利伐沙班常见的不良反应

Rivaroxaban is a small molecule oral anticoagulant jointly developed by Bayer and Johnson & Johnson, with the trade name Xarelto. Rivaroxaban is a representative drug of FXa inhibitors. It obtained marketing approval in Canada and the European Union on September 15 and October 1, 2008 respectively. Rivaroxaban tablets were approved for marketing by the State Food and Drug Administration in March 2009. Approved by the FDA on July 1, 2011, the drug is used to prevent deep vein thrombosis in patients undergoing knee or hip replacement surgery. Today we want to learn about the common adverse reactions of rivaroxaban.

1. Renal damage: In patients with severe renal impairment (creatinine clearance <30 mL/min), the plasma concentration of rivaroxaban may be significantly increased, leading to an increased risk of bleeding. Rivaroxaban is not recommended for patients with creatinine clearance <15 mL/min. Rivaroxaban should be used with caution in patients with creatinine clearance 15-29 mL/min. Rivaroxaban should be used with caution in patients with moderate renal impairment (creatinine clearance 30-49 mL/min) when used concomitantly with other drugs that may increase rivaroxaban plasma concentrations. 

2. Liver damage: In cirrhotic patients with moderate liver damage (ChildPugh B category), the plasma concentration of rivaroxaban may be significantly increased, leading to an increased risk of bleeding. Rivaroxaban is contraindicated in patients with liver disease associated with coagulation abnormalities and clinically relevant risk of bleeding. 

3. Concomitant use of rivaroxaban is not recommended in patients receiving systemic azole-antifungal agents (such as ketoconazole, itraconazole, voriconazole, and posaconazole) or HIV protease inhibitors (such as ritonavir). These active substances are potent inhibitors of CYP3A4 and P-gp and, therefore, may increase rivaroxaban plasma concentrations and cause a clinically relevant increase in the risk of bleeding. Fluconazole is considered to have a small effect on rivaroxaban plasma concentrations and can be coadministered with caution. Use caution in patients receiving concomitant medications that affect hemostasis, such as nonsteroidal anti-inflammatory drugs (NSAIDs), acetylsalicylic acid, platelet aggregation inhibitors, or other antithrombotic agents. 

In general, the common adverse reactions of rivaroxaban are: 1. Blood and lymphatic system diseases: agranulocytosis, thrombocytopenia; 2. Gastrointestinal diseases: retroperitoneal bleeding; 3. Hepatobiliary diseases: jaundice, cholestasis, hepatitis (including liver Cell damage); 4. Immune system diseases: hypersensitivity, allergic reaction, anaphylactic shock, angioedema; 5. Nervous system diseases: cerebral hemorrhage, subdural hematoma, epidural hematoma, hemiparesis; 6. Skin and subcutaneous tissue: Stevens-Johnson syndrome; 7. Increased risk of stroke after premature discontinuation in patients with non-valvular atrial fibrillation; 8. Bleeding risk; 9. Spinal/epidural hematoma.

The above are the common adverse reactions of rivaroxaban. I hope it can help you!