'subclinical dose' of Rivaroxaban

[Ivan_the_Terrible]

It's possible in Russia to buy Rivaroxaban over the counter in various dosages. I'm reluctant to take it at all because of concerns about side-effects but would consider a low dose, such as 10 mg. My former GP said there was no point in taking a 'subclinical dose'. I don't fully understand the concept in this context. One glass of wine has half the effect of two, so why shouldn't half the recommended dose have some effect? Thanks for any explanations.

[etheral]

Rivaroxiban is an anticoagulant classified as a Direct Oral Anticoagulant (DOAC) that works by inhibiting Factor Xa.The recommended dose which has been tested by the manufacturer is 20 mg once daily with food. There is no evidence that a lessor dose (10mg) will inhibit Factor Xa and result in anticoagulation. The main negative effects that I could find seem to be GI distress. An alternative drug would be apixaban that is dosed at 5mg twice a day and works in the same manner. Hope this explanation is clear and answers your question. Best, etheral

[Ivan_the_Terrible in reply to etheral]

Thank you. Rivaroxaban is produced in tablets of 2.5mg, 5 mg, 10mg and 20mg. There has to be a reason for the smaller doses. I did come across a paper indicating that the 2.5 mg size was prescribed together with aspirin but it's quite difficult to understand.

If there is a certain dosage required to be effective surely this varies from individual to individual according to size and weight. Yet so far as I can tell the same 20 mg dose is given to everyone. Given my height and weight if there is a subclinical dose the standard dose may be subclinical for me and I'd be wasting my time taking it as prescribed.

I'll be very glad if you are able to continue discussing this. I have a lot of mistrust of modern one-size-fits-all medicine, especially when administered publicly within budget constraints. Given the ongoing tinnitus I suffer following the second COVID jab and the failure of my GP to demonstrate that I gave informed consent I hope you'll have some sympathy.

[etheral in reply to Ivan_the_Terrible]

The smaller doses are indicated for Coronary Artery Disease to be taken along with aspirin or Cloperigal, and also for a short time along with and for a short period of time with heparin for treatment of Deep Vein Thrombosis.

[Ivan_the_Terrible in reply to etheral]

Thank you for that explanation. If you have any comments on the weight/size to dosage ratio I'd be interested. My former GP did preface his remarks about 'subclinical dose' with 'you're a big fellow' referring to my height more than my weight and a cardioversion nurse said 'don't put on more than another 7 kg or the Rivaroxaban won' t work. ' Why she didn't talk about raising the dose I don't know. The same goes for all medicines with recommended dosages, surely these are for people of average size and can and in some cases should be adjusted for height and weight. If I am to follow medical recommendation and take Rivaroxaban surely I need to be sure I'm taking enough.

[etheral in reply to Ivan_the_Terrible]

According to the Merck Manuel, no dosage adjustments are recommended due to obesity.

[Ivan_the_Terrible in reply to etheral]

Thanks for consulting the manual. Does it say anything about height? Maybe it isn't a one size fits all dose and I've been prescribed the maximum dose. I am 6ft5 (195cm). It would be great to know

[JOY2THEWORLD49 in reply to etheral]

Hi. What is GI distress?

I take 110mg x twice day of PRADAXA. I am 73 now.

I chose it because it is reversible and easy to obtain the anti dote.

Cheri. JOY

[etheral in reply to JOY2THEWORLD49]

Gastrointestinal, stomach , indigestion etc

[JOY2THEWORLD49 in reply to etheral]

Best thing ever to have your gall bladder tests done.

Bowel uo under anaesthetic with a camera.

Another time mouth to stomach.

Then ultra sound.

I'd been complaining since 4 years with acid stomach.

At 50 they looked and removed it as gall bladderhad disintergrated!

I finally found out that my grandpa had his out.

I got 4 port holes as my surgeon picked off bits from surrounding organs!

I finally got my life back. But I keep to a LOW FAT diet.

Since 2000 year I was soon able to eat some things which were a no no. Like chicken fat, melted cheese etc but I keep it down.

When gall bladder is removed the bile drips in 24/7 with no guide how much yoy need to digest what you have eaten.

I have two stainless steel clips only which show up on spinal Xrays.

Vinegar gets me and Butter Chicken. Some spices.

Cheri. JOY

[JOY2THEWORLD49]

HiI may have to change from PRADAXA. But first I reduced the 150mg x twice day to 110ng x 2 tines day.

More energy, natural teeth can bite almonds now and tiny hard headed rash is kess.

Take PRADAXA which is eversible.

Rivearoxiban is harder to get an anti reversing drug.

Never take 2 doses at once.

Rather miss the dose if you are not sure.

chei. JOY

[Ivan_the_Terrible in reply to JOY2THEWORLD49]

I had never heard of it. I was rushed into hospital for an appendictomy the Christmas before last and it was, a great advantage that I wasn't taking Rivaroxaban.

[JOY2THEWORLD49 in reply to Ivan_the_Terrible]

Hi In NZ there is the rat blood thinner but folks taken off it. Too many bleeds.

We have the other 3 to choose from PRADAXA Dabigatran another name.

Riveroxaban and the other starting with A.......................

The antidote is cheaper and easier to reverse PRADAXA..

I had to stop it 3 24hrs prior and 3 x 24hs after operation in both operations.

Recently TVT Johnson and Johnson's surgical mesh removal.

Feb 2020 Thyroidectomy with 12 lymph nodes removed with 2 affected with the same Papillary Cancer.

I am 73 years and whilst Whangarei discharged me with 1110mg x twice a day I was transferred to Kaitaia Hospital for the weekend and arrangement to put services in place then they changed it to 150mg x twice a day.

Never, never should have had the increase. Only found out by rereading Whangarei Hospitals discharge papers. It is the principal hospital.

I was furious and rang up my Dr directly.

as my Carotid Arteries were clear of clots and cholesterol, and age with A.F. 110mg was best for me.

cherio JOY

[Ivan_the_Terrible in reply to JOY2THEWORLD49]

Thank you. I'm approaching 68 and have largely resisted blood-thinner thus far but will probably go on to them. Thanks for mentioning an alternative.

[Crystalbowl]

I was on Riveroxaban 20 mg for quite a few years but recently the dose was reduced to 15 mg with no explanation given and it is one tablet which I take with all the others after breakfast. I am very thin and not so tall any more. Now about 5ft 5.5 ins. Used to be 5ft 9”!

[JOY2THEWORLD49 in reply to Crystalbowl]

HiWhow that's alot to loose.

I have disappeared by 1/2 cm only!

My bone density is minus .5 though.

I love morning sun without sunscreen and I enjoy yoghurt and milky cocoa etc.

No rounded shoulders etc.

cheri JOY

[Ivan_the_Terrible in reply to Crystalbowl]

I'll guess that's down to size. I know little about dosage levels but the discussion has been helpful. Thanks.

[Crystalbowl]

I was wrong about my daily dose of Digoxin. Each tablet is 62.5 mcg and I have to take 3 so 187.5 mcg.