Xarelto 20: Uses, How It Works, Side Effects

What is Xarelto 20 used for?

Xarelto 20 is a prescription medicine. It is used, on a doctor's advice, to treat and prevent blood clots and to lower the risk of clot-related stroke in some people.

• Treating deep vein thrombosis (a clot in a leg vein) and pulmonary embolism (a clot in the lung), and preventing them from coming back
• Lowering the risk of stroke and clots elsewhere in the body in adults with atrial fibrillation not caused by a heart valve problem
• In some adults with coronary or peripheral artery disease, lowering the risk of heart attack and stroke, usually together with another medicine, when a doctor judges it suitable

How does Xarelto 20 work?

Blood clots when a chain of clotting proteins is switched on one after another. Rivaroxaban blocks one of these proteins, called factor Xa, which is a key step in the chain. With factor Xa blocked, the blood forms clots more slowly and existing clots are less likely to grow.

What happens in your body after you take it

1. You swallow the tablet with food

   The tablet dissolves in the gut and rivaroxaban is absorbed into the blood. Taking it with food helps the body absorb the full dose.

2. It travels in the blood

   Rivaroxaban is carried around the body attached to blood proteins and reaches the blood flowing through the veins and arteries.

3. It blocks factor Xa

   Factor Xa is a clotting protein that helps make thrombin, which builds the clot. Rivaroxaban attaches to it directly and stops it working.

4. Clot formation slows

   With less thrombin made, clots form and grow more slowly, which lowers the risk of a clot blocking a vessel in the legs, lungs, heart or brain.

5. The body clears it

   Rivaroxaban is removed by the kidneys and the liver. In healthy adults its half-life is about 5 to 9 hours, longer in older people, so doses must be taken on time. People with kidney or liver problems may need a different plan.

How to take Xarelto 20

Take Xarelto 20 exactly as your doctor has prescribed or as printed on the pack. Your doctor decides the dose and how long you need it, and may change it depending on your condition and kidney function.

• Take it with food, at the same time each day, as your doctor has told you.
• If you miss a dose, take it as soon as you remember. If it is almost time for the next dose, skip the missed one. Do not take two doses together to make up.
• Do not stop taking it unless your doctor tells you to. Stopping early can raise the risk of a clot or stroke.
• Your doctor may check your kidney function from time to time.
• Carry a card or note saying that you take an anticoagulant, and tell every doctor and dentist.

Side effects of Xarelto 20

Bleeding is the most common side effect. Some bleeding is minor, but some needs urgent medical help.

Uncommon or mild

• Easy bruising
• Nosebleeds or bleeding gums
• Bleeding from cuts that takes longer to stop
• Heavier or longer periods

Who should be careful

Some people need to check with a doctor before taking Xarelto 20, or need extra care while taking it.

• Do not stop it suddenly or on your own: stopping early can raise the risk of a clot or stroke
• Active bleeding, or a condition that raises bleeding risk such as a stomach or bowel ulcer, recent bleeding in the brain or recent brain or spine surgery
• Liver disease, or kidney disease: the medicine may be unsuitable or the plan may need to change
• Spinal or epidural anaesthesia, or a spinal puncture: tell the doctor that you take it, because clots near the spine can cause lasting paralysis
• Pregnancy and breastfeeding: it is not used; if you could become pregnant, use effective contraception and tell your doctor at once if you become pregnant
• Surgery, tooth extraction or any procedure: tell the doctor or dentist beforehand that you take it
• Alcohol can add to the risk of bleeding

Medicines and things that interact with Xarelto 20

Xarelto 20 can change how other medicines work, and some medicines change its effect. This is not a complete list, so tell your doctor or pharmacist about everything you take, including herbal remedies and painkillers bought over the counter.

• Other blood thinners such as warfarin, and antiplatelet medicines such as aspirin or clopidogrel: the risk of bleeding rises, so they should be used together only on a doctor's advice
• NSAID painkillers such as ibuprofen or diclofenac: they raise the risk of bleeding
• Some antifungal medicines and HIV medicines: they can raise the level of rivaroxaban and are usually avoided
• Some epilepsy medicines, some antibiotics and St John's wort: they can lower or change its effect
• Some antidepressants (SSRIs): may add to the risk of bleeding

If someone takes too much

Storage

Store below 30 C in a dry place, protected from light and moisture, in the original pack, and out of the reach of children. Do not use after the expiry date. Check the pack for the exact storage instructions.

Regulatory status in India

Approved for sale in India as a prescription medicine. Single-ingredient rivaroxaban is not known to be on the CDSCO list of medicines banned under section 26A of the Drugs and Cosmetics Act. Xarelto 20 contains rivaroxaban only.

Other brands with the same medicine

Rivaroxaban 20 mg tablets are sold under other brand names and as generic medicines. They contain the same medicine; check the label for the strength. Rivaroxaban is made in other strengths that are used differently, so never switch strength or product without asking your doctor.

Other strengths and forms

Rivaroxaban is sold in other strengths, such as lower-strength tablets used for different conditions. The strength is printed on the pack and is not the same across products, so check the label of the one you have.

Common questions