew to take it with evening meal, but because that's not always at the same time, etc. I have been taking it in the evening with a couple of crackers or whatever. Doctors never mentioned the importance of taking it with plenty of food.

[BobD Volunteer in reply to Tux18]

I think the meal may be more important than keeping to acurate time. An hour either way shouldn't make any difference surely.

[CDreamer]

Hi Polly -

I read that thread as well and was also wondering although I am on Apixaban which is x2 daily.

My understanding of the rationale from that thread was that the full 100% cover for Xarelto was actually 12-14 hours rather than 24hours and that as most strokes tended to occur in the morning it was suggested that it would provide more efficacious protection against stroke if taken in the evening. I haven’t done any reading of the research to support that reasoning so couldn’t comment but BobD’s point makes a lot more sense to me.

I suggested my friend take her tablet in the evening - along with her evening meal - as she had some problems taking it in the morning and I knew she didn’t have any breakfast. At that time I did a lot of reading around the metabolising/efficacy of many of the anticoagulants and was concerned that she wouldn’t get the benefit of full protection and her blood work was showing elevated liver enzymes, which was probably a result of the drug not being adequately absorbed.

Most people will tend to have a more substantial meal in the evening than for breakfast. Would that influence the numbers if the maximum biological availability is achieved? From what I have read how the body metabolises the drug so that maximum biological availability is achieved is incredibly important part in the whole process, although seemingly overlooked by the majority.

I think there is still much we need to learn about these drugs and their efficacy and what is often again overlooked is an individual’s ability to metabolise every pill effectively at any given time.

[Buffafly in reply to CDreamer]

Needs to be high calorie including fat, protein not mentioned.

[Tyson4ever in reply to CDreamer]

Appreciate your comments.

Moving to a more plant based diet and with cholesterol issues does pose some difficulties.

[CDreamer in reply to Tyson4ever]

It shouldn’t as it is important to eat plenty of fats for nerve health - sources - oily fish, avocados, nuts, olive oil - all great and if you eat eggs then one egg has the perfect proportions of protein, fat & carbs.

[Tyson4ever in reply to CDreamer]

I always have a bowl of mixed nuts with my breakfast and this morning added a good dollop of full fat yogurt to my porridge and banana.

All those who take rivaroxaban with their breakfast

Share your recipes, would be interesting.

The help and support on this forum is invaluable.

Jo

[CDreamer in reply to Tyson4ever]

Great idea!

[Tux18 in reply to CDreamer]

I did not realize that xarelto only lasted 12-14 hrs. That doesn’t seem good at all.

[CDreamer in reply to Tux18]

That’s not quite right I don’t think, but I’m not an expert.

My understanding is that the efficacy of the drug was designed to be for 24 hours - however - the bioavailability inside the body will vary dependant upon different factors including how well it is absorbed - which is dependant upon what you take it with. You will have some protection over the 24 hours but you may have better efficacy within 12-14 hour period.

The discussion began with a study showing that more people had more strokes in the morning than in the evening so perhaps it was a good idea to take it in the evening rather than the morning so that you would have maximum protection in the morning.

I have to say though that the uncertainty of this absorption issue is one of the main reasons I chose to go with a x2 a day anti-coagulant.

[Tux18 in reply to CDreamer]

Interesting and helpful information. I have not heard of a 2X day anti-coagulant.

And it certainly makes sense that sense that Xarelto must give some protection for longer than 12-14 hrs. Thank you for taking the time to explain further on this topic.

[Tyson4ever]

I don't think the time of day it is taken is paticularly importanth but as Bob said should be taken with a proper meal with sufficient fat content.

I take mine in the morning with breakfast consisting of a bowl of porridge made with semi skimmed milk, sliced banana on top and a small bowl of mixed nuts.

I find it more convenient in the morning as I can give myself an hour or so window in which to take it, depending on what I'm doing that day. I have in the past tried to take it in the evening but found it increasingly more difficult to pin down the time of an evening meal.

Jo

[CDreamer in reply to Tyson4ever]

It is whatever suits you but the point is that it is the protein and fat content of any meal with which you take Xarelto which is really important and porridge and semi-skimmed milk just wouldn’t be enough - high in carbs, not fat and protein. I would suggest you need to take with more fat - if you used full fat milk or but yogurt on top rather than using skimmed that would do it - or add in a boiled egg? Fat content is really important to metabolise Xarelto.

[Polly159 in reply to CDreamer]

That's interesting - would become to have this info on the leaflet.

[CDreamer in reply to Polly159]

I haven’t read the leaflet recently but I am surprised that it doesn’t have a lot more information about how to take meds on many drugs.

If it says ‘take WITH food’ - it literally means that but rarely explains the reason why. Take before or after or between or on an empty stomach or with a full glass of water or at least 2 hours between other meds - it’s really important to follow those instructions otherwise you may compromise the efficacy but how many people first - read the full leaflet and second follow the instructions to the letter?

[Polly159 in reply to CDreamer]

The Xarelto leaflet that I currently have doesn't mention time of day or with/without/before/after food...

[CDreamer in reply to Polly159]

And that is BobD's point and why an urgent bulletin was circulated........

[majjic in reply to CDreamer]

I hadn't heard about any of this and i've been taking Xarelto for just over a year...I have either bite sized shredded wheat or porridge for breakfast and i used to make them with skimmed milk but since reading about the fat content i've been using full cream milk...I also load the breakfast up with berries....I'm trying to lose weight too but i'm wondering if i should add buttered toast to the cereal....Any comments or advice would be greatly appreciated....By the way i'm in the UK too....I can't take it with dinner either because it's not possible to have my dinner at any kind of consistant time....Sometimes is 7pm and next night it might be 9.30pm.

[CDreamer in reply to majjic]

I was just thinking about exactly what you describe - suggestions - chuck the berries with cereal (high sugar so only a small handful daily) & add a few nuts instead or replace milk with plain kefir or have fruit (in season) - i stew windfalls sweetened with only sultanas & bottle for quick add in the morning- with plain yogurt or have a boiled egg - or smashed avocado topped with poached egg. Ditch the berries, the carbs (wheatabix) if you can or at least keep to x1 week as also sugar and not going to help weight loss or general health Look at a Keto type eating plan - healthy high fat/protein is NOT Full English - especially for breakfast - if that’s when you take your tablet. Avoid toast, butter, cereals. Look at the Healthy Eating forum - lots of great ideas & quite a few of the AF forum post there.

Aim to eat at least 30-50 different food types per week - eat the rainbow as highly coloured foods contain great micro nutrients for improved health. Check out Emma’s Nutrition on YouTube for some great advice & tips.

It takes effort but so worth it to improve health through eating.

Best wishes CD

[Polly159]

Just noticed the typo in my heading! If carrots thinned our blood, we'd all be laughing!

[jeanjeannie50 in reply to Polly159]

Polly I'd been wondering where carrots came into it, thought perhaps you'd found some natural wonder cure for us. You've made me laugh!

If you want to edit your post, go to the bottom of it and click on the More down arrow and scroll down to Edit, when change done click on Edit response.

[Polly159 in reply to jeanjeannie50]

Thanks! Took me a while to notice the typo!

[regalone]

I did not take Xarelto with food, no one told me to and I neglected to read the instructions, my bone marrow stopped making red blood cells and I actually came close to dying. I had a red blood cell count of just a bit over 5.....finally the problem was figured out and I needed an immediate transfusion of 3 pints of blood. I've since changed to warfarin and haven't found the very occasional testing my blood (tiny prick on the finger) at all annoying....a lot less scary than almost dying. The electrophysiologist who finally found the problem and treated me for this now lectures on it when he's at cardiology conventions.

[Gillybean123]

You have just made me read up on this. I have taken it for years after my main meal but usually before bed with my others. I have always eaten late I know wrong but that's life. Anyway 2.5 mg and 10 mg can be taken with or without food and 15 and 20mg definitely with food. Now I have always eaten fat free wherever possible. So I need to find out how much fat content I need to consume. Decisions decisions!!!!

[Gillybean123 in reply to Gillybean123]

I haven't found anything written yet saying about the fat content.

[Ppiman]

It’s odd isn’t it? I was told to take my dose (20mg) in the morning.

I had noticed what you’ve reported, though, and asked about it. It is in the USA only, it seems, where this is in the leaflet, so presumably the FDA decided on the basis of studies that it was best at that time. The EU and UK health authorities only say it must be taken with food. I looked at some studies on the Internet and these showed only that food was needed with 10 or 20mg doses, and that fatty foods were slightly better still.

Steve

[100h]

I was taking mine in the morning. After my ablation when I restarted on all my meds in hospital they gave me the xarelto in the evening.. When I asked why they said the absorption is better with a typical evening meal.

[Polly159 in reply to 100h]

Interesting

[Hidden]

I take mine in the morning, no one has ever suggested different to me.

[Kaz747]

I take mine in the morning. My breakfast is usually a smoothie containing full fat yogurt, chia, sunflower, linseed & hemp seeds (which contain healthy fats), psyllium husks, almond and coconut milk, blueberries and a banana.

if I eat something different I make sure it’s substantial and includes some fat.

[Twosticks]

My doctor says to take it any time of day regular times with food .

[Argosy]

Hi Polly,

When I went for an prep appointment for the ablation I was told to take it at 6 in the evening rather than in the morning. So we now have a little ditty in the household " Don't forget, rivaroxaban at 6!" Silly but it seems to work for, just a shame the ablation didn't, am now waiting for a second. Have a good day and take care.

[Alessa69]

I’ve been on Xarelto for nearly a year now. I was told to take it with a meal containing fat, so I opt for taking it with breakfast, as mine includes a full fat organic yoghurt or boiled egg. My timing for Breakfast is relatively consistent& I remember to take it.... whereas dinner does not contain so much fat. I had not heard about timings re optimal anti- coagulation & stroke risks though , more things to think about !

[horseblister]

I am taking my Xarelto in the evening with my evening meal because I was started on Warfarin in the hospital when I was first diagnosed with AF. when the anticoag clinic asked me to be transfered to a DOAC the Advanced Practitioner Nurse said I had to continue taking the same time as warfarin.

[goldey]

If any of you feel that your meal is lacking in enough fat to make your Xeralto happy, you can always grab a couple Reese Peanut Butter cups for dessert ......... <giggle>

[silviageci]

Have no idea, I take it in the morning with muy morning pills to make sure I take at the same time everyday, any other suggestion will be welcomed