Xarelto

Xarelto is an anticoagulant medicine (blood thinner) that is used to treat and prevent dangerous blood clots in your blood vessels. This medicine reduces the risk of thrombosis.

Xarelto is an anticoagulant medicine (blood thinner) that is used to treat and prevent dangerous blood clots in your blood vessels. This medicine reduces the risk of thrombosis.

Xarelto contains the active ingredient rivaroxaban, also known as a direct oral anticoagulant. This medicine works by binding to a protein involved in the blood clotting process, clotting factor Xa. This inhibits the formation of chemicals that activate clotting factors in the blood, thereby making the blood less able to clot.

Taking Xarelto does not require additional medical care, such as blood testing at an anticoagulant clinic as is the case with the use of other blood thinners.

Sometimes blood clots can form inside the blood vessels. The reactions that result in the formation of a blood clot are balanced by other reactions that stop the clotting process. This balance can get disrupted. The clot can block a blood vessel or travel in the bloodstream and eventually get lodged in a blood vessel that supplies a vital organ. This is called thrombosis. The consequences are serous: a blocked, or partially blocked, artery or vein can cause a heart attack, stroke or pulmonary embolism.

Xarelto prevents and treats clot formation, thereby reducing the risk of thrombosis.

Xarelto is primarily prescribed for:

• Preventing blood clots in patients that have had hip or knee replacement surgery.
• Preventing blood clots that could cause a stroke in patients with a type of irregular heartbeat called atrial fibrillation.
• Treating blood clots in the veins of the legs (deep vein thrombosis) or in the lungs (pulmonary embolism) and preventing recurrence.

It is important to follow the instructions given by your doctor or pharmacist when using Xarelto. The general guidelines for use are as follows:

• The tablets should be taken at the same time each day to avoid missing a dose. Direct oral anticoagulants need to be taken consistently every day in order to be effective.
• If you need to take this medicine twice a day, then space the doses evenly throughout the day (e.g., morning and evening).
• Tablets of 15 mg and 20 mg should be taken with food. Tablets of 2.5 mg and 10 mg can be taken with or without food.
• The tablets should be swallowed whole with some water. If you have difficulty swallowing the tablets, they may be crushed prior to administration and taken with some apple sauce or dissolved in water.
• Missed a dose? If you take this medicine once a day, take your missed dose as soon as you remember. If you take this medicine twice a day, you may take it as soon as you remember unless it is almost time for your next scheduled dose. If you do not remember until the following day, then skip the missed dose and continue with your regular dosing schedule.

For more information on how to use Xarelto, see the package leaflet.

Xarelto comes in tablets of 2.5 mg, 10 mg, 15 mg and 20 mg. Strength, length of treatment and daily dose must be determined by a doctor. The general guidelines for use are as follows:

• Adults:

Depending on the condition: prescribed dose and strength, once or twice a day.

• Children:

Xarelto tablets are only suitable for use in children weighing 30 kg or more. The dosage should be determined by a doctor.

For more information on the dosage of Xarelto, see the package leaflet.

The following are some of the side effects that may be associated with Xarelto. Just because a side effect is stated here doesn't mean that all people taking Xarelto will experience that or any side effect. Possible side effects include:

• Increased risk of bleeding, for example nosebleeds, bleeding from bruising or bleeding in other areas. If you notice blood in your urine or your stools, bleeding in the eyes, unusual vaginal bleeding or if you vomit blood or cough up blood, it's important that you let your doctor know straight away.
• Gastrointestinal symptoms such as nausea, stomach pain, diarrhoea and constipation.
• Fever.
• Itching, skin rash.
• Headache.
• Dizziness.

See the package leaflet for a complete list of side effects of Xarelto. If you experience any of the side effects detailed above or any other side effects, you should consult a doctor.

This anticoagulant medicine is not suitable for everyone. Do not use Xarelto if you:

• are allergic to the active ingredient rivaroxaban or any other ingredient in this medicine.
• currently have any severe bleeding or have kidney problems.
• have any condition that increases the risk of bleeding, such as a liver disease, an aneurysm or a peptic ulcer.
• are taking other anticoagulant medicines (unless you are switching to Xarelto).
• are pregnant or breastfeeding.

In some cases, Xarelto should be used with extreme caution. For instance, if you:

• have an increased risk of bleeding due to a kidney disease, high blood pressure, or certain lung disorders, eye disorders or gastrointestinal condition.
• suffer from antiphospholipid syndrome.
• have an artificial heart valve.

For more information on warnings, see the package leaflet. If the above applies to you or if you are not sure whether this medicine is suitable for you, speak to a doctor.

Some medicines may interfere with the effectiveness of other medicines. This is called interaction: an adverse reaction caused by a combination of medicines. Xarelto is known to interact with the following medicines:

• Medicines that can affect blood clotting, such as aspirin (acetylsalicylic acid), phenprocoumon and acenocoumarol.
• Anti-inflammatory painkillers (NSAIDs) such as diclofenac and celecoxib.
• Certain medications to slow down heart rate.
• Certain antidepressants (including second-generation antidepressants (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) as well as the herbal medicine St John's Wort).
• Certain antiretroviral medications (e.g. ritonavir).
• Certain antifungal medicines (e.g. ketoconazole).
• Certain anti-epilepsy medicines (e.g. carbamazepine).

For a complete list of medicines that may interfere with the way Xarelto works, please see the package leaflet. Your doctor will also have a list of medicines that you should avoid mixing Xarelto with.

Xarelto is only available at pharmacies or online pharmacies.

Xarelto is a prescription-only medicine. This means you need a prescription from a registered doctor to obtain it.

Package leaflet Xarelto 15 mg 20 mg film-coated tablets. (n.d.). Apotheekvoorzorg.nl. Consulted on 21 July 2021 on https://www.apotheekvoorzorg.nl/Leden/Assortiment/bijsluiters/12338.pdf

Royal Dutch Pharmaceutical Society. (14 July 2021). Rivaroxaban. Apotheek.nl. https://www.apotheek.nl/medicijnen/rivaroxaban?product=xarelto

Netherlands Thrombosis Foundation. (21 June 2021). What are Direct Oral Anticoagulants (DOACs)? Thrombosis Foundation. https://www.trombosestichting.nl/trombose/behandeling/doac/

Dutch National Health Care Institute. (n.d.). Rivaroxaban. Farmacotherapeutic Compass. Consulted on 21 July 2021 on https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/r/rivaroxaban