Rivaroxaban (Xarelto®) and edoxaban (Lixiana®) are two popular anticoagulant medicines prescribed in the UK. Both drugs belong to the same class of anticoagulants, commonly known as blood thinners. What is the difference between both drugs? Rivaroxaban versus edoxaban looks into the use, similarities and differences between both drugs.
Rivaroxaban versus edoxaban: drug classification
Rivaroxaban and edoxaban belong to a group of drugs called novel oral anticoagulants (NOACs). Rivaroxaban and edoxaban are also described as direct oral anticoagulants (DOACs). For many years warfarin was the main anticoagulant prescribed in the UK. In the last few years, the use of warfarin diminished in place of NOACs. Other NOACs licensed in the UK include:
- Apixaban (Eliquis®)
- Dabigatran (Pradaxa®)
Novel oral anticoagulants are more advantageous over warfarin treatment. Unlike warfarin, which requires regular monitoring of the international normalized ratio (INR), rivaroxaban and edoxaban do not require regular blood tests as INR measurements are not required for both drugs. Additionally, both drugs have a simpler dosing regime than warfarin. Rivaroxaban and edoxaban are usually taken once daily. Initial treatment with rivaroxaban may require twice a day dose (the initial treatment of acute DVT or PE).
What are anticoagulants used for?
Anticoagulants are drugs which prevent the formation of blood clots in the body. The formation of a blood clot can lead to serious health emergencies such as stroke and heart attack. Anticoagulants can be used in the treatment and/or prevention of clot formation in the conditions listed below.
Rivaroxaban is licensed for the treatment of the following conditions (emc, 2022):
- Prevention of venous thromboembolism (VTE) in adult patients undergoing elective hip or knee replacement surgery.
- Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) and prevention of both conditions happening again.
What is edoxaban used for?
Edoxaban’s licensed use is partially similar in terms of the use in the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) and prevention of recurrent DVT and PE.
Additionally, edoxaban is also licensed for the prevention of stroke and systemic embolism in adult patients with (nonvalvular) atrial fibrillation (NVAF), who have one or more additional factors, for example, hypertension (high blood pressure), congestive heart failure, aged 75 or over, diabetes, prior stroke or transient ischaemic attack (emc, 2022).
Do rivaroxaban and edoxaban work in the same way?
Both drugs have the same mechanism of action. Rivaroxaban and edoxaban inhibit (stop) factor Xa which prevents thrombin production. Thrombin plays a central role in the development of blood clots.
Are rivaroxaban or edoxaban taken in the same way?
Rivaroxaban is taken with or after food. Xarelto tablets can be crushed and mixed with water in patients with swallowing difficulties.
In July 2019, The Medicines and Healthcare products Regulatory Agency (MHRA) issued a drug safety update recommending that rivaroxaban 15mg and 20mg (only) should be taken with food as decreased effectiveness was observed when 15mg or 20mg tablets were taken on an empty stomach (Gov.uk, 2019).
Edoxaban can be taken with or without food.
Recommended anticoagulant in the UK
The National Institute for Health and Care Excellence (NICE) does not recommend any specific anticoagulant as a first-line therapy. Nevertheless, novel anticoagulants such as rivaroxaban and edoxaban are more commonly prescribed.
Edoxaban switching programme
For the last couple of months patients with Non-Valvular Atrial Fibrillation (NVAF) have been switched to edoxaban treatment from other novel anticoagulants, mainly from rivaroxaban. Many areas in the UK take part in the edoxaban switching programme. Patients who currently take rivaroxaban or another direct oral anticoagulant (DOACs) are switched to edoxaban treatment.
The main reason for switching from rivaroxaban (or another anticoagulant) to edoxaban (NHS, 2022):
- Simple dosing (once a day dose)
- Edoxaban can be taken on a full or an empty stomach
- Lower cost of edoxaban
It is recommended that rivaroxaban (Xarelto) is taken with food, which may be difficult for some patients and switching to edoxaban definitely improves this compliance. Some savings from prescribing edoxaban instead of other anticoagulants are expected since NHS pays the following for each anticoagulant (December 22):
- Edoxaban (28): £49.00
- Rivaroxaban/Xarelto (28): £50.40
- Apixaban 5mg tablets (56): £53.20
Rivaroxaban versus edoxaban: possible side effects
Both rivaroxaban and edoxaban (and other similar drugs) may cause bleeding, which may potentially be life-threatening. Symptoms of excessive bleeding, which sometimes may not be obvious may include:
- Dizziness
- Unusual weakness
- Tiredness
- Being pale
- Unexplained swelling
- Headache
- Breathlessness
Bleeding into the brain inside the skull is a serious medical emergency. Read more about the risks and signs of bleeding in the product information leaflet (PIL). In addition to the risk of bleeding rivaroxaban’s PIL advices on the very rare risk of severe skin reactions, and signs of severe allergic reactions (more details inside rivaroxaban’s leaflet).
Rivaroxaban – common side effects
Edoxaban – common side effects
Rivaroxaban vs edoxaban: which drug is more popular?
Rivaroxaban is more commonly prescribed than edoxaban. However, a sharp increase in prescribing is observed. Since the switching initiative takes place, one would expect edoxaban to be more popular than rivaroxaban in the coming months.
Conclusion
Rivaroxaban and edoxaban belong to the same class of newer anticoagulants. Newer anticoagulants offer more advantages when compared to treatment with warfarin, an older anticoagulant. A recent drive to switch patients from rivaroxaban to edoxaban is driven simply by the lower cost of edoxaban and simpler administration requirements (with/without food, once daily dose).
References:
Emc (2022). SmPC: Lixiana 15mg Film-Coated Tablets. Available at: https://www.medicines.org.uk/emc/product/6907/smpc Accessed on 19/12/2022
Emc (2022). SmPC: Xarelto 20mg film-coated tablets. https://www.medicines.org.uk/emc/product/2793/smpc Accessed on 19/12/2022
Gov.uk (2019). Rivaroxaban (Xarelto▼): reminder that 15 mg and 20 mg tablets should be taken with food. Available at: https://www.gov.uk/drug-safety-update/rivaroxaban-xarelto-reminder-that-15-mg-and-20-mg-tablets-should-be-taken-with-food Accessed on 19/12/2022
NHS (2022). NHS Wes Essex Clinical Commissioning Group. Edoxaban Switch Programme – Frequently Asked Questions. Available at: https://westessexccg.nhs.uk/your-health/medicines-optimisation-and-pharmacy/clinical-guidelines-and-prescribing-formularies/02-cardiovascular-system/3870-doac-edoxaban-switch-faqs/file Accessed on 26/12/2022
