31 July 2009

Prescribers treating patients who have had total hip or knee replacement surgery can access an independent review of the oral anticoagulant rivaroxaban (Xarelto) in the August issue of NPS RADAR.

NPS RADAR provides independent information about new medicines and changes to PBS listings to health professionals and is published to coincide with PBS updates, giving health professionals access to information when they need it.

“GPs and pharmacists may see patients who have been initiated on rivaroxaban in hospital. They should be aware that rivaroxaban has only been evaluated for use in preventing deep vein thrombosis and pulmonary embolism after elective total hip or total knee replacement surgery,” NPS senior adviser, quality use of medicines, Judith Mackson said.

“Duration of the therapy is 14 days after knee replacement or 35 days after hip replacement and no longer. Some patients will need a GP prescription soon after discharge to cover the remaining duration of therapy. GPs will need to take into account the number of tablets the hospital has provided when selecting a suitable pack size and instructing the patient on how many tablets to take.”

Dose adjustment and titration, and monitoring of prothrombin time are not required. As with other anticoagulants, managing the risk of bleeding is a primary concern, and patients should be alert to possible signs of bleeding.

“Prescribers should be aware that there are only small differences in efficacy and safety between rivaroxaban, low molecular weight heparins (Clexane and Fragmin), fondaparinux (Arixtra) and dabigatran (Pradaxa),” Ms Mackson said.

Other topics covered in the latest edition of NPS RADAR include:

• Hydromorphone prolonged-release tablets (Jurnista) for chronic severe disabling pain
• Oxybutynin patch (Oxytrol) PBS listed as an alternative for overactive bladder
• Update on PBS listings for Aboriginal peoples and Torres Strait Islander
• Sitagliptin with metformin
• (Janumet) fixed-dose combination tablets PBS listed for type 2 diabetes mellitus
• Risedronate (Actonel Once-a-month) and summary of anti-resorptive drug listings
• Lanthanum (Fosrenol) tablets for adults with chronic kidney disease who are on dialysis

For full copies of these reviews visit www.nps.org.au/radar

ENDS

The National Prescribing Service Limited (NPS) is an independent, non-profit organisation for Quality Use of Medicines funded by the Australian Government Department of Health and Ageing