What is Xarelto?

Xarelto (Rivaroxaban) – Everything You Need To Know

Doctor blood pressure examTo disinterested observers, it seems like new medications are released at furious pace, flooding pharmacies with endless new pills. To patients who need help, though, the pace of drug development can seem agonizingly slow. The story of Xarelto, an exciting medication now being prescribed to certain patients as a blood thinner, offers a perfect example of how the process of creating a new drug can be both very quick and very slow.

A Basic Overview

Rivaroxaban is a blood-thinning medication that prevents clotting through a previously-unknown interference mechanism in the ordinary coagulation process. This is a groundbreaking drug with potentially revolutionary applications. It’s the first in a new class of blood thinners that use the same new highly effective method of  action. Xarelto is prescribed as an ordinary oral tablet, and its effects are potent enough to provide twenty-four results with a single daily dose. Currently used to reduce the risk of blood clotting, pulmonary embolism, or deep vein thrombosis. Patients with atrial fibrillation and those who have recently had major orthopedic surgery are also prescribed Xarelto.

Scientific Background

Xarelto is the trade name for rivaroxaban. It’s a strong anticoagulant with a very novel method of action. It works by suppressing factor Xa, one of the key components in the chemical chain that causes blood to coagulate. Other factor Xa inhibitors are being developed and a few alternatives are starting to appear on the market, but it is the first such inhibitor to receive approval for limited prescription. rivaroxaban is easily absorbed when taken orally, and it suppresses coagulation effectively for eight to twelve hours. It takes another twelve hours for factor Xa to return to normal in the body, meaning that a single daily dose (usually 10-20 mg) of Xarelto is sufficient to significantly reduce the risk of clotting.

Conditions Rivaroxaban Can Be Used To Treat

bloodthinnerscanbeusedforstrokepreventionAs mentioned above, it is currently prescribed to patients who are at risk for deep vein thrombosis and pulmonary embolism. Those who have an established problem with atrial fibrillation and patients who are recovering from knee or hip surgery can also get a prescription. One of the major factors in the considerable amount of interest Xarelto attracts is that it represents an extremely promising candidate for use as a general medication to reduce the risk of stroke. The most common medication used for this purpose now, Warfarin, has a number of undesirable side effects, and patients and doctors would both like to see a more effective replacement for it.

Where Did it Come From?

Naturally-occurring compounds that inhibit factor Xa and prevent clotting have been reported in various insects for more than thirty years. Aggressive laboratory study improved the understanding of these compounds’ method of action and suggested that synthesizing a chemically-stable equivalent might be both possible and useful. Several major pharmaceutical companies began aggressive development of factor Xa inhibitors, and Bayer’s Rivaroxaban is the first viable example approved for limited prescription. Bayer markets Xarelto directly in Europe, and its distribution in the United States is handled by Janssen Pharmeceutica (a Belgian company). Xarelto is also being prescribed on a limited basis in China and developing markets around the world.

The Economic Impact

Since its approval for certain conditions in 2008 in Europe, rivaroxaban has already proven to be highly profitable for Bayer. FDA approval in 2011 greatly increased prescriptions and sales of the drug, and it is one of the most important new medications contributing to the steady growth in sales Bayer has experienced in the past few years. (Total sales grew seven percent in 2012.) The makers of Xarelto, the pharmaceutical industry as a whole, and investors in pharmaceutical stocks are all watching its progress carefully. If it gains approval for wide use as a preventative medication to reduce the risk of stroke, it could become a true “blockbuster” drug. The potential profit for effective drugs that can replace warfarin is estimated to be at least twenty billion dollars a year. If Xarelto is approved for this use, Bayer will be carving the first (and probably largest) slice of that pie.

Typical Usage Patterns

Rivaroxaban is an easy-to-take medication. A single daily dose in tablet form meets all patients’ needs. Patients using it are strongly encouraged to follow doctors’ instructions as closely as possible. Higher doses (i.e. the 15 and 20 milligram pills) should be taken following a meal, while the lighter 10 milligram dose is suitable for use at any time. Due to its recent release and minimal history, patients taking it are advised to be very vigilant in noting and reporting side effects. Users are typically advised to contact their doctors immediately if they encounter any adverse effects whatsoever.

Side Effects And Risks

Like many blood thinners, Xarelto causes easy bleeding and can make minor injuries bleed longer. The major potential side effect of using it is the possibility of internal bleeding. This is a very serious problem, but not actually life-threatening. Symptoms of internal bleeding can include blood in the urine, stool, or phlegm. Strange swelling and inexplicable pains may also be caused by internal bleeding. Headaches, fainting, changes in vision, slurred speech, or severe confusion are signs of serious internal bleeding. Because it’s currently being used with close supervision by doctors, the treatment of side effects related to taking this medication has been both rapid and highly effective so far, but even so there are some patients who have reported some pretty negative reactions to the medication, and even a few deaths have been reported. This has led to numerous lawsuits here in the United States, with more expected to follow in the coming years.

Drug Interactions And Complications

Xarelto is generally not prescribed to patients who have experienced significant liver or kidney problems. Doctors will need to review a patient’s full medical history looking for these and other issues before prescribing the drug. If you are using this medication then you should mention it immediately whenever you are seeing a doctor or dentist; healthcare professionals have to treat patients on anticoagulant medication with special care. Other blood-thinning medications, antiplatelet drugs, and SSRIs and SNRIs can interact with Xarelto. Other drugs and non-prescription treatments may cause Rivaroxaban to stay in the body longer than intended; these include antifungal agents, St. John’s wort, protease inhibitors for HIV, and other medicines. Careful review with a doctor is required before any type of blood thinning medication is prescribed.

Even as it accumulates a strong track record for preventing blood clots in patients with a relatively narrow range of issues, Xarelto is undergoing continued trials to determine its suitability as a stroke-reduction treatment. For patients who are sick of taking warfarin, the results can’t come soon enough. Hopefully, Xarelto will prove to be useful in this wider role and lead to improved standards of care for millions of people at risk for stroke.


Blood Thinners Central


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