Can you take Xarelto in the morning? (3+ instruction)

In this article, we will discuss the dosing instructions of Xarelto. What is the appropriate time to take Xarelto? Additionally, we will talk about the precautionary measures while taking Xarelto. 

Can you take Xarelto in the morning? 

You can take Xarelto in the morning if it’s prescribed by your physician. Xarelto is usually administered as a single dose in the evening. If your physician prescribes you a dose of Xarelto twice a day, you can take it in the morning and evening. When Xarelto is taken in the evening, it stays in the system for a longer time.  (1,2)

Xarelto is an anticoagulant that acts by thinning the blood to prevent clot formation in blood vessels. It is important to follow the instructions provided by the physician to avoid any complications. Do not alter the course of your treatment without consulting your physician. 

Sudden discontinuation of Xarelto before completion of the treatment can increase the risk of stroke, blockage in arteries, and myocardial infarction. Seek immediate medical help if you notice any unwanted changes, easy bruising, uncontrolled bleeding, altered mental status, etc. 

What does the research suggest?

A comparison study between the impact of morning and evening dosing of Xarelto by Ziegler et al. found that evening dosing of Xarelto led to prolonged exposure to Xarelto concentration in the system. (1)

The dose of Xarelto ranges from 2.5mg twice daily to 20 mg once daily, depending upon your condition. Xarelto is a novel direct anticoagulant that inhibits factor Xa, which prevents coagulation cascade and clot formation. (3) The half-life of Xarelto is 5 to 9 hours, and in some individuals, it can range from 11 to 13 hours. Xarelto can be taken with or without food. (2)

A pharmacokinetics-based study about the effect of food and meal timing on Xarelto was analysed. The study compared clinical phase trials and concluded that the meal-time intake did not influence the pharmacokinetic properties of Xarelto. (4)

What are the things you should know before taking Xarelto? 

Xarelto is an anticoagulant that prevents clot formation by thinning the blood. Xarelto decreases the clotting factor in your body, which reduces your body’s ability to form clots. 

In conditions such as stroke, atrial fibrillation, deep venous thrombosis and after surgical procedures. The risk of forming blood clots is high, which can cut the blood supply to a particular part of the body and lead to life-threatening conditions. Hence, anticoagulants/blood thinning agents are prescribed to avoid blockage of the arteries. 

With the use of anticoagulants, the risk of bleeding is also increased. If the dose of the drug is more than usual or if you accidentally consume a double dose of the drug, it can increase the risk of bleeding. 

The use of Xarelto can cause easy bruising and excessive bleeding in some cases. If you are planning for any dental surgery or any invasive procedure, make sure you inform the respective physician about your anticoagulant therapy in order to prevent uncontrolled bleeding. It is not recommended to get tattoos, piercings, or any procedure which can cause cuts on your skin. 

When not to take Xarelto? 

There are a few conditions and situations where you have to avoid taking Xarelto, such as: 

Allery: if you are allergic to the medication, you may experience swelling, hives, itching, fever, trouble breathing, vomiting, wheezing, congestion, etc. If you experience these side effects, stop taking the drug and seek medical help immediately. 

Active pathological bleeding: If you have active bleeding in your body, such as bleeding gums, GI bleeding, open wounds, etc., it is not recommended to take Xarelto. 

Antiphospholipid syndrome: It is not recommended to take Xarelto if you have been diagnosed with antiphospholipid syndrome. 

Hepatic impairment: The role of the liver in metabolising Xarelto is very important if you have severe liver damage (Child-Pugh class B and C).

Renal impairment: A proper dose adjustment is necessary if you have renal impairment. Xarelto is not recommended if you have end-stage renal disease. 

Valvular disease: Xarelto is not recommended if you have prosthetic heart valves, rheumatic heart disease, severe mitral stenosis, or mechanical valves. 

Patients with an increased risk of bleeding: In conditions such as acquired bleeding disorder, severe arterial hypertension, ulcerative GI disease, vascular retinopathy, etc. 

What to avoid while taking Xarelto? 

Xarelto is primarily metabolised by the enzymes CYP3A4/5 and CYP2J2 and also through P-glycoprotein (P-gp); some foods and herbal medications inhibit these enzymes, leading to an increased concentration of Xarelto in the blood and increase the risk of bleeding. Here are certain foods, fruits and herbal supplements to avoid while taking Xarelto. (2,5)

Foods Action
Oats Inhibits P-gp.
Gingko Inhibits CYP (3A4, 1A1, 1A2, 2B6, 2C9, 2E1) and P-gp. 
Cinnamon, ginger and Turmeric It has antiplatelet activity, enhances anticoagulant properties and increases the risk of bleeding.
Capsicum, grapefruit Inhibits CYP3A4 and P-gp.
St John’s wort Inhibis CYP450 (1A2, 2C9, 3A4) and P-gp.
Mango Inhibits CYP450 enzymes and P-gp
Fish oil Has antiplatelet activities. 
Black and long pepper Increases plasma concentration of Xarelto

Unlike warfarin, Xarelto does not interact with vitamin K supplements or food that contains vitamin K. Hence, it is safe to take multivitamins and food that contain vitamin K. 

Drugs such as antidepressants (sertraline, fluoxetine), NSAIDs ( ibuprofen, naproxen), Aspirin, etc. can interact with Xarelto and can increase or decrease its action. Always consult a physician before taking any medication to avoid the risk of bleeding and other complications. 

In my opinion, Xarelto is most effective when taken in the evening. However, if your physician has prescribed you Xarelto in divided doses, it can be taken in the morning and evening. If you miss a dose of Xarelto, take it as soon as you remember on the same day and avoid taking double doses at a time. 

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