Xarelto®
definition
Xarelto® is a drug with the active ingredient rivaroxaban and is one of the new oral drugs for anticoagulation, colloquially known as blood thinners.
It is a direct inhibitor of a factor in blood clotting. Xarelto® is used in particular for the prophylaxis of strokes in the case of atrial fibrillation, but it also has a number of other indications.
Compared to other drugs, Xarelto® has the advantage that the intake does not have to be monitored by constant blood tests.
Xarelto® requires a prescription and the dose must be precisely determined by the family doctor.
Indications for Xarelto®
The diseases which require taking Xarelto® are all to be found in the area of blood clotting. The most common reason to take Xarelto® is atrial fibrillation.
The uncontrolled movements of the atria can cause blood clots to form and reach other organs from the heart. These can then trigger a stroke in the brain. Xarelto® reduces blood clotting and can therefore be used for prevention.
Even after heart valve surgery and other heart operations, those affected must take Xarelto® or other anticoagulants for life. After hip or knee replacement operations, some people have to take Xarelto® for a few months to prevent thrombi in the veins and the associated pulmonary embolisms.
After lung embolisms, thromboses or strokes have already been overcome, Xarelto® can be used to prevent the disease from recurring. Deep vein thrombosis is an indication that can lead to long-term use of Xarelto® even in young people. However, young women should use good contraception, as Xarelto® must not be taken during pregnancy.
Read more on the topic: Causes of Thrombosis
Xarelto® for thrombosis prophylaxis
One indication for taking Xarelto® is the prevention of thrombosis. This is carried out for groups of people who are at increased risk of thrombosis. These include people after major operations, bedridden people, genetic predispositions, tumor diseases and people who have already suffered a thrombosis.
Other drugs are also available for thrombosis prophylaxis, some of which have to be injected, while Xarelto® can be taken as a tablet.
Read more on the topic:
- Postoperative thrombosis prophylaxis
- Thrombosis prophylaxis: start and duration
Side effects of Xarelto®
Xarelto® works on blood clotting and thus influences an important control process in the body. This can lead to sometimes serious side effects. The side effects of Xarelto® can be broken down according to frequency.
Common side effects are: anemia, dizziness and headache, eye and conjunctival bleeding, nosebleeds, bleeding gums, bleeding in the gastrointestinal tract, nausea and vomiting, constipation or diarrhea, itching, extremity pain, blood in the urine, fever, water retention, tiredness and postoperative bleeding after surgery.
Occasional side effects are: changes in the blood count, allergic reactions, cerebral haemorrhage and liver dysfunction.
Rare side effects are: jaundice, muscle bleeding and liver inflammation. Very rare side effects are: allergic shock, Stevens-Johnson syndrome and DRESS syndrome.
Read more on the topic: Side effects of Xarelto®
Side effect: hair loss
The frequent small bleeding throughout the body can lead to a lack of blood when taking Xarelto®, i.e. a anemia, as the new formation of blood cannot keep up with the loss. This leads to a lack of oxygen throughout the body.
The body prioritizes which cells are essential for life and are therefore supplied with oxygen first. Since hair is not essential for life, the hair follicles are poorly supplied with even a slight deficiency and the hair will fall out.
Read more on the topic: Causes of hair loss
The formation of blood can be stimulated by certain dietary supplements and medication and thus hair loss can be stopped. However, it is important that major sources of bleeding are identified and the cause is combated.
Read more on the topic:
- This is how you fix an iron deficiency
- Foods with iron
Side effect: weight gain
Studies could not find a connection between taking Xarelto® and significant weight gain. Those affected who report weight gain often have other factors that can explain this change in body weight.
Xarelto® is often used after operations for thrombosis prophylaxis and these operations are often associated with a lack of exercise. Impaired mobility can contribute to excess calories and weight gain.
Read more on the topic: Successful weight loss through weight training
Side effect: diarrhea
Diarrhea or general gastrointestinal complaints are among the more common side effects of Xarelto®. This can have different reasons.
Approximately half of Xarelto® is excreted in the stool. This can lead to irritation in the intestine and disrupt the absorption of water in the intestine.
Intolerance to components of the drug can also trigger diarrhea. If the diarrhea is bloody, the cause of the bleeding should be investigated.
Read more on the topic: Home remedies to treat diarrhea or diet for diarrhea
Side effect: tiredness
Fatigue is a typical symptom of anemia, which is a relatively common side effect when taking Xarelto. The red blood cells transport oxygen in the body and the brain in particular needs a lot of oxygen. Frequent bleeding therefore leads to the loss of red blood cells and thus to a poorer oxygen supply. The brain saves oxygen by reducing its performance and making those affected feel tired and limp.
Read more on the topic:
- Symptoms of iron deficiency
- Always tired - what can I do?
Side effect: nosebleeds
Especially in the cold season, the mucous membranes of the nose are often irritated and dry. In the case of slight irritation, such as blowing your nose, the veins can burst and bleed. In people taking Xarelto®, the bleeding may be more severe because Xarelto® restricts normal bleeding. This can lead to a great deal of blood loss.
The bleeding can often be stopped by local compression, i.e. squeezing the nose. If the bleeding does not stop, a doctor should be consulted or if the bleeding is very heavy and the associated circulatory problems, the emergency services should be notified.
Read more on the topic: How can you stop nosebleeds?
Side effect: muscle and joint pain
When taking Xarelto®, the probability of bleeding increases in all areas of the body. With minor injuries, which usually do not lead to excessive bleeding, those affected develop bruises.This also happens in joints and muscles and therefore often leads to pain when exercising after exercise or minor injuries.
With larger blunt injuries, there is a risk of compartment syndrome. This is a constriction of nerves and muscle tissue due to increased bleeding and represents an acute danger. In the event of significant movement restrictions, the attending physician should be consulted.
Read more on the topic: How do you treat a bruise?
Interaction with other drugs
Some medicines for fungal infections or HIV can inhibit the breakdown mechanisms of Xarelto®, so that higher doses of Xarelto® are present in the body. This increases the risk of bleeding. Some antibiotics have a similar, but somewhat weaker effect on Xarelto®.
Other anticoagulants also increase the risk of bleeding.
Medicines that increase the breakdown process of Xarelto® can weaken its effect and thus lead to thrombi and strokes.
Effectiveness of the pill
The contraceptive pill is a widely used contraceptive measure and since women who take Xarelto® should pay attention to contraception, it is a possible safeguard. However, since Xarelto® is partly converted and broken down via a mechanism that is also responsible for the pill, the effect of both substances can be changed.
Contraception is therefore not as safe as it is for people who are not taking Xarelto. Additional contraception, for example with condoms, makes sense.
Read more on the topic: Which drugs affect the way the pill works? or pill doesn't work
Contraindications for Xarelto®
Young women should use good contraception, as pregnancy and breastfeeding are contraindications for taking Xarelto®.
Certain liver diseases that affect blood clotting can also rule out the use of Xarelto®.
Read more on the topic: Hepatic insufficiency
If the kidney function is significantly impaired, Xarelto® cannot be used or the dose can be reduced, as part of the drug is excreted through the kidneys.
Read more on the topic: Renal failure
Xarelto® should not be taken before a spinal cord anesthesia or surgery with large blood loss.
Read more on the topic: Spinal anesthesia
Use during pregnancy and breastfeeding
Studies have shown that the active ingredient rivaroxaban, which is contained in Xarelto®, can pass both the placental barrier and through breast milk. If the unborn child passes through the placenta, symptoms of poisoning are possible and the risk of bleeding for mother and child is too high.
Xarelto® should therefore not be taken during pregnancy or while breastfeeding. If the indication for anticoagulant is nevertheless given, alternative medication should be considered and the mother's blood clotting should be closely monitored.
Read more on the topic: Medication during pregnancy
What should be considered in case of renal insufficiency?
Xarelto® is partially metabolized and excreted via the kidneys. If the kidney function is severely restricted, this degradation can be inhibited. This means that the active ingredient stays in the blood longer and works longer. Depending on the severity of the restriction, the dosage of Xarelto® must therefore be adjusted.
Read more on the topic: Stages of renal failure
Alternative substances should be used in patients who require dialysis, as Xarelto® cannot be completely filtered out during dialysis. This makes dosing difficult or even impossible.
Xarelto® and alcohol - are they compatible?
Colloquially, alcohol has a blood-thinning effect, i.e. it has an effect on blood clotting. This is exactly where Xarelto® works, which is intended to specifically reduce blood clotting.
Combined, the intake of Xarelto® and alcohol can mean an increased risk of bleeding and lead to life-threatening internal bleeding or nosebleeds.
You should avoid alcohol while taking Xarelto®. Particularly large amounts of alcohol should be strictly avoided.
Read more on the topic: Xarelto® and alcohol
At which operations do I have to stop using Xarelto®?
Before operations, it must be carefully weighed up whether the risk of bleeding or thrombus is greater.
In major operations with the risk of blood loss, Xarelto® must be discontinued beforehand; Xarelto® can usually continue to be taken for smaller operations such as dental surgery. Major interventions that are not absolutely necessary should only be performed if the risk of thrombus formation can be controlled by other means.
Those affected should clarify whether Xarelto® has to be discontinued in the preliminary discussion with their surgeon and anesthetist.
Read more on the topic: Postoperative anemia
Dosing of Xarelto®
The dosage of Xarelto® depends on various factors.
For the prophylaxis of strokes in atrial fibrillation, Xarelto® 20mg is administered once a day. If the kidney function is poor, the dosage can be reduced.
The following dosage scheme is used to treat deep vein thrombosis: For the first 21 days, those affected take 15mg Xarelto® twice a day and from the 22nd day 20mg once a day. After six months of treatment, Xarelto® is only passed on for prophylaxis and is reduced to 10 or 20 mg once a day. In the case of kidney damage, the dose must be reduced as the active ingredient is broken down more slowly. The dosage may vary depending on the indication for Xarelto®.
Is there an antidote?
Xarelto® has a strong influence on blood clotting and can therefore lead to heavy bleeding as a side effect. In addition, acute illnesses or accidents that require emergency surgery can be dangerous when taking Xarelto.
However, Xarelto® cannot be antagonized, which means there is no antidote. This is a problem with both bleeding complications and overdoses.
The bleeding can therefore only be treated symptomatically. The bleeding can be controlled by manual pressure on a bleeding wound or by using a local anticoagulant. When taken directly, activated charcoal can bind the amount of active ingredient in the gastrointestinal tract that has not yet been absorbed and thus prevent it from being absorbed into the blood. This is a possibility to weaken the effect, especially if Xarelto® is accidentally taken.
The lack of an antidote is a disadvantage of the new oral anticoagulants, since antagonization with vitamin K is possible with the classic Marcumar. However, Xarelto® has a short half-life, so that the active ingredient is broken down by the body itself in a few hours to days and the bleeding only needs to be kept under control until then.
How expensive is Xarelto®?
Xarelto® is a prescription drug that is paid for by health insurers. Statutory health insurance patients only have to pay an additional payment of € 5 and can be exempted from this if they have chronic complaints.
The cost of Xarelto® for self-payers is € 365 for the first three months. Preparations with lower doses for prophylaxis are somewhat cheaper.
Alternatives to Xarelto®
As a direct inhibitor of coagulation factor 10a, Xarelto® is a relatively new active ingredient to inhibit blood clotting. Just like Xarelto®, apixaban and edoxaban also act directly on this factor. These new oral anticoagulants also include thrombin inhibitors such as dabigatran.
The classic alternative to the new oral anticoagulants are the coumarins, i.e. marcumar or warfarin, which inhibit the vitamin K required for clotting.
Read more on the topic: Nutrition at Marcumar
Depending on what is to be treated or prevented with the anticoagulants, other classes of active substances, such as ASA, low molecular weight heparins and pentasaccharides, can also be used.
Read more on the topic: Dosage of Clexane
The treating family doctor should discuss exactly which medication is the right one with his patient.
What should be considered when stopping?
Xarelto® is an active ingredient that is prescribed by the treating family doctor with good reason. Discontinuation should never be carried out without consulting a doctor.
After stopping Xarelto®, the risk of thrombus formation increases significantly and those affected can develop strokes, heart attacks, vascular occlusions and many other life-threatening complications.
In the event of intolerance to Xarelto®, a new active ingredient should therefore be used immediately and not just Xarelto® discontinued. The time without treatment with anticoagulants should be made as short as possible. If the medication is changed, the risk of bleeding also increases, which is a major problem with Xarelto®, as there is no direct antidote for Xarelto®. If there are signs of bleeding, a doctor should be consulted immediately.
The effect of Xarelto® decreases significantly after a few hours to days after stopping it and must therefore be carefully monitored. However, it is not necessary to check the blood levels while taking or stopping Xarelto®.
