Rivaroxaban (Xarelto): take with food, bleeding signs and contraception

Rivaroxaban helps prevent clots forming in veins and arteries. The NHS lists preventing deep vein thrombosis and pulmonary embolism, reducing the risk of stroke in atrial fibrillation, preventing clots after knee or hip replacement, and treating coronary heart disease and recovery after a heart attack among its uses.

It is available on prescription only. Most adults and children can take it, although dosing depends on the condition being treated.

You will usually take it once or twice a day, at the same time every day, and the NHS specifically says to take it with food. Swallow the tablet with water. You can eat and drink as normal otherwise, and there is no alcohol restriction on the NHS page.

Missed a dose? Take it as soon as you remember unless the next dose is due, in which case skip it, and never double up. If you take too much, call NHS 111.

The NHS lists a previous allergic reaction or serious side effect from rivaroxaban or another anticoagulant, active significant bleeding, conditions with higher bleeding risk such as stomach or bowel ulcers and certain cancers, a recent bleed in the brain or brain surgery, high blood pressure, liver disease, antiphospholipid syndrome, and pregnancy or breastfeeding.

Tell your prescriber about any condition on this list so that they can decide whether rivaroxaban is right for you.

Bleeding more than usual is one of the most common effects: long bleeding from cuts, nosebleeds, bleeding gums when brushing, easy bruising and heavier or longer periods. Other effects reported include anaemia, itchy skin, arm or leg pain or swelling, constipation or diarrhoea, stomach pain, indigestion, nausea, vomiting, and faintness or dizziness on standing.

A serious problem is heavy or internal bleeding: blood in urine or stools, blood in vomit, coughing blood, bleeding in the eye, bleeding from a surgical wound, or signs of brain bleeding such as sudden severe headache, confusion, slurred speech or weakness. Call 999 for suspected brain bleeding or anaphylaxis, and NHS 111 for a head injury or other serious effect.

Medicines that can interact include other anticoagulants such as warfarin, antifungals, heart rhythm medicines, SSRIs, anti-inflammatory painkillers, epilepsy treatments, certain antibiotics and St John's wort. Tell your doctor about all medicines, herbal remedies, vitamins and supplements.

Always carry the anticoagulant alert card, and show it to any doctor or dentist before a procedure. Tell healthcare staff you take rivaroxaban before any operation.

Rivaroxaban is not used during pregnancy because it may not be safe for the baby. If there is any chance you could become pregnant, you must use contraception, because it could cause bleeding that harms you and your baby. It passes into breast milk and should not be used while breastfeeding.

The message about stopping is firm: do not stop unless a doctor tells you to, because stopping suddenly can be dangerous.