Rivaroxaban (Xarelto)

These instructions are for caregivers of Children's Hospital of Philadelphia (CHOP) patients who are prescribed rivaroxaban.

Important information about rivaroxaban:

• Rivaroxaban, also known by the brand name Xarelto®, is an anticoagulant. An anticoagulant is a medicine that is used to help prevent blood clots and to stop existing blood clots from growing larger. Learn more about rivaroxaban.

• Blood clotting is an important part of the normal healing process for injured blood vessels.

• Too much clotting can be dangerous. Blood clots can block normal blood flow causing pain and swelling.

• Blood clots can develop in the heart, arteries, or in veins. A clot that occurs in the large veins is called a deep vein thrombosis (DVT). DVT can happen in any part of the body (legs, abdomen, or arms).

• They can also break into pieces and go to the lungs or to the brain. Blood clots in the lungs can cause a pulmonary embolism (PE). Blood clots in the brain can cause a stroke. Blood clots going to the lungs or brain can be life threatening.

Your dose is based on:

• The reason rivaroxaban is being prescribed

• Your weight

• Your ability to eat and absorb food

• Your kidney function

Instructions for taking rivaroxaban:

• Rivaroxaban should be taken with food as ordered.

• Rivaroxaban comes as a tablet in the following strengths: 2.5 mg, 10 mg, 15 mg, 20 mg and as a liquid (oral suspension), 150 mg/150 mL.

• The tablet can be crushed and mixed with applesauce or water.

• The bottle of rivaroxaban suspension comes with 2 oral syringes to measure the dose. Do not put the syringes in a dishwasher. To clean your syringes, rinse with tap water and air dry. This will prevent removing the dosing markings on the syringe barrel.

• Store rivaroxaban suspension at room temperature (between 68°-77°F or 20°-25°C). Look at the suspension before giving. Be sure that there are no lumps or granules at the bottom of the bottle.

• Gently mix before each use. Do not shake the bottle too fast to avoid foaming as foam can lead to giving the wrong dose.

• Rivaroxaban should be taken with food as ordered.

• Avoid eating or drinking grapefruit-containing products when taking rivaroxaban. Grapefruit may increase the amount of rivaroxaban in the body.

Missed doses

• Do not double a dose to make up for a missed dose.

• If your child vomits or spits up right after or within 30 minutes of taking the oral suspension, give a new full dose. If your child vomits more than 30 minutes after taking the oral suspension, do not give the dose again. Give the next dose at the regularly scheduled time.

• Contact your anticoagulant management team if vomiting or spitting up persists.

• Contact your anticoagulant management team if you are unsure what to do about a missed dose.

Other medicines

• Ask your healthcare provider, anticoagulant management team, or pharmacist before taking any new medicines. This includes over-the-counter medicines, vitamins, and herbal products. Some drugs and supplements can affect how rivaroxaban works.

• Avoid use of aspirin, ibuprofen, and any non-steroidal anti-inflammatory (NSAIDs). These drugs can increase the risk of bleeding when taken with any anticoagulant.

What are the risks of taking rivaroxaban?

The biggest risk of taking rivaroxaban or any anticoagulant is an increased bleeding risk from things such as trauma, injury, or invasive procedures.

• Because of the increased risk for bleeding, it is important that we develop a plan if you need dental work, invasive procedures, or immunizations.

• If you have any bleeding, such as a nosebleed or have blood in your urine or stool, immediately call your anticoagulation management team.

Safety instructions

Physical activity is an important part of overall health. We encourage you to be active. Safety and activity recommendations for people taking anticoagulation are based on age and abilities. The goal is to minimize your risk of injury, especially head and neck trauma.

• Use approved, age-appropriate seat belts in cars and motor vehicles.

• Use appropriate helmets and protective equipment, for example, when riding a bike.

• Avoid rough contact and collision sports. No football, hockey, lacrosse or wrestling.

• Avoid activities that can increase your risk for head trauma such as rock climbing, horseback riding, diving and skateboarding.

• Use caution in activities such as baseball, softball, and soccer.

Communication while taking rivaroxaban

Good communication between you and your healthcare team increases the safety and success of anticoagulation therapy. It also decreases your risk of bleeding and clot formation.

By starting anticoagulation therapy, you (or your parent or legal guardian if you are under 18) accept and agree to follow the team's dosing recommendations and contact your anticoagulation management team if:

• If you have abnormal bleeding. This includes heavy or prolonged periods for patients that menstruate.

• If you have symptoms of a clot, pulmonary embolism, or stroke.

• If you are injured or experience trauma.

• If you are planning an invasive procedure, for example, surgery, dental work, and immunizations.

• If you cannot make a scheduled appointment.

• Refills:

  • Call your team at least 3 business days before you run out of rivaroxaban tablets .

  • Call your team at least 7 days before you run out of rivaroxaban suspension .

Please contact your CHOP anticoagulation management team with questions or concerns:

Division of Hematology

215-590-3535

Hemostasis and Thrombosis Center

For non-urgent issues, send your team a message in the MyCHOP portal.

Reviewed on June 1, 2023, by Marilyn S. Blumenstein, MSN, CRNP