Forgot to take Rivaroxoban last night 😱 can I change to taking in the morning?

[Tilly1957]

I forgot to take Rivaroxoban last night, only just realised! I am assuming I just leave it until tonight now? It would be a lot easier to take it at the sane time as the Bisoprolol.

[Hidden]

Hi. I always take mine in the morning. Was there a particular reason you were told to take it at night? (E.g other meds)

[Tilly1957 in reply to Hidden]

Think it’s because it’s with the main meal. X

[CDreamer]

As long as you take with a substantial meal you can take it any time of day. My understanding is that Taking with food is the most important part.

[Tilly1957 in reply to CDreamer]

My substantial meal is at teatime. X

[CDreamer in reply to Tilly1957]

See my reply below.

[BobD Volunteer]

To add to CDreamer's comment it is only properly absorbed when taken with a substantial meal containing fat. There was a bulletin about a year ago about this after a few people had strokes because they were taking it at breakfast time without proper food. A slice of toast is NOT enough.

By the way for future reference I put a pinned post up a while back explaining the medical advice regarding missed anticoagaulants and what to do. It covered all the DOACS plus warfarin.

[Tilly1957 in reply to BobD]

Thank you, BobD, I will see if so can find it x

[Tilly1957 in reply to BobD]

Found the pinned post - my understanding is that I should take the missed dose now, but take today’s from tomorrow?

“Rivaroxaban

If you are taking either 15mg or 20mg once a day and have forgotten a dose take it as soon as you remember. Do not take more than one tablet in a single day. Take the next tablet on the following day at your usual time and then carry on a normal.”

[BobD Volunteer in reply to Tilly1957]

That makes sense. If for example you normally take in the morning and remember at 8pm then you should take it then (with that proper meal) and take your normal tablet next morning but not two on the same day. The food aspect is vital though or stroke protection will be compromised.

[meadfoot]

I take mine with my evening meal purely because it needs a substantial meal which includes fat to be properly absorbed. I dont eat enough at breakfast to fully absorb the drug to best effect. Now you have missed a dose is a good time to start over and take it at a time that suits you best as long as the food aspect is taken into considerstion.

[Tilly1957 in reply to meadfoot]

My main meal is at teatime. I doubt my breakfast or lunch would be sufficient enough 😱 x

[CDreamer in reply to Tilly1957]

Doesn’t have to have a lot of fat, just some - avocados, nuts, olive oil, butter - all count so a salad with olive oil dressing would suffice.

[Tilly1957 in reply to CDreamer]

Cool x

[Griffin9 in reply to meadfoot]

I wasn't aware of this as I usually take mine with my porridge in the morning. The reason I'm taking it is because I'm due to have the operation next week and to see if there's any side effects, so no real concern if I miss one at this point. I might change to evenings from now on.

[Buffafly]

I changed to Apixaban because I sometimes have bowel problems that are best treated with fasting, also likely to bring on AF, so didn’t work well with Rivaroxaban requirements. Also not such a long gap if you miss one. I have found it much better all round for me.

[Jonathan_C]

I was advised that as the med is most 'active' 2-3 hours after taking it you should have it in the evening as your are more likely to be in bed/watching TV/getting frisky at that time. Therefore risk of bruising is lower compared to taking it in the morning when you could be at risk of bruising from bumping into the garden shed or falling off your mountain bike.

[LaceyLady]

It’s a pity the Drs do not ask about the patients diet before prescribing Rivoxaban.

[Stainsby01]

I am on Rivaroxaban and no where in the instructions does it say it should be taken with a substantial meal containing fat.!! I have not heard that before, where does this information come from? Mine is Xarelto manufactured by Bayer. Says take with a meal and swallowed with water. Be interested to hear any comments. 🤔

[CDreamer in reply to Stainsby01]

And therein lies the difficulty because many GPs are also not aware. Bob & I were at the same meeting when our arrhythmia nurse mentioned it about 5 years ago & that was the first I’d heard of it too. There was a Red Alert put out by the AFA about 6 months ago.

[Stainsby01 in reply to CDreamer]

Thank you. Still can't see where it says high fat high calorific food, to take tablet. Says take with food and swallow with water. Have read the link from baba.

[baba in reply to Stainsby01]

gov.uk/drug-safety-update/r...

[Stainsby01 in reply to baba]

Thank you

[CDreamer in reply to Stainsby01]

Quote:-

Importance of taking rivaroxaban 15 mg and 20 mg tablets with food

Clinical trials of rivaroxaban showed that food intake does not affect absorption of 2.5 mg or 10 mg tablets, while absorption of 20 mg tablets was optimal when taken with high-fat, high-calorie meal. For this reason, rivaroxaban 15 mg and 20 mg tablets are to be taken with food.

[Stainsby01 in reply to CDreamer]

I read that, but Bayer instructions just say, take with food and swallow with water. I don't eat a high fat diet but take mine at breakfast with my other prescription drugs and have been doing this for 4 years. Never take them on an empty stomach, should I be worried??

[CDreamer in reply to Stainsby01]

You don’t need a lot of fat so if you take at breakfast and have some sort of fat - milk, yogurt - on cereals as long as not zero fat, nuts, butters on toast etc should be ok. ‘Substantial meal’ = 500 calories so 2 pieces of toast with butter & milk in tea & coffee would just about suffice.

There is, or should be, some fat in every snack & meal. I do take high fat - low carb foods & lose weight & feel much better on it. It’s the carbs that do the damage!

The most balanced food re: protein/fat/carbs you can eat is an egg.

A friend of mine had problems when taking in morning as she starves until midday - liver enzymes went up. Soon as she changed to taking with main meal - everything returned to normal.

I read a study which said Rivaroxaban is best taken in evening.

[Stainsby01 in reply to CDreamer]

Thank you so much for your reply. I have either cereal and milk, fruit and yoghurt or eggs for breakfast. Very careful with carbs, limit to no more than 2 servings per day, usually one and my go to snacks are fruit and nuts. I've lost 19lb during lockdown and my blood sugar has come down. Only problem with Rivaroxoban are nose bleeds. Four cauterisations, and other treatments, still have them. Frustrating and inconvenient . Thank you once more.

[JudiHalf in reply to Stainsby01]

I take mine in the morning after my breakfast of cereal and fruit with a cup of tea!

[Pedroboy]

A miss of a day won't matter; just continue the next day.

[Tilly1957 in reply to Pedroboy]

Yep, that is what the GP confirmed when I spoke with him 🥰

[daysyday1]

I'm pleased this subject has come up but very concerned that I have been taking Rivaroxiban for the past 3 years late at night with just a cup of tea. I have never been told that it should be taken with a meal containing fat and I even asked the pharmacist when I should take it when it was first prescribed. I told her that I took my other meds early morning and late at night, and she said either would be fine. Think I need to review this in light of this discussion. Thank you all for the advice.

[Tilly1957]

I think it also depends on the dose you are taking, and why you are taking it, which both affects optimum time of day to take it and with/without food and how much/type of food! Best people to ask are the manufacturers of the drug, I guess! Given the information shared in this post, and bits and pieces I have read on the net, I will stick to taking it with my evening meal x