Rivaroxaban is a type of medicine known as an anticoagulant, or blood thinner.

It makes your blood flow through your veins more easily. This means your blood will be less likely to make a dangerous blood clot.

People who are more at risk of developing a blood clot include those who have:

• an abnormal heartbeat (atrial fibrillation)
• recently had surgery to replace a hip or knee joint
• unstable angina
• coronary heart disease
• peripheral artery disease

It's also used to treat people who have had a health problem caused by a blood clot, such as:

• a stroke
• a heart attack
• a blood clot in the leg (deep vein thrombosis, or DVT)
• a blood clot in the lungs (pulmonary embolism)

Rivaroxaban is only available on prescription. It comes as tablets.

• It's usual to take rivaroxaban once or twice a day.
• Take rivaroxaban just after you have eaten a meal or snack. It's important to take it with food to help your body absorb the whole dose.
• The most common side effect of rivaroxaban is bleeding more easily than normal, such as having nosebleeds, heavier periods, bleeding gums and bruising. It tends to happen in the first few weeks of treatment or if you're unwell.
• Always carry your anticoagulant alert card with you. Show it to your doctor or dentist before you have surgery or dental treatment. It's important they know you're taking rivaroxaban, as it may put you at risk of bleeding.
• Rivaroxaban is also called by the brand name Xarelto.

Rivaroxaban can be taken by adults aged 18 and over.

Rivaroxaban is not suitable for some people. Tell your doctor if you:

• have had an allergic reaction to rivaroxaban or any other medicines in the past
• are trying to get pregnant or you're already pregnant - rivaroxaban can be harmful to your baby
• have liver problems
• are taking any other medicines that affect blood clotting, such as warfarin
• have any injuries that are currently bleeding a lot (such as a wound or a stomach ulcer)
• are taking the herbal remedy St John's wort (often taken for depression)
• have antiphospholipid syndrome, a condition that affects the immune system and makes you more likely to get blood clots

It's very important to take rivaroxaban as your doctor has told you.

It's usual to take it once a day just after you have eaten a meal or snack.

It's important to take rivaroxaban with some food to help your body absorb the whole dose. Try to take it at the same time every day.

People who are taking rivaroxaban to treat DVT or a pulmonary embolism may need to take it twice a day for the first few weeks. Your doctor will tell you if you need to do this.

If you have trouble swallowing pills, speak to your doctor or pharmacist.

You can crush rivaroxaban tablets and mix them with water or apple purée. Swallow this mixture, then eat some food straight away.

How much will I take?

Your dose of rivaroxaban depends on why you're taking it:

• For people with a heart condition called atrial fibrillation - the usual dose is 20mg a day. But your doctor might prescribe a lower dose if you have kidney disease and are at a higher risk of bleeding.
• For people who have had a blood clot (DVT or pulmonary embolism) - the usual dose is 20mg a day. You might need to take a dose of 15mg twice a day for the first few weeks of taking rivaroxaban. If you have kidney disease and are at a higher risk of bleeding, your doctor may prescribe a lower dose.
• For people who have had an operation to replace a hip or knee joint - the usual dose is 10mg a day.
• For people who have had a heart attack or have a heart condition called unstable angina - the usual dose is 2.5mg twice a day.

If you're unsure what dose you need to take, check with your doctor or pharmacist.

What if I forget to take it?

What you need to do depends on the dose you normally take:

• If you normally take 10mg, 15mg or 20mg once a day - take a dose as soon as you remember, unless it's nearly time for your next one. Take your next dose at the usual time and then carry on as normal. Never take more than 1 dose in a single day.
• If you normally take 15mg twice a day - take a dose as soon as you remember. You can take 2 x 15mg tablets at the same time to get a total of 2 doses in 1 day. Never take more than 2 doses in 1 day.
• If you normally take 2.5mg twice a day - take a dose as soon as you remember, unless it's nearly time for your next one. Do not take a double dose to make up for a missed one. Take your next dose at the usual time, and then carry on as normal.

It's very important that you remember to take rivaroxaban every day.

If you forget doses often, it may help to set an alarm to remind you.

You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

If you're worried, contact your doctor or pharmacist.

What if I take too much?

Ask your doctor or pharmacist for advice straight away, as overdose puts you at risk of bleeding.

How long will I take it for?

How long you need to take rivaroxaban will depend on why you're taking it.

If you have had an operation to replace your knee or hip joint, you'll probably take rivaroxaban for 2 to 5 weeks.

If you have had a blood clot (DVT or pulmonary embolism), you'll normally take rivaroxaban for at least 3 months. Depending on what caused the blood clot, you might need to take it for longer.

If you have a heart problem like atrial fibrillation or have had a heart attack, you might need to take rivaroxaban long term or even for the rest of your life.

Anticoagulant alert card

Your doctor or pharmacist will give you an anticoagulant alert card.

Carry this with you all the time. It tells healthcare professionals that you're taking an anticoagulant. This can be useful for them to know in case of a medical emergency.

If you need any medical or dental treatment, show your anticoagulant alert card to the nurse, doctor or dentist.

This includes before you have vaccinations and routine sessions with the dental hygienist.

Your doctor may advise you to stop taking rivaroxaban or reduce your dose for a short time.

Switching from warfarin to rivaroxaban

If you need to switch from warfarin to rivaroxaban, your doctor will advise you when to stop taking warfarin. This will probably be a few days before you start rivaroxaban.

Your doctor or anticoagulant clinic will do a blood test called the international normalised ratio (INR) to check how quickly your blood's clotting.

This is to help decide exactly when you should start taking rivaroxaban.

Switching from rivaroxaban to warfarin

If you need to switch from rivaroxaban to warfarin, you may need to take both medicines together for a few days.

Your doctor or anticoagulant clinic will do a blood test called the international normalised ratio (INR) to check how quickly your blood's clotting.

This is to help decide exactly when you should stop taking rivaroxaban.

While rivaroxaban has enormous benefits, the downside is that it can make you bleed more than normal.

This is because while you're taking rivaroxaban, your blood will not clot as easily.

Less serious bleeding

It's usual to bleed more easily than normal while you're taking rivaroxaban.

The kind of bleeding you might have includes:

• periods that are heavier and last longer than normal
• bleeding for a little longer than usual if you cut yourself
• occasional nosebleeds (that last for less than 10 minutes)
• bleeding from your gums when you brush your teeth
• bruises that come up more easily and take longer to fade than usual

This type of bleeding is not dangerous and should stop by itself.

If it happens, keep taking the rivaroxaban, but tell your doctor if the bleeding bothers you or does not stop.

Things you can do to help yourself

• Cuts - press on the cut for 10 minutes with a clean cloth.
• Nosebleeds - find out how to stop a nosebleed or watch this video on stopping nosebleeds.
• Bleeding gums - if your gums are bleeding, try using a soft toothbrush and waxed dental floss to clean your teeth.
• Bruises - these are harmless, but can be unsightly. It might help to make them fade more quickly if you put an ice pack wrapped in a towel over the bruise for 10 minutes at a time several times a day.

What you can do to prevent bleeding

While you're taking rivaroxaban, be careful when you do activities that might cause an injury or a cut or bruising.

It can help to:

• stop playing contact sports or other activities than can cause a head injury, such as football, rugby, hockey and horse riding
• wear gloves when you use sharp objects like scissors, knives and gardening tools
• stop wet shaving or removing hair with wax - use an electric razor or hair-removing cream instead
• take dentures (false teeth) or retainers out for a few hours a day, if you wear them, to give your gums a rest - do not wear dentures or retainers that do not fit properly
• tell your doctor, dentist or nurse that you take rivaroxaban before you have any medical or dental procedures or surgery - this includes vaccinations and routine appointments with the dental hygienist

Serious bleeding

Occasionally, you can have serious bleeding from taking rivaroxaban.

This can be dangerous and needs urgent medical attention.

Like all medicines, rivaroxaban can cause side effects, although not everyone gets them.

Very rarely, rivaroxaban can lead to bleeding in the brain. This can cause a very severe headache, fits (seizures), changes to your eyesight, numbness or tingling in your arms or legs, and make you feel very tired, weak or sick.

If you suddenly get any of these symptoms, contact your doctor immediately. This is an emergency.

Common side effects

These common side effects happen in more than 1 in 100 people.

They're usually mild and do not last long, but talk to your doctor or pharmacist if these side effects bother you or do not go away:

• tiredness and lack of energy, shortness of breath, noticeable heartbeats (heart palpitations) and pale skin - these can be signs of anaemia
• feeling dizzy or lightheaded
• a mild rash
• feeling or being sick (nausea or vomiting)

Serious allergic reaction

In rare cases, rivaroxaban can cause a serious allergic reaction (anaphylaxis).

These are not all the side effects of rivaroxaban.

For a full list, see the leaflet inside your medicines packet.

What to do about:

• signs of anaemia - talk to your doctor, who may arrange a blood test.
• feeling dizzy or lightheaded - if rivaroxaban makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so you do not faint, then sit until you feel better. If the dizziness does not go away or keeps happening, speak to your doctor. They may arrange a blood test to see if you have anaemia.
• a mild rash - it may help to take an antihistamine, which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you. If the rash does not go away within a few days, speak to your doctor.
• feeling or being sick (nausea or vomiting) - stick to simple meals and do not eat rich or spicy food. If you're vomiting, try having small, frequent sips of water to avoid dehydration.

Rivaroxaban is not normally recommended during pregnancy or while breastfeeding.

Some medicines and supplements can interfere with rivaroxaban.

This can lead to serious side effects.

Tell your doctor if you're taking these medicines before starting rivaroxaban:

• any other anticoagulant, such as warfarin or enoxaparin
• drugs to treat fungal or bacterial infections, such as fluconazole, erythromycin or clarithromycin
• drugs to treat HIV, such as ritonavir
• drugs to treat epilepsy, such as carbamazepine or phenytoin
• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin

Can I take rivaroxaban with everyday painkillers?

You can take paracetamol while you're taking rivaroxaban.

Do not take aspirin or ibuprofen while you're taking rivaroxaban unless a doctor has said it's OK to. They increase the chance of bleeding.

Mixing rivaroxaban with herbal remedies and supplements

Do not take St John's wort, the herbal remedy for depression, while you're taking rivaroxaban.

It can increase your risk of side effects.