Rivaroxaban (Oral)

Rivaroxaban is a drug prescribed to people who've just had knee or hip surgery and are at risk of deep vein thrombosis.

Overview

Rivaroxaban is prescribed to patients who are suffering from or at risk of getting deep vein thrombosis. This is a condition whereby harmful blood clots form in the blood vessels of your legs, which could then possibly travel to your lungs and become trapped in blood vessels there. In turn, this can cause what is known as a pulmonary embolism.

Rivaroxaban is taken for several days following knee or hip replacement surgery, at which time you will be unable to walk, meaning that blood clots are more likely to form. If you suffer from rhythmic heart problems, then rivaroxaban may be used to prevent blood clots and strokes.

On a basic level, rivaroxaban is an anticoagulant, or Xa inhibitor, which decreases your blood's ability to clot, thus preventing clots inside of the blood vessels. It is only available by prescription, as you must undergo a full medical examination before being prescribed it. Rivaroxaban has the potential to interact with a number of other drugs and foods and can also cause potentially harmful side effects.

Conditions Treated

  • Deep vein thrombosis

Type of Medicine

  • Tablet

Side Effects

Side effects are common with all drugs and are not necessarily a cause for major alarm. However, if any of the side effects listed directly below occur, then contact your doctor immediately and seek immediate medical assistance.

More common:

  • Difficulty swallowing or breathing
  • Dizziness
  • Prolonged bleeding from cuts
  • Bladder or bowel dysfunction
  • Bloody stools
  • Headache
  • Numbness
  • Crawling, numbness, burning, itching, prickling, tingling or feeling of pins and needles
  • Black or red, tarry stools
  • Back pain
  • Bleeding gums
  • Paralysis
  • Dark or red-brown urine
  • Increased vaginal bleeding or menstrual flow
  • Leg weakness
  • Nosebleeds
  • Vomiting of material that looks like coffee grounds or blood
  • Coughing up blood

Less common:

  • Fainting
  • Wound secretion
  • Pain in the legs or arms

Rare:

  • Painful or difficult urination
  • Burning while urinating

Incidence not known:

  • Irregular or fast heartbeat
  • Fever with or without chills
  • Blistering, loosening, or peeling of the skin
  • Diarrhea
  • Severe headache
  • General feeling of weakness or tiredness
  • Hives, skin rash, or itching
  • Muscle or joint pain
  • Loss of appetite
  • Side or lower back pain
  • Unusual bruising or bleeding
  • Unusual weakness or tiredness
  • Stomach or abdominal swelling or pain
  • Chills
  • Clay-colored stools
  • Hoarseness or a cough
  • Dark urine
  • Blurred vision
  • Red, irritated eyes
  • Yellow skin or eyes
  • Vomiting or nausea
  • Swelling or puffiness of the eyelids or around the tongue, lips, eyes or face
  • Red skin lesions, often with a purple center
  • Sore throat
  • Ulcers, white spots or sores or white spots on the lips or in the mouth
  • Tightness in the chest
  • Unpleasant breath odor

As well as the above, you could experience some side effects which, though unpleasant, may not necessarily warrant immediate medical attention. In many cases, such side effects may pass. If you experience any of the below and are worried or if they are cooling you prolonged discomfort, you can still contact your doctor. They may decide to alter your dosage or could advise upon other methods to lessen the unwanted effects.

Less common:

  • Muscle spasms
  • Blisters

As well as all of these side effects, others may occur. If you think they are related to you taking rivaroxaban and you are worried about them, then contact your doctor.

Dosage

Depending on your exact medical situation and the intended purpose of the drug, your dosage may vary compared to other patients. Below, you can find average dosage allowances, but they should not affect how much you take. Instead, follow the exact guidelines as laid out by your doctor. The total amount you take will also depend on the strength of the tablets you are prescribed, as well as your amount of doses each day and time between doses.

If you have just had hip replacement surgery and are trying to prevent deep vein thrombosis:

  • Adults: Take 10 mg once per day for 35 days. Your first dose should be at least 6-10 hours following your surgery.
  • Children: The exact dosage and proper use will be outlined by your doctor.

If you have just had knee replacement surgery and are trying to prevent deep vein thrombosis:

  • Adults: Take 10 mg once per day for 12 days. Your first dose should be at least 6-10 hours following your surgery.
  • Children: The exact dosage and proper use will be outlined by your doctor.

If you are attempting to prevent a recurring problem of deep vein thrombosis and pulmonary embolism:

  • Adults: Take 20 mg once per day alongside food.
  • Children: The exact dosage and proper use will be outlined by your doctor.

If you are preventing strokes and blood clots and have nonvalvular atrial fibrillation:

  • Adults: Take 15 to 20 mg once per day with your evening meal.
  • Children: The exact dosage and proper use will be outlined by your doctor.

If you are treating deep vein thrombosis or pulmonary embolism

  • Adults: Take 15 mg two times per day with food to start. This shall last 21 days. You may then be prescribed 20 mg to be taken once a day at the same time with food.
  • Children: The exact dosage and proper use will be outlined by your doctor.

When taking rivaroxaban, you are required to take it on a fixed schedule every day. If for any reason you miss a dose, then be sure to contact your doctor or pharmacist straight away, as they can give you accurate instructions. Usually, if you miss a dose and are scheduled to be taking it just once a day, then you should take it as soon as possible and then continue taking it at the same time, as usual, the following day onwards.

If you are trying to treat a blood clot and are taking it twice a day but miss a dose, then you should take your missed dose as soon as possible. If this means taking two doses at the same time, then that is usually acceptable, but then continue as usual the next day. However, you should still contact your doctor to ask if this is the best course of action for you.

Follow your doctor's exact instructions as closely as possible, regardless of whether the information presented here differs. Do not take a higher dosage, have more than you are told to each day or take medication when you have been told to stop. Your medication will likely also come with a medication guide, which you can read to better familiarize yourself with rivaroxaban.

It is usually recommended that the 10 mg tablets are eaten with or without food, whereas the 15 to 20 mg tablets must usually be eaten with food. Regardless, be sure to stick to taking the tablet at the same time each day.

If you are unable to swallow the tablets whole, then here are some other acceptable means to swallow:

  • You may crush the 10, 15 or 20 mg tablets and mix them with a small portion of applesauce. If so, follow immediately by food.
  • If you are using a gastric or nasogastric feeding tube, then the 10, 15 and 20 mg tablets can be crushed and then suspended in 50ml of water to then be administered by tube. Following this, you must have enteral feeding.

Interactions

As mentioned, rivaroxaban has been known to interact with a wide range of things, including many types of drugs. Before your surgery, and ultimately being prescribed this drug to stop deep vein thrombosis, you will be asked about any other drugs you take. You should inform the doctors clearly of all other drugs you are currently taking, including prescription, non-prescription and herbal drugs and any supplements. With this information, they can properly decide if rivaroxaban is the right drug to take or if an alternative would be better suited. They may instead be able to find a different way to limit any potentially harmful or unpleasant side effects that may occur.

Below you can find a list of drugs with which it is not recommended you take rivaroxaban. There is known to be an interaction between these two drugs:

  • Defibrotide

As well as the above, a large range of drugs are known to react with rivaroxaban, but not necessarily as severely. Still, it is not recommended that they are taken in their usual dosages, and your doctor may prescribe a limited dosage of the two, or may request you change one or both of the drugs. Do not make this decision yourself, as your doctor is best placed to alter any of your medications.

  • Tiaprofenic Acid
  • Sibutramine
  • Aceclofenac
  • Dexibuprofen
  • Dexketoprofen
  • Indinavir
  • Acemetacin
  • Amtolmetin Guacil
  • Anagrelide
  • Anistreplase
  • Apixaban
  • Argatroban
  • Aspirin
  • Bemiparin
  • Bivalirudin
  • Tenecteplase
  • Tenoxicam
  • Cangrelor
  • Carbamazepine
  • Celecoxib
  • Choline Salicylate
  • Cilostazol
  • Citalopram
  • Reteplase, Recombinant
  • Warfarin
  • Tolfenamic Acid
  • Rifampin
  • Ritonavir
  • Rofecoxib
  • Selexipag
  • Sertraline
  • Vortioxetine
  • Tolmetin
  • Treprostinil
  • Urokinase
  • Valdecoxib
  • Venlafaxine
  • Bromfenac
  • Bufexamac
  • Droxicam
  • Dipyrone
  • Drotrecogin Alfa
  • St. John's Wort
  • Duloxetine
  • Edoxaban
  • Eliglustat
  • Enoxaparin
  • Oxaprozin
  • Oxyphenbutazone
  • Acenocoumarol
  • Eptifibatide
  • Iloprost
  • Nintedanib
  • Abciximab
  • Itraconazole
  • Ketoconazole
  • Heparin
  • Ibuprofen
  • Epoprostenol
  • Clarithromycin
  • Escitalopram
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Fenoprofen
  • Fepradinol
  • Feprazone
  • Floctafenine
  • Flufenamic Acid
  • Fluoxetine
  • Clonixin
  • Nepafenac
  • Niflumic Acid
  • Nimesulide
  •  Vilazodone
  • Mefenamic Acid
  • Orlistat
  • Lumiracoxib
  • Lepirudin
  • Levomilnacipran
  • Lopinavir
  • Lornoxicam
  • Felbinac
  • Fenofibrate
  • Fenofibric Acid
  • Loxoprofen
  • Flurbiprofen
  • Fluvoxamine
  • Fondaparinux
  • Meloxicam
  • Nabumetone
  • Nadroparin
  • Naproxen
  • Primidone
  • Phenytoin
  • Meclofenamate
  • Streptokinase
  • Sulfinpyrazone
  • Sulindac
  • Telaprevir
  • Prasugrel
  • Ticlopidine
  • Tinzaparin
  • Tirofiban
  • Vorapaxar
  • Nefazodone
  • Parecoxib
  • Milnacipran
  • Morniflumate
  • Paroxetine
  • Pentosan Polysulfate Sodium
  • Phenindione
  • Phenprocoumon
  • Phenylbutazone
  • Ketorolac
  • Piketoprofen
  • Piracetam
  • Piroxicam
  • Pranoprofen
  • Alipogene Tiparvovec
  • Alteplase, Recombinant
  • Clopidogrel
  • Cobicistat
  • Collagenase, Clostridium histolyticum
  • Conivaptan
  • Dabigatran Etexilate
  • Simeprevir
  • Darunavir
  • Desirudin
  • Desvenlafaxine
  • Indomethacin
  • Nimesulide Beta Cyclodextrin
  • Diclofenac
  • Diflunisal
  • Dipyridamole
  • Dalteparin
  • Danaparoid
  • Propyphenazone
  • Proquazone
  • Protein C
  • Ketoprofen
  • Proglumetacin

Beyond these drugs, your doctor will also need to understand the full extent of your dietary intake. There may be an increased chance of harmful side effects occurring if you consume certain food or drink. It may also be the case that rivaroxaban will be likely to react with tobacco or alcohol, so you should be honest about any amounts of those you consume. Your doctor may require you to alter some aspects of your diet to limit any potential interactions from occurring.

Furthermore, any other medical problems you suffer from could weigh heavily on your doctor's ability to prescribe you rivaroxaban. In particular, be clear to make them aware of any of the following you may suffer from.

  • Active major bleeding
  • Prosthetic heart valve (if so, this drug should not be used)
  • Severe or moderate liver disease
  • A recent history of surgery, such as on your spine, brain or eye (if so, use with caution, as there may be an increased risk of bleeding)
  • Bleeding problems
  • Intestinal or stomach ulcer or bleeding
  • Kidney disease (if so, use with caution; your body may be slower in removing the medicine, which could increase the effects of it)
  • Recent history of a stroke
  • Blood vessel problems
  • Catheter insertion in your spine

Warnings

As with taking any prescription drugs, your doctor will first need to consult with you to weigh up the chances of any potentially harmful side effects occurring. Firstly, you will be required to make them well aware of any allergies you face. These allergies could be in relation to animals, food, preservatives, dyes, drugs and, of course, rivaroxaban. It is known to interact with a wide variety of things, so be honest and forthright.

As of writing, no appropriate studies have been performed into an analysis of the relationship between rivaroxaban and pediatric patients. Your doctor will need to fully assess your child before deciding whether it is a suitable drug to prescribe. It may be they would choose a different medication, or alter the dosage compared to what an adult may receive.

The studies performed on geriatric patients with regards to rivaroxaban have not demonstrated any specific problem with using the drug. However, it must be recognized that elderly patients can tend to be more susceptible to blood clots or kidney disease. Your doctor may, therefore, limit the dosage received or switch to a different medicine. If you are prone to such issues, then be sure to make your doctor fully aware before taking rivaroxaban.

As of writing, there is no clear indication whether enough studies have been performed on pregnant women using rivaroxaban. Your doctor will have the most up to date information involving any potential risks. If you are currently taking this drug and you become pregnant, notify your doctor immediately, as they may need to alter your drug or dosage.

Similarly, a lack of studies have been performed regarding women who are breastfeeding, and it is your doctor who is best placed to decide whether rivaroxaban is a suitable drug. They will carefully weigh any potential risks alongside the benefits of using it.

Your doctor will schedule you in for regular appointments when taking rivaroxaban, and some may include blood tests. It is vital you attend all of these so they can properly track your condition.

Whilst taking rivaroxaban, you are more prone to bleeding or bruising, so you should try and avoid the following:

  • Rough sports
  • Other situations leading to being cut or bruised
  • Using razors, fingernail clippers or other sharp objects
  • Forceful blowing of or picking your nose

Whilst using rivaroxaban, make any doctors or dentists who perform on you aware that you are taking it.

As mentioned, this drug can lead to bleeding problems, especially if you suffer from kidney problems or have a catheter in your back for pain medicine or anesthesia (an epidural). Notify your doctor if you suffer from unusual bruising or bleeding, bleeding gums, blood in your stool or urine, black tarry stools, numbness, tingling or weakness or your lower legs or of red pinpoint spots on your skin. This could be a sign that your kidney problems have gotten worse.

If you suffer from any of the following, then contact your doctor immediately as they could be signs of kidney problems:

  • Confusion
  • Dizziness
  • Swelling of your face, hands or ankles
  • Unusual weakness or tiredness
  • Nausea
  • Decreased urine output
  • Rapid weight gain

Be sure to use added caution when using a toothpick, dental floss or toothbrush. Check with your doctor before having any dental work performed and speak to your doctor or dentist, who may advise upon an alternate method to clean your teeth and gums.

If you suddenly stop taking this drug, it could potentially cause a stroke, so don't do so unless instructed by your doctor.

If you are pregnant, planning to become pregnant or suddenly become pregnant whilst taking this drug, inform your doctor immediately.

Under no circumstances should you take any other drugs whilst using rivaroxaban, unless told to do so by your doctor.

Storage

Be sure to store your rivaroxaban in a closed container, away from direct sunlight, heat, and moisture. It should be kept at room temperature and should not be allowed to freeze at any time. Once you are done using your rivaroxaban, dispose of any leftover drugs in a safe and sensible manner, by which your doctor has instructed you to.

The same protocol should be followed if you find that it is out of date. Do not take out of date medication; instead, request a new prescription. Be sure that your rivaroxaban is kept in a safe place away from children, as it can be harmful.

Summary

If you are about to have some form of surgery whereby deep vein thrombosis will be a potential risk, then rivaroxaban is a useful drug in helping to prevent this. However, it should only be taken following a careful medical examination and under strict guidelines, as offered by your doctor. Rivaroxaban is known to react with a wide variety of different drugs and foods and can lead to some potentially worrying side effects, as listed above. If, at any time, you feel such unwanted effects and are worried, contact your doctor immediately.

Try and follow your prescription guidelines as closely as possible, as failing to take a dose or altering the schedule will reduce the intended benefits rivaroxaban offers. Once you are finished with your course of treatment, stop taking the drug. If you feel like you are still at risk or have worrying signs of deep vein thrombosis appearing, contact your doctor immediately.

 

Resources
Last Reviewed:
January 30, 2018
Last Updated:
February 10, 2018