Rivaflo

Indications

Rivaroxaban is a blood thinner (anticoagulant). It is used to:

• Prevent stroke and blood clots in people with atrial fibrillation (an irregular heart rhythm) not caused by a heart valve problem.
• Treat deep vein thrombosis (DVT, a clot in a leg vein) and pulmonary embolism (PE, a clot in the lungs), and prevent them from coming back.
• Prevent clots after hip or knee replacement surgery.
• At a low dose, together with Aspirin, reduce heart attack and stroke in some people with coronary artery disease or peripheral artery disease.

How It Works

It blocks factor Xa, a protein needed for blood to clot. This makes it harder for harmful clots to form or grow.

Dosage and Administration

The dose depends on the condition and kidney function and is set by the doctor. Common adult doses:

• Atrial fibrillation: 20 mg once a day with the evening meal (15 mg once a day if kidney function is reduced).
• DVT or PE treatment: 15 mg twice a day for the first 3 weeks, then 20 mg once a day; later the doctor may lower it to 10 mg once a day.
• After hip or knee replacement: 10 mg once a day, starting 6 to 10 hours after surgery, for the period prescribed.
• With Aspirin for artery disease: 2.5 mg twice a day.

Take the 15 mg and 20 mg tablets with food; 2.5 mg and 10 mg can be taken with or without food. If you cannot swallow tablets, they may be crushed and mixed with water or apple puree just before taking. Take it at the same time each day. Do not stop taking it unless your doctor tells you to, as this raises the risk of stroke or clots. Children: as prescribed.

Interactions

• Other blood thinners (Warfarin, Heparin, Enoxaparin, Apixaban, Dabigatran): greatly increase bleeding risk; not taken together except when switching under medical guidance.
• Antiplatelet medicines (Aspirin, Clopidogrel, Ticagrelor), painkillers such as Ibuprofen and Naproxen, and antidepressants such as Fluoxetine or Sertraline: increase bleeding risk.
• Ketoconazole, Itraconazole, Posaconazole and HIV protease inhibitors such as Ritonavir: raise rivaroxaban levels; usually avoided.
• Rifampicin, Carbamazepine, Phenytoin, Phenobarbital and St John's wort: lower rivaroxaban levels and may make it less effective.

Contraindications

• Active major bleeding, or a condition with a high risk of bleeding (such as a recent brain bleed, active stomach ulcer or recent brain, spine or eye surgery).
• Liver disease with a bleeding tendency.
• Use with other anticoagulants, except when switching.
• Pregnancy and breastfeeding.
• Allergy to rivaroxaban.
• It is not recommended for people with mechanical heart valves or antiphospholipid syndrome.

Side Effects

Bleeding is the main side effect: nosebleeds, bleeding gums, easy bruising, heavier periods, and bleeding that takes longer to stop. Other effects include anaemia, dizziness, nausea, stomach pain and itching. Get urgent medical help if you have black or tarry stools, red or dark brown urine, vomit blood or material like coffee grounds, cough up blood, have bleeding that will not stop, a severe headache, sudden weakness, numbness, confusion or problems speaking or seeing, or after any fall or head injury.

Pregnancy and Lactation

Do not use during pregnancy. Women who could become pregnant should use effective contraception and tell the doctor at once if they become pregnant. Do not breastfeed while taking it; the doctor will advise on alternatives.

Precautions and Warnings

Tell every doctor and dentist that you take rivaroxaban, especially before surgery, dental work or a spinal injection; it may need to be stopped for a short time. Tell your doctor if you have kidney or liver disease, a stomach ulcer, uncontrolled high blood pressure or a history of bleeding. Spinal or epidural anaesthesia while taking it can rarely cause a blood clot around the spine; report back pain, numbness or leg weakness at once. Carry a card or note saying you take a blood thinner. If you miss a dose, follow the leaflet or ask your pharmacist; do not take a double dose to make up, except as directed in the twice-daily phase of DVT treatment.

Overdose

Overdose increases the risk of serious bleeding. Seek emergency medical help immediately, even if there is no bleeding yet. Hospitals can give treatment to reverse its effect if needed.

Therapeutic Class

Anticoagulant; direct factor Xa inhibitor.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.