In modern orthopedics, the drug Xarelto is widely used - instructions for use, patients and doctors indicate its anticoagulant effectiveness in bone fractures and extensive surgical interventions. The drug helps to eliminate and prevent complications manifested by vascular thrombosis, pulmonary and systemic thromboembolism.
A drug intended for the treatment and prevention of thrombosis, thromboembolism, myocardial infarction. The drug is produced by the German pharmaceutical company Bayer. Tablets are prescribed by a doctor after conducting the necessary tests, excluding the presence of contraindications. If the instructions for use are not followed, the medicine can be harmful to health.
The composition and form of the drug
Xarelto is sold in pharmacies in pill form. The pills have a round, biconvex shape, covered with a film membrane. The tablets are painted in red-brown color, on their surface is engraved by the manufacturer and dosage. According to the instructions, the pills have the composition indicated in the table:
Micronized Rivaroxaban (10, 15, 20 mg)
Sodium Lauryl Sulfate
Dye - Red Iron Oxide
According to the instructions, the drug is a direct-acting anticoagulant. The medicine helps to suppress platelet activation. This pharmacological action helps in the treatment and prevention of thrombosis. The tool has high bioavailability, has a quick effect and a predictable dose-dependent response. Substances included in the composition are excreted by the liver.
The drug is prescribed by doctors after the patient undergoes the necessary diagnostic tests. The instructions for use include the following indications:
- prevention of myocardial infarction, stroke and thromboembolism in patients with non-valve atrial fibrillation;
- treatment of deep vein thrombosis, pulmonary embolism;
- thrombosis prophylaxis;
- the need for preventive measures to prevent venous thromboembolism in patients undergoing surgery on the lower extremities.
Dosage and administration
The instruction prescribes to take the drug inside by 1 tablet twice a day. The course of treatment is 1 year. If necessary, therapy can be extended for another 12 months. If for some reason the reception was missed, according to the instructions, it is recommended to immediately take a pill, then continue using it in the usual way. You can swallow pills regardless of meals.
Caution when prescribing the drug should be observed when the patient is undergoing therapy with drugs that affect hemostasis (platelet aggregation inhibitors, other antithrombotic drugs). Patients who have experienced acute coronary syndrome, taking Xarelto with acetylsalicylic acid, can drink non-steroidal anti-inflammatory drugs, if their use justifies the risk of bleeding.
Patients with the possibility of ulcerative lesions of the gastrointestinal tract are allowed to use appropriate preventive measures. If there has been a decrease in blood pressure or a drop in hemoglobin levels has been noted in a laboratory blood test, specialists should detect a source of bleeding.
When performing spinal or epidural anesthesia, spinal puncture in patients who receive platelet aggregation inhibitors for the prevention of thromboembolism, there is a risk of a hematoma. This phenomenon can cause paralysis. The possibility of complications increases with the use of a permanent epidural catheter, therapy with drugs that affect hemostasis. To reduce the risk of bleeding, it is better to perform a puncture when rivaroxaban will have weak anticoagulant activity.
Xarelto should be discontinued 12 hours before surgery or an invasive procedure. There are known cases of fainting and severe dizziness against the background of the use of a medication. This factor can significantly affect the ability to control vehicles, work with complex mechanisms. If such reactions were noted, patients are forbidden to drive, to manipulate devices that require increased attention.
Studies related to the safety and efficacy of Xarelto during pregnancy have been conducted in animals. As a result, the toxic effect of rivaroxaban on the body of the expectant mother and child was revealed. The drug is contraindicated during pregnancy due to the high risk of penetration of the active substance through the placenta and the possibility of bleeding. For women in childbearing age, medication is allowed only when using contraception.
Studies on the feasibility of taking Xarelto during breastfeeding conducted on animals have shown that the active substance is excreted in milk. Experiments have proven that toxic substances can enter the baby’s body during feeding. Xarelto is allowed to start taking only after the lactation period has ended.
In case of impaired renal and hepatic function
The instructions for use of Xarelto say that taking the drug is contraindicated for people suffering from severe renal failure with creatine clearance less than 15 ml / min. There are no clinical studies. With caution, a medicine is prescribed for patients with a severe form of the disease with a CC of 30-15 ml / min. Under the supervision of a doctor, the drug is used in the treatment of patients with moderate renal failure who simultaneously drink medications that increase the concentration of rivaroxaban in blood plasma.
The use of Xarelto is contraindicated in patients who have liver diseases that occur with coagulopathy. Prescribing can lead to bleeding. The pharmacological activity of the drug may increase in people suffering from impaired functioning of the moderate organ. The presence of other liver diseases in patients taking Xarelto does not require adjustment of the required dose.
The active substance Xarelto is not an inhibitor and does not induce isoenzymes related to the main isoforms of cytochrome. The drug is not recommended to be used simultaneously with systemic therapy with the azole group. Such drugs are potent inhibitors of the CYP3A4 isoenzyme and P-glycoprotein. They can multiply the pharmacological effects of Xarelto. Concomitant use with rifampicin, carbamazepine, phenobarbital reduces the effectiveness of rivaroxaban.
Caution should be exercised when using the drug with parenteral anticoagulants, since such an interaction can cause bleeding. A similar effect is observed when the drug is combined with non-steroidal anti-inflammatory drugs. The combined use of tablets with 500 mg of acetylsalicylic acid did not reveal a clinically significant interaction. There is no data on the combination with dronedarone.
Xarelto and alcohol
Clinical studies have been conducted on the compatibility of Xarelto and alcohol. As a result, it turned out that the use of the drug in conjunction with alcohol can lead to a number of undesirable consequences, provoke the occurrence of side effects and bleeding. The instructions for use of Xarelto say that this drug is forbidden to use with alcohol.
The pharmacological effects of Xarelto may increase the risk of bleeding. Particularly high probability of occurrence in patients suffering from severe arterial hypertension or being treated with drugs that affect hemostasis. Any organs and tissues can become a source of bleeding. The consequences of this negative reaction of the body are the formation of anemia.
Complications of a hemorrhagic nature can be manifested by weakness, edema of unclear etiology, pallor of the skin, dizziness, headache, shock of unknown origin, shortness of breath. Due to anemia, pain in the chest, angina pectoris, which are signs of myocardial ischemia, may occur. Against the background of bleeding, cases of the appearance of renal failure and interfascial space syndrome were recorded.
There are other side effects from taking the drug Xarelto - instructions for use indicate such consequences:
- On the part of the cardiovascular and hematopoietic systems, the appearance of hematomas, thrombocythemia, anemia, tachycardia, a pronounced decrease in blood pressure.
- The skin reacts with a rash, itching, urticaria, hemorrhage, ecchymosis.
- The effect on the immune system is manifested in the form of allergic dermatitis and other reactions.
- Adverse reactions of the digestive system: bleeding gums, pain in the gastrointestinal tract, a feeling of dryness in the mouth, diarrhea, constipation, nausea and vomiting, dyspeptic symptoms.
- From the respiratory system, nosebleeds, hemoptysis are possible.
- The reaction of the organs of vision is manifested in the form of hemorrhage in the eye.
- Jaundice may develop, liver failure may occur.
- From the musculoskeletal system: pain in the limbs, hemorrhage in the muscles, deterioration of their tone, hemarthrosis.
With uncontrolled administration of Xarelto, bleeding may occur. To cope with the consequences of an overdose, reduce the absorption of rivaroxaban, you need to drink activated charcoal. To establish control of bleeding, surgical hemostasis, mechanical compression, infusion therapy are carried out, red blood cells, freshly frozen plasma, and platelet preparations are used.
There are no studies regarding the effectiveness of aminocaproic acid. If treatment has failed, specific procoagulant agents are used. There is limited experience with tranexamic acid overdose with Xarelto. There are no studies on the desirability of using Desmopressin.
The drug can provoke negative changes in the body. Xarelto medicine is forbidden to some categories of patients - the attached instructions for use provide the following contraindications:
- allergic reactions to rivaroxaban or auxiliary components of the medication;
- the presence of active bleeding of clinical significance (intracranial, gastrointestinal);
- liver diseases that occur with coagulopathy (cirrhosis, functional organ disorders);
- therapy with other drugs that have an anticoagulant effect (Warfarin, Enoxaparin, Apixaban);
- severe renal failure;
- treatment of patients who have undergone a transient ischemic attack or stroke with antiplatelet agents;
- pregnancy and lactation;
- age up to 18 years;
- lactose intolerance, congenital lactase deficiency.
There are several conditions under which the drug is prescribed under the supervision of a specialist. With caution, Xarelto is taken in the presence of the following factors:
- increased risk of bleeding;
- severe injuries, wounds;
- moderate renal failure;
- treatment with drugs that affect hemostasis;
- systemic antifungal therapy with agents belonging to the azole group;
- treatment with HIV protease inhibitors.
Terms of sale and storage
Xarelto can only be bought by prescription. The shelf life of the drug is 3 years. In order for the medicine to maintain its therapeutic properties, it must be stored at a temperature not exceeding 30 degrees. Keep the medication out of the reach of children.
The drug has several analogues that are similar in pharmacological action. Before replacing the medication, consult your doctor. Popular analogues of Xarelto are:
- Clexane is a direct anticoagulant, low molecular weight heparin. It is released in the form of a solution for injection. The tool is intended for the treatment and prevention of thrombosis, thromboembolism, myocardial infarction. It is prescribed with caution in the presence of open wounds and serious injuries.
- Pradax - a drug with anticoagulant and antithrombotic effects. It is used in orthopedics during recovery after surgery, if there were no extensive injuries with the threat of bleeding. It is released in the form of capsules.
You can buy the drug in pharmacies or order in online stores. The cost of the drug in different outlets can be compared using the table:
Price (in rubles)
Network "5 mg"
Alice, 38 years old I took this medicine for deep vein thrombosis. The doctor prescribed 15 mg twice a day. I have been undergoing therapy for almost six months. The drug has shown its effectiveness. The pain and feeling of heaviness of the lower extremities gradually disappears. Recent ultrasound diagnostics have revealed improvements.
Svetlana, 43 years old. I had thrombotic masses in the lower extremities. After consulting a doctor, she started using Xarelto 20 mg each. I was a little worried because of the side effects indicated in the instructions, but they did not occur. After 2 months of use, Doppler veins showed that the blood clots resolved, vascular patency returned to normal.
Margarita, 56 years old. When I was diagnosed with an anticoagulant, the doctor prescribed Warfarin. However, after some time I started bleeding, so I replaced Xarelto. The instruction assumes a risk of complications, but they did not arise. The drug is effective, has a convenient form of use - 1 tablet / day.Attention! The information presented in the article is for guidance only. Materials of the article do not call for independent treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment based on the individual characteristics of a particular patient.