Hello,

I tried to look on the forum for this answer but nothing came up, so sorry if this is repetitive.

Last night I forgot to take my Xarelto 20mg at 9pm, realised this morning and took it at 8am

Now, tonight do I take it as usual at 9pm or wait for the next day at 9pm? (which seems really long 36 hours...)

I have contacted my doctor but he's not answering...

Any advice would be great the the Internet is giving me conflicting reports

Regards
Rebecca, Paris, France

I'm sure it's explained on the accompanying sheet of paper.
Usually, it's written something like:

If you forget a dose, take it as soon as possible, then follow as usual.
If it's already time for the next dose, don't take a double dose.

In your case, take your next dose this evening as usual.

Just go back to your usual schedule and take the next dose at 9pm tonight.

Xarelto is one-a-day versus the two-a-day for Eliquis. Therefore Xarelto has a longer serum half-life. Missing or shifting a dose by 12 hours isn't going to change much. I wouldn't get too terribly worried as long as you get back on schedule.

Quote
wolfpack
Therefore Xarelto has a longer serum half-life.

This is something that has long puzzled me about Xarelto. It actually has a shorter half-life than Eliquis so I've never understood how it can be a single dose drug while Eliquis is twice daily. Xarelto's half-life is 5-9 hours in younger patients and 12 hours in the elderly, whereas Eliquis is 12 hours (after repeated doses). I can only guess that Xarelto's effects must last longer than its physical presence in the body.

Initial conditions, I expect. If, in fact, it decays more quickly than Eliquis then the starting point must be higher so that it stays in therapeutic range for a day.

As I recall there was a minor bit of skullduggery regarding Xarelto's clinical trials. Johnson & Johnson contracted Duke University's Clinical Research Institute (DCRI) to do the trials and they specifically skipped the 2x/day option. DCRI may sound academic but it's not. It's for-profit. Much like the shining tower of Quintiles just a few miles down I-40 from the Durham exits, near the airport. Heck, they may even have been sub-contracted in on it. I don't know. But those organizations exist to answer the questions that their paying customers ask of them, not the questions that broader science may ask.

Bottom line, I'd prefer Eliquis if it were me. But if I were only on it for an ablation for a few months I wouldn't worry too much. The caveat being that if you've ever had a GI bleed then push for the Eliquis. And stay away from Pradaxa at all costs.

I've read also that Xarelto causes a lot more severe nosebleeds possibly due to it being strong enough to last a whole day.

I've tried 3 OAC to date.
Pradaxa, Xarelto, Lixiana (= Savaysa).
I'm doing better with Pradaxa, which must be taken 2*/day. Both Xarelto and Lixiana are taken 1*/day, and both gave me stomach pain and benign anal bleeding.
I've not tried Eliquis, but the fact it's to take 2*/day is probably less aggressive on the GI tract.