Professional Development Presents April 2016 Med Of The Month. XARELTO (Rivaroxaban)

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1 Med of the Month For any question regarding April 2016 Med of the Month: Xarelto You may contact: Sherr Ann Arabit MSN, RN-BC, CCRN/Professional Development Department Ext 4196

2 Professional Development Presents April 2016 Med Of The Month IN2742 XARELTO (Rivaroxaban) OBJECTIVE: To discuss the use/indication of Xarelto in the management and prevention of clots as an anti-coagulant or blood thinner.

3 Brand Name: Xarelto, Xarelto Starter Pack Generic Name: Rivaroxaban Class: Anticoagulant, Factor Xa Inhibitor Supplied as: 10 mg, 15 mg and 20 mg tablets Route/Dosage & Administration: Treatment of DVT, PE 15mg po BID with food x 21 days, then 20mg po daily with food for >/= 3months. Post-op DVT thromboprophylaxis knee replacement: 10mg po daily x 12 to 14 days or up to 35 days hip replacement: 10mg po daily x 35 days Non-valvular atrial fibrillation 20mg po daily with evening meal 10 mg tablet PO : Take with or without food. 15 mg or 20 mg tablet PO: Take with food. If unable to swallow whole tablets: Tablets may be crushed and mixed with apple sauce immediately prior to use. NG tube/g tube route: Tablets may be crushed and mixed in 50 ml of water, Administer the suspension within 4 hours of preparation. Missed dose: Once-Daily dose: Take a dose as soon as possible on the same day. Do not use extra medicine to make up for a missed dose. Twice-Daily dose: (15 mg tablet): Take a dose immediately to ensure 30 mg of Rivaroxaban is administered per day (two 15 mg tablets may be taken together) This is only for people who take a total of 30 mg/day. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.

4 Adverse Reactions and Side Effects: Allergic reaction--- itching or hives, swelling in your face/hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing. Blistering, peeling, or red skin rash. Decrease in how much you urinate. Heavy menstrual bleeding, or vaginal bleeding. Red or brown urine, bloody or black tarry stools. Unusual bleeding or bruising, including frequent nosebleeds. Vomiting blood or material that looks like coffee grounds Fatigue, syncope Nausea, abdominal pain, dyspepsia Toothache Urinary tract infection Hemorrhage Limb pain, osteoarthritis, muscle spasm, muscle weakness Oropharyngeal pain, sinusitis Burning, numbness or tingling feeling that is not normal Severe headache, feeling confused Pain, swelling or new drainage at wound sites Increased serum transaminases Drug-Drug Interactions Carbamazepine, conivaptan, indinavir, itraconzaole, ketoconazole, lopinavir, phenobarbital, phenytoin, rifampin, ritonavir, St. John s Wort. Warning/Precautions: 1. Most common complication is bleeding. 2. Avoid use in patients with moderate to severe hepatic impairment associated with coagulopathy. 3.Use with caution in patients when used for post operative thromboprophylaxis that may increase rivaroxaban systemic exposure which may cause renal impairment or acute renal failure.

5 Nursing Consideration: Routine monitoring of coagulation tests not required; antifactor Xa activity measurement is preferred. CBC with differential, renal function and hepatic function tests prior to initiation. Avoid abrupt discontinuation in patients with atrial fibrillation re: increased risk for stroke. Temporarily discontinue at least 24 hours prior to surgery or an invasive procedure. Patient & Family Teaching: Tell your doctor if you are pregnant or breastfeeding, if you have kidney disease, liver disease, bleeding problems or an artificial heart valve. This medicine may increase your risk for bleeding; be careful to avoid injuries that could cause bleeding-stay away from rough sports or other situations where you could be bruised, cut or hurt. Brush/Floss gently. Avoid picking nose; If you need to blow your nose, blow gently. Tell your doctor if you are taking another blood thinner, because this also increases the risk of bleeding. DO NOT STOP using this medicine suddenly without telling your doctor, as you will have a higher risk of Stroke for a short time after you stop using this medicine. Your doctor will do lab tests at regular visits or intervals to check on the effects of this medicine. Keep all appointments. Tell any doctor or dentist who treats you that you are using this medicine. Keep all medicine out of reach of children. Never share your medicine with anyone. References: Lexicomp Online 2016 CareNotes System Submitted by: Teodora Gonzales BSN, RN-CCRN & Mitshuba Medalle BSN,RN-CCRN Reviewed and Approved by: RBMC Pharmaceutical Services