Rivaroxaban

Rivaroxaban is a direct oral anticoagulant (doac, factor xa inhibitor) medicine available in Bangladesh under many brand names. Below are its uses, side effects and precautions — and every brand with its current price.

• Stroke prevention in atrial fibrillation — non-valvular irregular heartbeat
• Deep vein thrombosis (DVT) — treatment and prevention of recurrence
• Pulmonary embolism (PE) — treatment and prevention of recurrence
• After hip or knee replacement surgery — preventing clots
• Coronary or peripheral artery disease — low "vascular dose" with aspirin in selected patients, per specialist

Bleeding is the main side effect, because the medicine deliberately reduces clotting:

• Easy bruising, longer bleeding from cuts
• Nosebleeds, bleeding gums
• Heavier or longer menstrual periods
• Anaemia, tiredness, dizziness
• Nausea, stomach discomfort; occasional liver test changes
• Itching or rash

Seek emergency help for signs of serious bleeding:

• Black or tarry stools, red or pink urine, vomiting blood or coffee-ground material
• Coughing up blood; unusually heavy menstrual flooding
• Bleeding that will not stop with 10 minutes of firm pressure
• Sudden severe headache, one-sided weakness, vision or speech change (possible brain bleed)
• Severe unexplained back pain or weakness after a spinal injection/anaesthesia

• Tell every doctor, dentist and surgeon that you take Rivaroxaban before any procedure, operation, tooth extraction or injection — it is usually paused 24–48 hours beforehand, but only on the prescriber's instruction, and restarted on schedule afterwards.
• Never miss doses and never run out of tablets — keep a few days' reserve, including when travelling.
• Your doctor will check kidney function (and sometimes liver tests and haemoglobin) periodically; attend all reviews.
• Avoid NSAID painkillers (ibuprofen, diclofenac) and aspirin unless specifically prescribed — use paracetamol for everyday pain.
• Limit alcohol; avoid activities with high injury risk; use a soft toothbrush and shave carefully.
• Carry an anticoagulant alert card so emergency staff know you take a blood thinner.
• Tell your doctor about kidney or liver disease, previous bleeding, ulcers or planned pregnancy.

• Other blood thinners (warfarin, heparin, clopidogrel, aspirin): major bleeding risk — combined only under specialist supervision
• NSAID painkillers (ibuprofen, diclofenac, naproxen): increase bleeding risk
• Azole antifungals (ketoconazole, itraconazole) and HIV protease inhibitors (ritonavir): strongly raise rivaroxaban levels — combination avoided
• Rifampicin, carbamazepine, phenytoin, St John's Wort: reduce rivaroxaban levels — risk of clot despite taking the medicine
• SSRIs/SNRIs (escitalopram, venlafaxine): add to bleeding tendency
• Clarithromycin, erythromycin: may raise levels, important in kidney impairment

Tell your doctor about all medicines, supplements and herbal products you use.

• Allergy to rivaroxaban
• Active major bleeding — such as bleeding ulcer or brain haemorrhage
• Conditions with high risk of major bleeding (recent brain/spine surgery, oesophageal varices, certain aneurysms)
• Liver disease with coagulopathy (including Child-Pugh B and C cirrhosis)
• Severe kidney failure (per the doctor's assessment of creatinine clearance)
• Pregnancy and breastfeeding
• Mechanical heart valves and antiphospholipid syndrome — warfarin is required instead

Pregnancy: Rivaroxaban is contraindicated in pregnancy — it crosses the placenta, carries a bleeding risk and safety has not been established. Women of childbearing age should use reliable contraception while taking it. If you become pregnant or plan to conceive, contact your doctor immediately; anticoagulation is usually switched to injectable heparin, which does not cross the placenta.

Lactation: Rivaroxaban passes into breast milk and must not be used while breastfeeding. Your doctor will either choose a breastfeeding-compatible anticoagulant or advise on feeding options.

Store below 30°C in a cool, dry place away from direct sunlight and moisture. Keep in the original blister pack until use, and keep out of the reach of children. Do not use after the expiry date.