Xarelto. Analogues are cheaper, instructions for use, where to buy, price, reviews

Xarelto is a medicine used as a treatment and prevention of thromboembolic conditions. The drug has a high cost, therefore, it is often replaced by cheaper similar medicines.

Forms of release and composition of the drug

This medication is manufactured in Germany as an oral tablet.

The active ingredient in the product is rivaroxaban.

Additional composition:

• microcrystalline cellulose;
• croscarmellose sodium;
• milk sugar;
• magnesium stearate;
• sodium salt of lauryl sulfuric acid;
• hypromellose 5cP;
• titanium dioxide;
• macrogol;
• red dye (for iron oxide).

The product is contained in plastic blisters and packed in cardboard containers.

Pharmacological properties

The drug belongs to the category of direct Xa inhibitors (anticoagulants).

Pharmacodynamics and pharmacokinetics

Xa is a factor promoting the conversion of prothrombin to thrombin. This leads to the formation of blood clots and platelet activation.

This factor is a trigger that increases the number of platelets by 300 thousand. once. Taking the drug allows you to stop this dynamics and prevent a sharp increase in the amount of thrombin. It is noted that the dosage used has an effect on the rate of suppression of factor Xa.

The prothrombin time in patients who underwent surgery, after 2-4 hours after taking a dose, ranges from 13 to 25 seconds.

In patients with deep vein thrombosis, this period of time varies within 15-32 s. The main component of the drug can influence the activated partial thromboplastin time. However, this factor is not taken into account.

With the systematic use of tablets, blood tests are not required. However, diagnostics can be used in cases when the dose of the drug was significantly exceeded or surgical interventions are coming.

The medicine has good absorbency. The maximum concentration of its components is observed after 2-4 hours. The tool can be used regardless of food intake. Wherein the bioavailability of the components ranges from 80 to 100%.

The tablets are absorbed mainly from the gastrointestinal tract. Exposure data decreased when the drug was injected. The bioavailability of the drug did not change when the tablets were taken with food, in ground form, or when added to food. Most of the drug interacts with plasma proteins.

When ingested, about 70% of the drug is excreted from the body through the intestines and the renal system. The rest leaves the body unchanged by renal excretion. The metabolites have low clearance.

The concentration of the drug in the blood in elderly patients is 1.5 times higher than in young patients. In this case, dosage adjustment is not required. The weight of patients does not significantly affect the level of the content of the active ingredient in the body.

Changes in the properties of the drug when using the tablets by patients of different races were not observed.

Changes in pharmacokinetic properties occurred in patients with severe hepatic impairment. Similar effects were observed in patients with functional disorders of the kidneys.

Indications for use

Ksarelto (cheaper analogs may have additional indications and contraindications) is prescribed as a treatment or prevention of thromboembolic disorders.

Indications:

• thromboembolism (venous form of pathology), including patients who have undergone previous surgery on the lower extremities;
• an exacerbated condition in the presence of deep vein thrombosis - during the rehabilitation period (at least six months) after surgical actions associated with the development of deep vein thrombosis;
• relapses of thromboembolic syndrome occurring in the pulmonary artery - therapy is carried out six months after surgery in the pulmonary artery.

The medicine is used only after examinations and a confirmed diagnosis.

Contraindications

The medication has restrictions on its use.

Contraindications:

• intolerance to the active composition;
• the presence of bleeding;
• risks of major bleeding - ulcers, trauma, neoplasms, surgical interventions;
• joint use of anticoagulants, including oral forms;
• severe liver damage with a high risk of bleeding, including cirrhosis;
• severe functional disorders of the kidneys;
• pregnancy and lactation;
• minor age.

With extreme caution, tablets can be used in the following cases:

• patients with a high risk of bleeding;
• the presence of moderate kidney failure;
• simultaneous administration of antifungal agents belonging to the azole group, as well as drugs that suppress the action of the protease of sexually transmitted diseases;
• severe functional disorders of the kidneys;
• simultaneous use of medications that affect hemostasis;
• the risks of the formation of gastric ulcer and duodenal ulcer.

Additional diagnostics are required to help determine the presence of contraindications in the patient.

At what age can the drug be used?

The drug is approved for prescription starting from the age of 18, since there is no data on taking pills in childhood or adolescence.

Instructions for use, dosage

Xarelto (cheaper analogs can have several dosage forms) is intended for oral use. Use the remedy regardless of food intake. If necessary, the capsule can be pre-crushed or introduced into the body using a probe.

In the prevention of venous thromboembolism (after surgery), 1 capsule is prescribed 1 time per day. The duration of therapy varies from 2 to 5 weeks. As a prophylaxis for deep vein thrombosis or pulmonary embolism, it is recommended to take 1 capsule 1 time per day.

Patients with functional kidney disorders of severe and moderate severity are prescribed 15 mg of the drug 2 times a day. The duration of the course is 21 days. Then the dosage should be adjusted.

Side effects

The drug can have a negative effect on the patient's body, causing various manifestations.

Side effects:

• Violations of hematopoietic processes: anemic conditions, the development of thrombocytosis.
• Immune disorders: allergic manifestations, dermatitis.
• Malfunctions of the central nervous system: the occurrence of headaches and dizziness, fainting, hemorrhagic processes.
• Visual impairment: hemorrhage in the eye area.
• Cardiovascular disorders: increased heart rate, bruising, decreased blood pressure.
• Respiratory disorders: opening of nosebleeds, coughing up blood.
• Disruptions from the gastrointestinal tract: constipation, nausea, vomiting, diarrheal syndrome. There is also soreness, dyspeptic disorders, bleeding develops.
• Hepatic disorders: decreased liver function, development of jaundice.
• Skin manifestations: rashes, itching, minor hemorrhagic processes, ecchymosis, urticaria.
• Pathologies of the connective tissue and the musculoskeletal system: pain in the extremities, hemorrhagic processes in the muscles or in the joint cavity.
• Renal dysfunctions and disorders of the urinary system: the discovery of bleeding in the urogenital system, deterioration of renal function.
• General disorders: fever, swelling, general malaise, decreased muscle tone.

In the event of the formation of adverse reactions, including unregistered signs, it is necessary to urgently consult a treating specialist.

Overdose

If the indicated dosages are exceeded, the agent can lead to the development of bleeding and other negative manifestations, including allergic reactions.

The drug has no antidote.

Treatment is selected individually. As a therapy, blood preparations, specific procoagulants, mechanical procedures to eliminate bleeding can be used.

If symptoms of an overdose occur, it is recommended to cancel further use of the medication and consult a specialist.

special instructions

Xarelto, if it is not possible to swallow the whole tablet, is allowed to be pre-crushed and added to food (for example, applesauce, infant formula). According to patient reviews, among the cheaper analogues of the drug, there are other oral forms that are convenient for use without prior grinding.

Patients with functional kidney lesions undergoing treatment with other drugs are prescribed capsules with extreme caution, since bleeding or thrombosis may develop. It is required to exercise great caution in patients taking drugs that have an effect on hemostasis.

It should be borne in mind that when performing diagnostic procedures (lumbar puncture), severe complications can occur, which, as a result of manipulations, can lead to paralysis.

The risk of developing paralysis increases with the use of catheters or medications that affect hemostasis after this procedure. In this case, patients should be under constant supervision of the attending physician.

It is recommended to stop taking pills a day before carrying out operational actions. The therapy is allowed to continue only after additional research confirming the absence of hemostatic disorders.

According to clinical data, in addition to the risks of bleeding as a result of taking the drug, no other specific pathologies have been identified. Taking the drug can lead to dizziness and fainting. Therefore, it is recommended to refuse to drive a car or carry out other work requiring high psychomotor functions.

Drug interactions

Taking the drug does not have a negative effect on various cytochrome isoforms.

The simultaneous use of capsules and CYP3A4 or P-gp can provoke increased action and severity of systemic effects.

Do not combine tablets with ketocanazole, as the effect of the main drug may increase.

The simultaneous use of the drug and clarithromycin can lead to a change in some of the pharmacodynamic parameters of the first agent.

A similar effect is noted with the simultaneous administration of capsules and the following drugs:

• erythromycin;
• fluconazole;
• dronedarone;
• rifampicin.

Pharmacodynamic reactions may change when tablets are combined with naproxen. It is not recommended to replace therapy and switch from rivaroxaban to phenindione and vice versa.

It is required to be very careful when combining the drug with anticoagulants.

The drug does not interact and does not cause pharmacodynamic changes when used together with the following agents:

• midazolam;
• atorvastatin;
• ranitid;
• aluminum / magnesium hydroxide;
• omeprazole;
• acetylsalicylic acid;
• digoxin;
• clopidogrel;
• naproxen;
• enoxaparin.

The drug does not affect the accuracy of laboratory parameters.

Cheap counterparts

Xarelto (cheaper analogs may differ not only in cost, but also in therapeutic effect) can lead to the development of intolerance reactions. If such manifestations occur, it is recommended to replace the agent with a drug similar in action and effectiveness.

Analogs:

• Warfarin. This medicine is produced in Denmark in the form of oral tablets. The main substance of the drug is warfarin, which belongs to the anticoagulant group. List of indications for taking capsules: pulmonary embolism, venous thrombosis, ischemic disorders, including stroke, thromboembolic pathologies, myocardial infarction (as a prophylaxis), prevention of thrombosis after operations. The tablets have numerous contraindications, therefore, before using them, it is imperative to consult a doctor. The dosage and duration of therapy depends on the severity of the pathology, the patient's condition and other factors. On average, 1-2 tablets are prescribed once a day. The method of sale is by prescription. The cost of packaging in Russian pharmacies ranges from 104 to 190 rubles.
• Eliquis. This drug is manufactured in the United States as an oral tablet. The main substance of the drug is apiskaban. The drug belongs to the category of antithrombotic agents and is used in the treatment of thromboembolic disorders. Indications for the use of tablets: venous thromboembolism, deep vein thrombosis, pulmonary embolism, prevention of stroke and thromboembolic diseases. List of contraindications: minor age, allergy to the composition, diseases and conditions associated with the risk of bleeding, the period of gestation and breastfeeding. The dosage and duration of the course is calculated individually according to the disease, its severity and other factors. Terms of dispensing - by prescription. The cost of the drug in Russian pharmacies ranges from 724 to 2528 rubles.
• Thrombomag. This pharmaceutical product is manufactured in Russia in the form of tablets for internal use. The main substances of the agent are 2 components - acetylsalicylic acid and magnesium hydroxide. The medication has a pronounced antiplatelet effect. Indications for taking pills: cardiovascular pathologies, including thrombosis, prevention of repeated episodes of myocardial infarction, thrombosis blood vessels, preventive treatment of thromboembolic disorders caused by previous surgical operations. Dosing regimen: 1 capsule 1 time per day. Take the pill 2 hours after eating. The duration of the course is set individually. The medicine has multiple contraindications, therefore, before using it, it is imperative to undergo research and consult a specialist. Method of implementation by prescription. The cost of packaging in pharmacies in Moscow and the Moscow region ranges from 50 to 62 rubles.

  

Ksarelto (cheaper analogs are selected taking into account the indications and portability of the components) should be replaced with another similar medicine only for in agreement with a specialist, since the independent selection and intake of similar drugs can lead to the development of severe consequences and complications.

Terms, conditions of sale and storage

• The tablets should be stored in a dry, dark place at temperatures up to 25 ⁰C.
• The shelf life of the product is 3 years from the date of manufacture.
• It is forbidden to use the drug after the expiry of the storage period engraved on the package.
• Dispensing method - by prescription.

Price

The cost of the drug may differ slightly from each other depending on the region and region of its sale.

Region / region	Dosage form / dosage	Price
Moscow, Moscow region	Tablets, 20 mg, 28 pcs.	RUB 1800-3840
St. Petersburg	Tablets, 15 mg, 28 pcs.	RUB 2800-3400
Saint Petersburg (suburbs)	Tablets, 10 mg, 100 pcs.	RUB 9600-10800
Novgorod region	Tablets, 10 mg, 30 pcs.	RUB 3200-3900
Leningrad region	Tablets, 15 mg, 100 pcs.	RUB 9900-10500

Before using Xarelto, you must consult with a specialist and carefully study the instructions for use. You can find out the exact price of the drug, as well as its cheaper analogues, at any pharmacy located in your place of residence.

Video about the drug

About the anticoagulant Xarelto: