Patients undergoing certain surgical procedures are at risk of developing blood clots, with the possibility of this manifesting into stroke or systemic embolism. Various treatment options are presently used for managing and preventing the condition, including the use of anticoagulants. Xarelto, brand name for Rivaroxaban is an anticoagulant that forms part of the treatment for the condition. The first orally active medication in its category it is a better choice over other drugs as it dispenses with the need for lab monitoring in certain circumstances. However, it is not free from undesirable effects; here is an in-depth look at the side effects of Xarelto and tips to prevent and mitigate the effects.
Overview of the anticoagulant and side effects of Xarelto
Belonging to the category of factor Xa inhibitors, Xarelto is prescribed for treating DVT (deep vein thrombosis), apart from PE (pulmonary embolism). The medication is also prescribed for the prevention of thrombosis by virtue of its prophylactic properties. Medications in strengths of 10 mg can be safely taken without the need for food, while stronger dosages of 15 mg or 20 mg need to be taken with food. It is typically prescribed for preventing venous thromboembolic events. Patients undergoing total hip or knee replacements are prone to the risks of blood clots. This may result in possible stroke and systemic embolism, and the medication is effectively used to treat and prevent the condition. It is used for patients diagnosed with nonvalvular atrial fibrillation. It is also used as a combination medication with aspirin for patients diagnosed with chronic artery disease, who are at risk of experiencing cardiovascular events.
Mechanism of action of the anticoagulant
Before we look at the side effects of Xarelto, here is a quick look at the mechanism of action of the medication. This will help understand the reason behind specific restrictions on its use. For instance, the medication is not considered safe for use by individuals below 18 years of age, and is also not prescribed for patients with renal impairment. The drug works by inhibiting the free and clout bound factor Xa that is necessary for the activation of prothrombin from factor II to factor IIa. The activation and the sequence of actions result in the formation of fibrin, that is effectively the completion of the clotting process.
By virtue of the inhibition of factor Xa, the generation of thrombin is halted, thereby preventing the blood clots. It is important to add here that mechanism of action of the drug is irreversible, which means that it is to be prescribed only when there is a clear need to prevent clotting. Additionally, the medication does not have any antidote, which again emphasises on the need for caution.
Recommended dosage for prevention of side effects of Xarelto
Studies have clearly documented the fact that a significant percentage of side effects of medications are attributed to incorrect dosage and improper administration of medications. It is of utmost importance to diligently follow dosage instructions and to take medications as explicitly advised by treating specialists. Available only on prescription, as a tablet, Xarelto is available as 2.5 mg, 10 mg, 15 mg and 20 mg tablets. Here is a look at the ideal dosages for various conditions to prevent side effects of Xarelto. Bear in mind that the below mentioned recommendations are only indicative in nature, and the actual dosages may vary from individual to individual, depending on various factors.
Individuals often make the mistake of taking a double dose to make up for a missed dose. This is to be avoided at all costs, and double dose is never to be taken, as this could result in serious complications. In the event that the patient is unable to swallow the tablet as a whole, the same may be crushed and taken in a mixture containing applesauce. Regardless of the manner in which it is consumed, food is to be consumed immediately after taking the stronger dosages. Patients who are administered medications through a gastric feeding tube are to create a suspension comprising crushed tablets with 50 milliliters (mL) of water, followed by intake of food.
As mentioned above, the dosage may differ from individual to individual, the number of daily doses, and the period of the treatment. For instance, individuals about to undergo/who have undergone hip replacement therapy are prescribed Xarelto for preventing deep venous thrombosis. The ideal dosage is 10 mg per day for a period of one month, with the first dose administered roughly about 10 hours after the procedure. In the case of knee replacement procedures, the dosage is the same, but the period of treatment typically reduces to less than a fortnight. Individuals diagnosed with possibility of recurrent DVT or PE are prescribed 10 mg per day for a period of 6 months. This is often prescribed in combination with blood thinners.
Before we look at the side effects of Xarelto, lets complete learning all about the ideal dosages for various conditions. Lower dosages of the drug are prescribed for preventing stroke and heart attack in individuals who are diagnosed with serious heart ailments. This includes coronary heart disease and periphery artery disease. The typical dosage in such conditions is 2.5 mg per day, taken in combination with aspirin of suitable dosages. Patients diagnosed with nonvalvular atrial fibrillation are recommended dosages of 15 mg per day or 20 mg per day to prevent the formation of blood clots or the avoid the risk of stroke. Finally, 10 mg per day is prescribed for preventing blood clots in patients undergoing hospitalization for certain illnesses. This is taken during the period of hospitalization, and post-hospitalization, for a period of one month.
Precautions to avoid side effects of Xarelto
To prevent side effects of Xarelto, it is necessary to follow certain precautions. The possibility of allergies cannot be ruled out, and individuals with a history of allergies to food products, preservatives, dyes or animal dander are to check the ingredients and consult a specialist prior to taking the medication. This will avoid the possibility of allergies that can actually turn serious in nature in rare instances. Similarly, the efficacy of the medication and possible side effects of Xarelto on children have not been studied. It is therefore necessary to seek specialist advice regarding the use of the medication on youngsters. The same conditions also apply to geriatric patients as the possibility of renal impairment or age – related kidney issues are possible. Dosages are accordingly adjusted to handle this issue, as per medical evaluation.
Side effects of Xarelto : known drug interactions
Drug interactions are a possibility and cannot be ruled out for any medication. Some of the possible side effects of Xarelto are attributed to drug interactions with other medications. Here is a compilation of possible drug interactions that patients need to be aware, so as to seek medical guidance. For instance, patients on defibrotide are advised to avoid the combination of the two medications, and make suitable changes by stopping either or both of the medications, to be replaced by safe combinations.
In certain instances, drug interactions are not serious in nature, but may warrant a change in dosage or timing of intake of either of the medications. For instance, side effects of Xarelto may be experienced if taken along with certain medications like abametapir, aceclofenac or acemetacin etc. The list of medications that could trigger interactions includes Amtolmetin Guacil, Apixaban, Bemiparin, Cangrelor, Cilostazol, Clarithromycin, Clopidogrel, Dalteparin, Dexibuprofen, Dipyridamole, Droxicam, Enoxaparin, Etoricoxib, Flufenamic Acid, Fluvoxamine, Ibrutinib, Ibuprofen, Itraconazole, Ketorolac, Lopinavir, Milnacipran, Naproxen, Nimesulide, Orlistat, Oxyphenbutazone, Phenindione, Phenytoin, Pranoprofen, Ritonavir, Simeprevir, Telaprevir, Tirofiban, Trazodone, Valdecoxib and Warfarin. This list is neither complete nor exhaustive and is mainly for an idea of the types of medications that may interact with Xarelto.
In addition to the above, side effects of Xarelto attributed to mild interactions necessitate the need for altering dosage or schedule. By virtue of the need for taking the medication along with food, it is necessary to choose the right diet. This is because certain dietary preferences may not be the most suitable for intake alongwith medications. Similarly, individuals consuming alcohol or tobacco products are also advised to avoid intoxicants as this could result in possible adverse reactions. These reactions may differ from person to person, as per the amount consumed and its effect on patients.
Finally, side effects of Xarelto are possible in patients with certain pre-existing conditions. For instance, patients diagnosed with antiphospholipid syndrome are to avoid the medication. Similarly, patients with a history of bleeding, or liver complications are also advised to either look at alternative medications or to seek medical advice prior. Individuals diagnosed with cancer are also at risk of developing undesirable effects from the medication. Patients who have had a catheter inserted in the spine or patients with any lung disease are also advised to exercise extreme caution when on Xarelto.
Other conditions that could interact with the medication include patients who have recently suffered a stroke, or individuals with bleeding problems in the stomach. Bleeding as a result of bowel ulcer is also a condition that could end up with adverse reactions. Side effects of Xarelto are likely to be experienced in individuals with renal impairment of any form of kidney diseases. Patients who have been implanted with prosthetic heart valve are not to be put on the medication. During the course of treatment, patients are expected to undergo appropriate tests for the purpose of monitoring various parameters. This includes blood tests and tests on urine samples. During the course of treatment, there is the likelihood of easily sustaining bruises and injuries, and patients are advised to exercise complete caution.