Experiences with

Rivaroxaban

Rivaroxaban is a type of medicine known as an anticoagulant.

It makes your blood flow through your veins more easily. This means your blood will be less likely to make a dangerous blood clot.

People who are more at risk of developing a blood clot include those who have:

• an irregular heartbeat (atrial fibrillation)
• recently had surgery to replace a hip or knee joint
• unstable angina
• coronary heart disease
• peripheral arterial disease

It's also used to treat people who have had a health problem caused by a blood clot, such as:

• a stroke
• a heart attack
• a blood clot in the leg – deep vein thrombosis (DVT)
• a blood clot in the lungs – a pulmonary embolism

Rivaroxaban is only available on prescription. It comes as tablets and granules.

Who can take rivaroxaban

Most adults aged 18 and over can take rivaroxaban.

Most children who have had a deep vein thrombosis (DVT) or blood clot in the lungs (pulmonary embolism) can also take it.

Who may not be able to take rivaroxaban

Rivaroxaban is not suitable for some people. To make sure it's safe for you, tell your doctor if you:

• have ever had an allergic reaction to rivaroxaban or any other medicine
• are trying to get pregnant or you're already pregnant – rivaroxaban can be harmful to your baby
• have liver or kidney problems
• have any injuries that are currently bleeding a lot, such as a wound
• have a stomach ulcer
• have antiphospholipid syndrome, a condition that affects the immune system and makes you more likely to get blood clots
• have ever had surgery to replace a heart valve

Dosage and strength

Rivaroxaban comes as 2.5mg, 5mg, 10mg and 20mg tablets.

It also comes as granules that you mix with water, for children and young people aged under 18.

Your dose of rivaroxaban depends on why you're taking it.

The usual dose in adults:

• for a heart condition called atrial fibrillation is 20mg a day, but your doctor might prescribe a lower dose if you have kidney disease and are at a higher risk of bleeding
• for a blood clot you've had (deep vein thrombosis (DVT) or pulmonary embolism) is 20mg a day. You might need to take a dose of 15mg twice a day for the first few weeks of taking rivaroxaban. If you have kidney disease and are at a higher risk of bleeding, your doctor may prescribe a lower dose
• after an operation to replace a hip or knee joint is 10mg a day
• after a heart attack or for a heart condition called unstable angina is 2.5mg twice a day

For children, the doctor will use your child's weight to work out the correct dose.

If you're unsure what dose you need to take, check with your doctor or pharmacist.

How to take it

You'll usually take rivaroxaban once a day just after a meal or snack. It's important to take it with some food to help your body absorb the whole dose.

Try to take it at the same time every day.

If you're taking rivaroxaban to treat DVT or a pulmonary embolism you may need to take it twice a day for the first few weeks. Your doctor will tell you if you need to do this.

Swallow the tablets with a drink of water.

If you find it difficult to swallow tablets you can crush rivaroxaban tablets and mix them with water or apple purée. Swallow this mixture, then eat some food straight away.

How long to take it for

How long you need to take rivaroxaban will depend on why you're taking it.

If you have had an operation to replace your knee or hip joint, you'll probably take rivaroxaban for 2 to 5 weeks.

If you have had a blood clot (DVT or pulmonary embolism), you'll usually take rivaroxaban for at least 3 months. Depending on what caused the blood clot, you might need to take it for longer.

If you have a heart problem like atrial fibrillation or have had a heart attack, you might need to take rivaroxaban long term or even for the rest of your life.

Do not stop taking rivaroxaban without talking to your doctor. If you stop taking it you may be at increased risk of serious health problems caused by blood clots.

If you forget to take it

If you forget a dose of rivaroxaban, what you need to do depends on the dose you take.

If you usually take:

• 10mg, 15mg or 20mg once a day – take a dose as soon as you remember, unless it's nearly time for your next one, in which case skip the missed dose. Take your next dose at the usual time and then carry on as normal. Never take more than 1 dose in a single day
• 15mg twice a day – take a dose as soon as you remember. If it's nearly time for your next dose you can take two, 15mg tablets at the same time to get a total of 2 doses in 1 day. Never take more than 2 doses in 1 day
• 2.5mg twice a day – take a dose as soon as you remember, unless it's nearly time for your next one, in which case skip the missed dose. Do not take 2 doses to make up for a missed one. Take your next dose at the usual time, and then carry on as normal

It's very important that you remember to take rivaroxaban every day.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much

Taking too much rivaroxaban puts you at risk of bleeding.

• you take more than your prescribed dose of rivaroxaban

Go to 111.nhs.uk or call 111

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the rivaroxaban packet or leaflet inside it, any remaining medicine, and any other medicines you take.

Your doctor or pharmacist will give you an anticoagulant alert card.

Carry this with you all the time. It tells healthcare professionals that you're taking an anticoagulant. This can be useful for them to know in case of a medical emergency.

If you need any medical or dental treatment, show your anticoagulant alert card to the nurse, doctor or dentist. This includes before you have vaccinations and routine sessions with the dental hygienist.

Your doctor may advise you to stop taking rivaroxaban or reduce your dose for a short time.

Switching from warfarin to rivaroxaban

If you need to switch from warfarin to rivaroxaban, your doctor will advise you when to stop taking warfarin. This will probably be a few days before you start taking rivaroxaban.

Your doctor or anticoagulant clinic will do a blood test called the international normalised ratio (INR) to check how quickly your blood's clotting. This is to help decide exactly when you should start taking rivaroxaban.

Switching from rivaroxaban to warfarin

If you need to switch from rivaroxaban to warfarin, you may need to take both medicines together for a few days.

Your doctor or anticoagulant clinic will do a blood test called the international normalised ratio (INR) to check how quickly your blood's clotting. This is to help decide exactly when you should stop taking rivaroxaban.

Bleeding and what to do about it

While rivaroxaban has enormous benefits, the downside is that it can make you bleed more than normal. This is because while you're taking rivaroxaban, your blood will not clot as easily.

Less serious bleeding

It's usual to bleed more easily than normal while you're taking rivaroxaban.

The kind of bleeding you might have includes:

• periods that are heavier and last longer than usual
• bleeding for a little longer than usual if you cut yourself
• occasional nosebleeds (that last for less than 10 minutes)
• bleeding from your gums when you brush your teeth
• bruises that come up more easily and take longer to fade than usual

This type of bleeding is not dangerous and should stop by itself.

If it happens, keep taking the rivaroxaban, but tell your doctor if the bleeding bothers you or does not stop.

Things you can do to help yourself:

• Cuts – press on the cut for 10 minutes with a clean cloth.
• Nosebleeds – sit or stand upright (do not lie down), pinch your nose just above your nostrils for 10 to 15 minutes, lean forward and breathe through your mouth, and place an icepack (or a bag of frozen peas wrapped in a teatowel) at the top of your nose.
• Bleeding gums – try using a soft toothbrush and waxed dental floss to clean your teeth.
• Bruises – these are harmless, but can be unsightly. It might help to make them fade more quickly if you put an ice pack wrapped in a towel over the bruise for 10 minutes at a time several times a day.

What you can do to prevent bleeding

While you're taking rivaroxaban, be careful when you do activities that might cause an injury or a cut or bruising.

It can help to:

• avoid playing contact sports or other activities that can cause an injury, such as football, rugby, hockey and horse riding
• wear gloves when you use sharp objects like scissors, knives and gardening tools
• stop wet shaving or removing hair with wax – use an electric razor or hair-removing cream instead
• take dentures (false teeth) or retainers out for a few hours a day, if you wear them, to give your gums a rest – do not wear dentures or retainers that do not fit properly
• tell your doctor, dentist or nurse that you take rivaroxaban before you have any medical or dental procedures or surgery – this includes vaccinations and routine appointments with the dental hygienist

Other common side effects

These common side effects of rivaroxaban happen in more than 1 in 100 people. They're usually mild and do not last long. There are things you can do to help cope with them:

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects

Serious bleeding

Occasionally, you can have serious bleeding from taking rivaroxaban. This can be dangerous and needs urgent medical attention.

• you have red pee or black poo
• you get bruises that happen for no reason, or bruises that are larger than you'd expect or keep growing in size

• you get nosebleeds that you cannot stop and that last longer than 10 minutes
• you have blood in your vomit or you're coughing up blood
• you get severe headaches
• you have any bleeding from a cut or injury that will not stop or slow down

These are symptoms of serious bleeding. If you have any serious bleeding, stop taking rivaroxaban.

Very rarely, rivaroxaban can lead to bleeding in the brain.

you have any of these symptoms:

• a very severe headache
• a seizure or fit
• sudden loss of vision or blurred vision
• numbness or tingling in your arms or legs

You may also feel very tired, weak or sick.

In rare cases, rivaroxaban can cause a serious allergic reaction (anaphylaxis).

These are not all the side effects of rivaroxaban. For a full list, see the leaflet inside your medicines packet.

Rivaroxaban and pregnancy

Rivaroxaban should not be taken during pregnancy.

If you take rivaroxaban and are planning to get pregnant or you become pregnant while taking it, speak to your doctor or specialist. You will need to be changed to a different medicine.

Rivaroxaban and breastfeeding

It may be OK to take rivaroxaban while breastfeeding, but talk to your doctor or pharmacist first.

Rivaroxaban gets into breast milk in very small amounts, and it is unlikely to cause side effects in your baby. However, we do not have very much information about rivaroxaban and breastfeeding, so your doctor may recommend a different medicine we know more about.

If your doctor says it's OK to take rivaroxaban while breastfeeding, then monitor your baby for any possible side effects.

Talk to your health visitor, midwife, pharmacist or doctor as soon as possible if:

• your baby is not feeding as well as usual
• your baby seems to bleed or bruise easily
• you have any other concerns about your baby

Rivaroxaban and fertility

There's no evidence to suggest that taking rivaroxaban reduces fertility in either men or women.

Speak to your doctor if you're trying to get pregnant.

Cautions with other medicines

Some medicines can affect how rivaroxaban works. This can lead to serious side effects.

Tell your doctor if you're taking any of these medicines before you start taking rivaroxaban:

• any other anticoagulant, such as warfarin or enoxaparin
• medicines to treat fungal or bacterial infections, such as fluconazole, erythromycin, clarithromycin or rifampicin
• medicines to treat HIV, such as ritonavir
• medicines to treat epilepsy, such as carbamazepine, phenytoin or phenobarbital
• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin

Taking rivaroxaban with everyday painkillers

You can take paracetamol while you're taking rivaroxaban.

Do not take aspirin or ibuprofen while you're taking rivaroxaban unless a doctor has said it's OK. They increase the chance of bleeding.

Mixing rivaroxaban with herbal remedies and supplements

Do not take St John's wort, the herbal remedy for depression, while you're taking rivaroxaban. It can increase your risk of side effects.

There's not enough information to say that other herbal remedies and supplements are safe to take with rivaroxaban. They're not tested in the same way as pharmacy and prescription medicines.

Related links

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