1. About 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.
2. Key facts
- 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.
3. Who can and can't take edoxaban
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
4. How and when to take it
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.
5. Bleeding - and what to do about it
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
Occasionally, you can have serious bleeding from taking edoxaban. This can be dangerous and needs urgent medical attention.
Urgent advice: Contact your doctor or anticoagulant clinic, or go to A&E straight away if:
- you have red pee or black poo
- you get bruises that happen for no reason, or bruises that are larger than you'd expect or that keep growing in size
- you get nosebleeds that last longer than 10 minutes
- you have blood in your vomit or you're coughing up blood
- you get severe headaches
- you have any bleeding from a cut or injury that won't stop or slow down
These are symptoms of serious bleeding. If you experience serious bleeding, stop taking edoxaban.
6. Other side effects
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).
Urgent advice: Contact a doctor straight away if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
These are warning signs of a serious allergic reaction. A serious allergic reaction is an emergency.
These are not all the side effects of edoxaban. For a full list see the leaflet inside your medicines packet.
You can report any suspected side effect to the UK safety scheme.
7. How to cope with side effects
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.
8. Pregnancy and breastfeeding
Edoxaban isn't normally recommended during pregnancy or while breastfeeding.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
9. Cautions with other medicines
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.
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.
Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.
10. Common questions
How does edoxaban work?
Edoxaban is a type of medicine known as an anticoagulant. It makes your blood clot more slowly.
Blood clotting (thickening) is a complicated process involving substances called clotting factors.
Clotting factors are made by the liver and help stop bleeding. They work with blood cells called platelets that trigger the clotting process to make sure your blood clots properly.
Edoxaban works by stopping a clotting factor called factor Xa from working. This thins your blood so it takes longer to clot.
How long does it take to work?
Edoxaban works within a few hours of taking it.
Is it safe to take it for a long time?
Edoxaban is safe to take for a long time. There don't seem to be any lasting harmful effects from taking it for many months and years.
What will happen if I stop taking it?
Do not stop taking edoxaban without talking to your doctor.
If you stop taking edoxaban, the rate at which your blood clots will return to what it was before you started taking it - usually within a day or two of stopping. This means that you may be at increased risk of serious problems like strokes, heart attacks, DVT or pulmonary embolism.
Are there any other similar medicines?
There are also anticoagulants that you take by injecting them. These include heparin, enoxaparin, dalteparin and tinzaparin. Not all medicines that prevent blood clots are suitable for everyone. Talk to your doctor or pharmacist to find out why you've been recommended a particular medicine.
Can I drink alcohol with it?
You can drink alcohol while taking edoxaban, so long as you stick to the national guidelines of no more than 14 units a week for men and women. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.
Drinking heavily - especially binge drinking lots of alcohol in one go - is dangerous while taking edoxaban. The alcohol can increase edoxaban's effect and make you more likely to bleed.
Is there any food or drink I need to avoid?
There are no foods or drinks you need to avoid while taking edoxaban.
Will I need to stop edoxaban before surgery?
Because of the risk of bleeding, your dose of edoxaban may need to be lowered or stopped a few days before you have an operation.
Tell the surgeon that you're taking edoxaban and show them your anticoagulant alert card.
You should also tell anyone else involved with your care, such as your anticoagulant specialist, so they can so they can arrange any changes to your medicine for you.
Will I need to stop edoxaban before dental treatment?
You can still go to your dentist as usual. But tell your dentist that you're taking edoxaban - and show them your anticoagulant alert card - before you have any treatment. This is especially important if you need to have a tooth out.
Most people don't need to change their edoxaban dose but your dentist may contact your doctor for advice before starting the dental treatment.
Can I have vaccinations?
You can have vaccinations while taking edoxaban.
Before you have them, be sure to show your anticoagulant alert card to the nurse or doctor. It's important to tell them that you are taking edoxaban, in case there is any bleeding at the injection site.
Will it affect my fertility?
There's no firm evidence to suggest that taking edoxaban will reduce fertility in either men or women.
However, speak to a pharmacist or your doctor before taking it if you're trying to get pregnant. This medicine isn't usually recommended in pregnancy.
Do I need to avoid sports?
You can continue to take part in non contact sports such as running, athletics, cycling, tennis and badminton. However, be sure to use the right protective clothing or equipment, like wearing a helmet when riding your bike.
Avoid all contact sports, particularly martial arts and kickboxing. This is because these types of sports could lead to an injury, which would further increase the risk of bleeding.
Can I drive or ride a bike?
Most people can drive or ride a bike while taking edoxaban.
However, if taking edoxaban makes you feel dizzy or lightheaded, then don't drive or ride until it goes away.
Can I have a tattoo or piercing?
Having a body piercing or tattoo isn't recommended while you're taking edoxaban. This is because of the increased risk of bleeding and infection.
If you still want to go ahead, talk to your doctor about your specific risks in case you need antibiotics.
And let the tattooist or piercer know beforehand that you're taking a blood thinning medicine.
Will I need to wear an emergency bracelet or carry an alert card?
You will need to carry an anticoagulant alert card with you at all times.
If you have an accident, it's important that the person treating you knows you are taking a blood thinner.