Edoxaban

Edoxaban is a type of medicine known as an anticoagulant - or blood thinner.

It makes your blood flow through your veins more easily. This means your blood will be less likely to make a dangerous blood clot.

It's used to treat people who have had a health problem caused by a blood clot such as:

• a stroke
• a heart attack
• a blood clot in the leg - a deep vein thrombosis (DVT)
• a blood clot in the lungs - a pulmonary embolism

It's also used to prevent blood clots if you're at high risk of having them in the future. People who are at high risk include those who have an abnormal heartbeat, known as atrial fibrillation.

Edoxaban is only available on prescription. It comes as tablets.

• It's usual to take edoxaban once a day.
• You can take edoxaban with or without food.
• The most common side effect of edoxaban is bleeding more easily than normal - such as having nosebleeds, bleeding gums and bruising. It tends to happen in the first few weeks of treatment or if you're unwell.
• Always carry your anticoagulant alert card with you. Show it to your doctor or dentist before you have surgery or dental treatment. It's important they know you're taking edoxaban, as it may put you at risk of bleeding.
• Edoxaban is also called by the brand name Lixiana.

Edoxaban can be taken by adults aged 18 and over.

Edoxaban isn't suitable for some people. Tell your doctor if you:

• have had an allergic reaction to edoxaban or any other medicines in the past
• are trying to get pregnant or you are already pregnant - edoxaban can be harmful to your baby
• have liver problems
• have had a recent spinal injury or surgery
• are taking any other medicines that affect blood clotting, such as warfarin
• have any injuries that are currently bleeding a lot (such as a wound)
• have a stomach ulcer
• are taking the herbal remedy St John's wort (often taken for depression)
• have antiphospholipid syndrome, a condition that affects the immune system and makes you more likely to get blood clots

It's important to take edoxaban as your doctor advises.

You'll usually take it once a day. Try to take it at the same time every day.

How much to take

The usual dose of edoxaban is 60mg a day. Your doctor may prescribe 30mg a day if you:

• have kidney disease
• have a low body weight
• are taking ciclosporin (to treat psoriasis and rheumatoid arthritis)
• are taking dronedarone (to treat atrial fibrillation)
• are taking erythromycin or ketoconazole (to treat fungal or bacterial infections)

If you're unsure what dose you need to take, check with your pharmacist or doctor.

What if I forget to take it?

Take your tablet as soon as you remember. If you only remember the following day, leave out the forgotten dose. Take your next dose at the usual time, and then carry on as normal.

Never take more than 1 dose in a single day.

If you're worried, speak to your pharmacist or doctor.

If you often forget doses, it may help to set an alarm to remind you. You could ask your pharmacist for advice on other ways to remember your medicines.

How long to take it for

How long you need to take edoxaban will depend on why you are taking it.

If you've had a blood clot (DVT or pulmonary embolism) you'll normally take edoxaban for at least 3 months. Depending on what caused the blood clot, you might need to take it for longer.

If you have atrial fibrillation you might need to take edoxaban long term or even for the rest of your life.

What if I take too much?

Ask your pharmacist or doctor for advice straight away as taking too much edoxaban puts you at risk of bleeding.

Anticoagulant alert card

Your doctor or pharmacist will give you an anticoagulant alert card. Carry this with you all the time. It tells healthcare professionals that you're taking an anticoagulant. This can be useful for them to know in case of a medical emergency.

If you need any medical or dental treatment, show your anticoagulant alert card to the nurse, doctor or dentist. This includes before you have vaccinations and routine sessions with the dental hygienist. Your doctor may advise you to stop taking edoxaban or reduce your dose for a short time.

Switching from warfarin to edoxaban

If you need to switch from warfarin to edoxaban, your doctor will advise you when to stop taking warfarin. This will probably be a few days before you start edoxaban.

Your doctor or anticoagulant clinic will do a blood test called the international normalised ratio (INR) to check how quickly your blood's clotting. This is to help decide exactly when you should start taking edoxaban.

Switching from edoxaban to warfarin

If you need to switch from edoxaban to warfarin, you may need to take both medicines together for a few days.

Your doctor or anticoagulant clinic will do a blood test called the international normalised ratio (INR) to check how quickly your blood's clotting. This is to help decide exactly when you should stop taking edoxaban.

While edoxaban has enormous benefits, the downside is that it can make you bleed more than normal. This is because while you're taking edoxaban your blood won't clot as easily.

Less serious bleeding

It's usual to bleed more easily than normal while you're taking edoxaban. The kind of bleeding you might have includes:

• periods that are heavier and last longer than normal
• bleeding for a little longer than usual if you cut yourself
• occasional nosebleeds (that last for less than 10 minutes)
• bleeding from your gums when you brush your teeth
• bruises that come up more easily and take longer to fade than usual

This type of bleeding isn't dangerous and should stop by itself. If it happens, keep taking the edoxaban, but tell your doctor if the bleeding bothers you or doesn't stop.

Things you can do to help yourself

• Cuts - press on the cut for 10 minutes with a clean cloth.
• Nosebleeds - read about how to stop a nosebleed or watch this video on stopping nosebleeds.
• Bleeding gums - if your gums are bleeding, try using a soft toothbrush and waxed dental floss to clean your teeth.
• Bruises - these are harmless but can be unsightly. It might help to make them fade more quickly if you put an ice pack wrapped in a towel over the bruise for 10 minutes at a time several times a day.

What you can do to prevent bleeding

While you're taking edoxaban be careful when you do activities that might cause an injury or a cut or bruising. It can help to:

• avoid playing contact sports or other activities that can cause an injury - such as football, rugby, hockey and horse riding
• wear gloves when you use sharp objects like scissors, knives and gardening tools
• stop wet shaving or removing hair with wax - use an electric razor or hair-removing cream instead
• take dentures (false teeth) or retainers out for a few hours a day, if you wear them, to give your gums a rest - don't wear dentures or retainers that don't fit properly
• tell your doctor, dentist or nurse that you take edoxaban before you have any medical or dental procedures or surgery - this includes vaccinations and routine appointments with the dental hygienist

Serious bleeding

Occasionally, you can have serious bleeding from taking edoxaban. This can be dangerous and needs urgent medical attention.

Like all medicines, edoxaban can cause side effects, although not everyone gets them.

Very rarely edoxaban can lead to bleeding in the brain. This can cause a very severe headache, fits (seizures), changes to your eyesight, numbness or tingling in your arms or legs, and make you feel very tired, weak or sick.

If you suddenly get any of these symptoms, contact your doctor immediately. This is an emergency.

Common side effects

These common side effects happen to more than 1 in 100 people. They are usually mild and don't last long, but talk to your pharmacist or doctor if these side effects bother you or don't go away:

• tiredness and lack of energy, shortness of breath, noticeable heartbeats (heart palpitations) and pale skin - these can be signs of anaemia
• feeling dizzy or lightheaded
• feeling or being sick (nausea or vomiting)
• stomach pain and indigestion

Serious allergic reaction

In rare cases, edoxaban can cause a serious allergic reaction (anaphylaxis).

These are not all the side effects of edoxaban. For a full list see the leaflet inside your medicines packet.

What to do about:

• signs of anaemia - speak to your doctor who may arrange a blood test
• feeling dizzy or lightheaded - if edoxaban makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so that you don't faint, then sit until you feel better. If the dizziness doesn't go away or keeps happening, speak to your doctor. They may arrange a blood test to see if you have anaemia.
• feeling or being sick (nausea or vomiting) - it may help to avoid rich or spicy food while you're taking edoxaban. If you're being sick, drink plenty of water by having small and frequent sips to avoid dehydration.
• stomach pain or indigestion - try to rest and relax. Putting a heat pad or covered hot water bottle on your stomach may also help. If you are in a lot of pain, speak to your pharmacist or doctor. If you need something to ease discomfort from indigestion, try taking an antacid. But don't put off seeing a pharmacist or doctor.

Edoxaban isn't normally recommended during pregnancy or while breastfeeding.

Some medicines and supplements can interfere with edoxaban. This can lead to serious side effects.

Tell your doctor if you're taking these medicines before you start taking edoxaban.

• any other anticoagulant, such as warfarin or enoxaparin
• drugs to treat fungal or bacterial infections, such as fluconazole, erythromycin or rifampicin
• drugs to treat abnormal heartbeat, such as dronedarone, quinidine and verapamil
• drugs to prevent organ rejection after a transplant, such as ciclosporin
• drugs used to treat epilepsy, such as carbamazepine, phenytoin and phenobarbital
• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin

Taking edoxaban with everyday painkillers

You can take paracetamol while you're taking edoxaban.

Do not take aspirin or ibuprofen while you're taking edoxaban unless a doctor has said it's OK to. They increase the chance of bleeding.

Mixing edoxaban with herbal remedies and supplements

Do not take St John's wort, the herbal remedy for depression, while you're taking edoxaban. It can increase your risk of side effects.

Related conditions

• Atrial fibrillation
• DVT (deep vein thrombosis)
• Heart attack
• Pulmonary embolism

Useful resources

• Edoxaban: forum
• AF Association: forum
• Anticoagulation UK: charity
• British Heart Foundation: charity