Anticoagulation - Being on long-term anticoagulation medication rivaroxaban (Xarelto®) or apixaban (Eliquis®)

Advice for patients prescribed rivaroxaban (Xarelto®) or apixaban (Eliquis®) medication.

How should I take the medication?

It is important that you follow instructions from your doctor and ensure that you do not miss or stop taking your medicine or lower the dosage without checking first with your doctor.

Try to take the tablet(s) at the same time every day to help you remember.

What if I forget to take my medication?

Rivaroxaban (Xarelto®)
If you are taking Xarelto® (ONCE a day):

1. If you have missed a dose, take it as soon as you remember (eg. later the same day). Do not take more than one tablet in a single day to make up for a forgotten dose. Take the next tablet on the following day and then carry on taking a tablet once a day as normal.
2. Do not take a double dose the next day to make up for a forgotten tablet the day before.

Apixaban (Eliquis®)
If you are taking Eliquis® (TWICE a day):

1. If you have missed a dose, you can take the next dose at the usual time.
2. Do not take a double dose to make up for a missed dose.

If you are regularly forgetting your dose (more than once a fortnight), speak to your pharmacist or doctor about strategies to help you take your medication, or if an alternative medication may be better for you.

Do I need to change my diet?

If you are taking Xarelto® or Eliquis® there are no dietary restrictions.

What if I need to take another new medication as well as Xarelto® or Eliquis®?

Please tell the prescribing doctor you are on anticoagulant medication and check with your pharmacist when you are dispensed new medications. Only a small number of medications interact with Xarelto® or Eliquis®.

What should I do if I get bleeding or bruising?

Any bleeding more than minor should be reported to your doctor promptly. This includes bruising without contact, nose bleeds, bleeding when brushing your teeth, blood in the bowel motion, or heavy periods (women). Increased bruising after contact, and slightly longer time to stop bleeding after injury or blood tests, is expected when being on anticoagulant medication.

What if I need to have surgery or a procedure?

Xarelto® and Eliquis® are anticoagulant medications that may need to be temporarily stopped for a procedure or surgery. Please take advice from the doctor or dentist performing the procedure/surgery, your GP, or your treating Haematologist.

For Healthcare Professionals:

1. Recommendations for management of these medications, can be found in: “New oral anticoagulants: a practical guide on prescription, laboratory testing and peri-procedural/bleeding management” Internal Medicine Journal 44(2014), (Table 6). https://onlinelibrary.wiley.com/doi/pdf/10.1111/imj.12448
   
   Healthcare professionals seeking advice on management of your anticoagulant medication before or after surgery or a procedure, should contact your Haematologist directly.

What should I do if I accidentally take too much medication?

If you take too much (overdose):

• Immediately telephone your doctor or the Poisons Information Centre to seek advice: Australia: 13 11 26 or New Zealand: 0800 POISON or 0800 764 766
• Or go to Accident and Emergency at the nearest hospital, if you think that you or anyone else may have taken too much anticoagulant medication.

Do this even if there are no signs of discomfort or poisoning. You may need urgent medical attention. Taking too much anticoagulant medication increases the risk of bleeding.