Xarelto Adverse Reactions

Summary of the safety profile: The safety of rivaroxaban has been evaluated in thirteen phase III studies in adults including 53,103 patients exposed to rivaroxaban and in two phase II and two phase III paediatric studies including 488 patients. See phase III studies as listed in Table 13. (See Table 13.)

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The most commonly reported adverse reactions in patients receiving rivaroxaban were bleedings (see Precautions and Description of selected adverse reactions as follows) (Table 14). The most commonly reported bleedings (≥4%) were epistaxis (5.8%) and gastrointestinal tract haemorrhage (4.1%).
In total about 65% of patients exposed to at least one dose of rivaroxaban were reported with treatment emergent adverse events. About 21% of the patients experienced adverse events considered related to treatment as assessed by investigators. (See Table 14.)

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Tabulated list of adverse reactions: The frequencies of adverse reactions reported with Xarelto in adult and paediatric patients are summarised in Table 15 as follows by system organ class (in MedDRA) and by frequency.
Frequencies are defined as: very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥1/1,000 to <1/100), rare (≥1/10,000 to <1/1,000), very rare ( <1/10,000), Not known (cannot be estimated from the available data). (See Table 15.)

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Description of selected adverse reactions: Due to the pharmacological mode of action, the use of Xarelto may be associated with an increased risk of occult or overt bleeding from any tissue or organ which may result in post haemorrhagic anaemia. The signs, symptoms, and severity (including fatal outcome) will vary according to the location and degree or extent of the bleeding and/or anaemia (see Management of bleeding under Overdosage). In the clinical studies mucosal bleedings (i.e. epistaxis, gingival, gastrointestinal, genito urinary including abnormal vaginal or increased menstrual bleeding) and anaemia were seen more frequently during long term rivaroxaban treatment compared with VKA treatment. Thus, in addition to adequate clinical surveillance, laboratory testing of haemoglobin/haematocrit could be of value to detect occult bleeding and quantify the clinical relevance of overt bleeding, as judged to be appropriate. The risk of bleedings may be increased in certain patient groups e.g. those patients with uncontrolled severe arterial hypertension and/or on concomitant treatment affecting haemostasis (see Haemorrhagic risk under Precautions). Menstrual bleeding may be intensified and/or prolonged. Haemorrhagic complications may present as weakness, paleness, dizziness, headache or unexplained swelling, dyspnoea and unexplained shock. In some cases as a consequence of anaemia, symptoms of cardiac ischaemia like chest pain or angina pectoris have been observed.
Known complications secondary to severe bleeding such as compartment syndrome and renal failure due to hypoperfusion have been reported for Xarelto. Therefore, the possibility of haemorrhage is to be considered in evaluating the condition in any anticoagulated patient.
Xarelto 15 mg and 20 mg: Paediatric population: Treatment of VTE and prevention of VTE recurrence: The safety assessment in children and adolescents is based on the safety data from two phase II and one phase III open-label active controlled studies in paediatric patients aged birth to less than 18 years.
The safety findings were generally similar between rivaroxaban and comparator in the various paediatric age groups. Overall, the safety profile in the 412 children and adolescents treated with rivaroxaban was similar to that observed in the adult population and consistent across age subgroups, although assessment is limited by the small number of patients.
In paediatric patients, headache (very common, 16.7%), fever (very common, 11.7%), epistaxis (very common, 11.2%), vomiting (very common, 10.7%), tachycardia (common, 1.5%), increase in bilirubin (common, 1.5%) and bilirubin conjugated increased (uncommon, 0.7%) were reported more frequently as compared to adults. Consistent with adult population, menorrhagia was observed in 6.6% (common) of female adolescents after menarche. Thrombocytopenia as observed in the post-marketing experience in adult population was common (4.6%) in paediatric clinical studies. The adverse drug reactions in paediatric patients were primarily mild to moderate in severity.
Post-marketing observations: The following adverse reactions have been reported post-marketing in temporal association with the use of Xarelto. The frequency of these adverse reactions reported from post-marketing experience cannot be estimated.
Immune system disorders: Angioedema and allergic oedema (In the pooled phase III trials, these events were uncommon (≥1/1,000 to< 1/100).
Hepatobiliary disorders: Cholestasis, Hepatitis (incl. hepatocellular injury) (In the pooled phase III trials, these events were rare (≥1/10,000 to <1/1,000).
Blood and lymphatic system disorders: Thrombocytopenia (In the pooled phase III trials, these events were uncommon (≥1/1,000 to <1/100)).
Skin and subcutaneous tissue disorders: Stevens-Johnson syndrome/Toxic Epidermal Necrolysis (In the pooled phase III trials, these events were estimated as very rare (<1/10,000).
Respiratory, thoracic and mediastinal disorders: Eosinophilic pneumonia (In the pooled phase III trials, these events were very rare (<1/10,000).
Renal and urinary disorders: Anticoagulant-related nephropathy (In the pooled phase III trials, the frequency cannot be estimated).