Rivaroxaban confusion

[Jst455]

I am taking 20mg of Rivaroxaban each day because I had an episode of atrial fibrillation. I take it at breakfast time because that is the only fixed mealtime in my day. Due to the nature of my work I often do not have the opportunity of an evening meal.

The guidance from NHS is to take it 'after a meal or snack'. My breakfast usually consists of porridge with fruit. The anti-coagulation nurse at my GP practice said this was acceptable.

However, there is contradictory advice on this forum suggesting that the tablet must be taken with a full meal. One rather evangelical contributor insists that this must include a quantity of fat.

I followed this advice and started putting on weight, which seemed a little counterintuitive for someone wishing to avoid heart disease, so I reverted to my normal diet.

The two recent studies made in New Zealand and Canada found that Rivaroxaban is 66% metabolised even on an empty stomach, so I'm wondering if the daily 'Full English' brigade might have misinterpreted what they were told?

If there are any registered pharmacists on here I would grateful for an informed opinion.

[Hidden]

The best way to get an informed opinion is to consult a doctor or pharmacist……..

[BobD Volunteer]

The advice given here resulted from a bulletin issued last year which showed that a number or people taking rivaroxaban had suffered strokes due to lack of proper absorption when taking with merely a snack and that some fat was required in the meal..

I am sure that if you contact the office they will explain the whys and wherefores.

[Jst455 in reply to BobD]

Which office?

[CDreamer in reply to Jst455]

The AFA - heartrhythmalliance.org/afa...

[Jst455 in reply to CDreamer]

Ah, thanks.

[CDreamer]

If you are having porridge with full fat milk that should contain sufficient fat.

My understanding is that because Rivaroxaban is a x1 per day medication it’s important to get more than 66% metabolised for effective 24hour cover simply because your liver will go into overdrive to rid excess not metabolised, which is what happened to a friend when she took on an empty stomach.

Everyone metabolises very differently and at different rates so it’s not always easy to be precise. A good friend of mine started to become ill and her Liver enzymes elevated with no explanation. We are both friendly with her GP who is a fully trained Lifestyle Medicine doctor and we suggested she take with a substantial meal instead of just her kefir and coffee in the morning and suddenly everything went back to normal within a few weeks. It was concluded that her liver enzymes rose because the Rivaroxaban wasn’t properly absorbed so liver went into overdrive to rid her body of excess. That was just after I had been at meeting - I think Bob was also there - where I heard of this phenomena for the first time.

I think people misunderstand - when I say fat I mean olive oil, avocado and nuts on my salads or boiled/poached eggs - not a ‘full English’, although I’ll go for that very occasionally.

A boiled egg has the perfect balance of fat, protein and carbohydrates so makes the perfect, balanced snack.

Unfortunately I’ve never had ‘informed’ advice on nutrition from any nurse, pharmacist or doctor who is not dual trained. The good ones say I don’t know and refer me to someone they know who does.

[Jst455 in reply to CDreamer]

I wonder what is prescribed for vegans?

[CDreamer in reply to Jst455]

Most fats are vegetable based - olive oil, hemp oil, seed oils, nuts, avacodo - need I go on?

[Jst455 in reply to CDreamer]

I was just curious about the eggs. Didn't mean to upset you.

[CDreamer in reply to Jst455]

I’m not upset - eggs for me are a favourite food as they feed Acetycholine production and a perfectly balanced food.

[Jst455 in reply to CDreamer]

I'm glad you're not in the 'eggs are bad for the heart' camp, I love eggs.

[CDreamer in reply to Jst455]

Na, I have been pescatarian and vegetarian for part of my life and don’t eat a lot of meat but always eaten eggs.

[Buffafly]

You could just change to Apixaban - that’s what I did. No dietary requirements but you do have to take two a day.

[Jst455]

That's useful to know, thank you. Any side effects?

[Kaz747]

I take Rivaroxaban with breakfast which is generally a shake that contains yogurt and seeds which have fat in them. Sometimes I have porridge or yogurt with fruit, nuts and seeds.

I have been on Apixiban and Pradaxa but had problems with both of them so Rivaroxiban is best for me.

[Jst455 in reply to Kaz747]

What were the problems with the alternative prescriptions?

[Kaz747 in reply to Jst455]

Pradaxa was no good as I have a hiatus hernia so the drug gave me gastric issues.

I was on Aixiban twice - the first time was for 4 weeks after a cardioversion for Atrial Flutter. I was shivering and couldn’t get warm and my BP was all over the place. I was having bad pains in my upper back so I was sent for a CT scan to rule out a pulmonary embolism. A few days after the cardioversion I was diagnosed with Shingles so we put all these symptoms down to that.

Afew months later when the Flutter was back and I developed AF I was put on Rivaroxiban. I’d gone off it for two days before an ablation but they couldn’t do the ablation because they found a small blood clot in my heart. My EP prescribed Apixiban again but I ended up back in hospital again 3 days later with the shivering, coldness, back pain and unstable blood pressure. I also had post menopausal bleeding. So my EP switched me back to Rivaroxiban.

Most people are fine with Apixiban but it didn’t seem to like me 😄

[Jst455 in reply to Kaz747]

I might avoid it if it causes gastric issues, I have IBS.

[Pickone in reply to Kaz747]

I have oatmeal with fruit every morning also. I have it with ground flax which is a good source of fat and omega-3.

[Frappy in reply to Kaz747]

I was prescribed Pradaxa, told I 'might have indigestion'. Two weeks into the regime I had serious chest pain radiating into my back. Went to ED, thankfully it was indigestion but like nothing I have ever experienced before. Over 2 months now on Rivaroxiban and still have chest pain from indigestion but not as bad as the first time. Do not recall any info about taking with meals. Will check this evening

[Snookersteve]

Hi, I had to change from Rivaroxaban due to a really bad rash which went on for months. I have been taking Apixaban for 6 months and have no side effects at all. Of course it is possible that you might have side effects with Apixaban, but you may feel it is worth a try. As Buffafly stated it has to be taken twice daily but no food requirements. I believe this may be why the NHS often favour Rivaroxaban because of the inconvenience of taking 2 doses daily and folks forgetting to take them. The cost of 28 days treatment to the NHS (in 2020) for Rivaroxaban is around £50 and for Apixaban around £53 so pretty similar in cost terms. Steve

[Jst455 in reply to Snookersteve]

Thank you.

[Suesouth]

Hi, I was diagnosed in April, and told to take rivaroxoban with or after food, I take it at breakfast time, which consists of two small pieces of toast with peanut butter and marmite, so far no problems, take beta blockers before breakfast, and blood pressure tablets about an hour before!!

[Jst455 in reply to Suesouth]

I take everything at the same time with breakfast, I haven't been told to do anything different, but when I read about Rivaroxaban and food on here I started to research it.It is a precautionary drug, and my stroke risk is low - I've only had two AF events, caused by viral infection.

[Tennisbud in reply to Jst455]

If you are worried about absorption take it at night or the evening. I saw you said you don’t have normal hours but I’d rather have my dose at night when I’m asleep for stroke protection when during the day if unfortunately you had a stroke you’d be aware of the symptoms.

[Jst455 in reply to Tennisbud]

Good point, but I'd have to have food. Also I'm trying to take it at the same time each day, and my strange hours would make an evening dose unpredictable.

[Alphakiwi]

Been on it for 2 yrs. Take it just before a plate of porridge and fruit in the morning. No probs

[Jst455 in reply to Alphakiwi]

Thank you! I shall carry on as normal.

[Suesouth]

My stroke risk is high, I’ve had two events since being diagnosed, get ultrasound next week! Best of luck

[Jst455 in reply to Suesouth]

Take care.

[Suesouth]

Thanks, you too

[beach_bum]

Consultant your pharmacist. Also the info sheet that comes with the meds is important, so read it thoroughly. All thinners are not the same. I am also on Rivaroxban *Xeralto* and was told taking it 3 hrs after my last meal was fine. I usually have a treat an hour before...a few grapes etc. I take both the thinners and channel blocker Diltiazem together as instructed. No issues. Not sure about the UK, but here in Canada you can call the Pharmacist any time for advice. 🙂

[Jst455 in reply to beach_bum]

thank you

[gtreen]

been on apixabanfor three years never had a problem had 3 strokes over 20 years still kicking

[Pickone]

I add ground flax seed to my oatmeal for this reason.

[Jst455]

So it might be a case of quality not quantity?

[robster68]

Have been on Rivaroxaban for about 6months, sometimes taken with just a banana, sometimes just with cereal. Never had an issue. But as alluded to already, it's different for everybody and would definitely get advice from your gp, Arrhythmia specialist or Cardiologist.