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Xarelto is the brand name for the prescription medication rivaroxaban, a blood thinner, or anticoagulant, that prevents blood clots from forming. Xarelto is in a class of medications called factor Xa inhibitors, which means they affect the action of an enzyme, Factor X, that is involved in blood clotting. Janssen Pharmaceuticals manufactures Xarelto; there is no generic form of rivaroxaban available in the United States.
Xarelto was first approved by the Food and Drug Administration (FDA) in 2011 to (DVT) and prevent (PE) in people having hip or knee replacement surgery. DVT is a condition that develops when a blood clot forms in a vein deep inside the body, usually in the lower leg or thigh. DVT may lead to PE, which is a blood clot in the lung. Also in 2011, the FDA approved Xarelto for people diagnosed with a type of irregular heartbeat called nonvalvular atrial fibrillation (or afib) that is not related to a heart valve problem. Increases a person's risk for blood clots. In 2012, the FDA expanded the approved uses of Xarelto to include prevention of recurring DVT and PE.
Drugs contain side effects which is the reason why commercials or advertisements put many disclaimers about the unwanted symptoms after taking the drug(s). Examples with specific medications [ edit ] Abortion, miscarriage or uterine hemorrhage associated with misoprostol (Cytotec), a labor-inducing drug (this is a case where the adverse effect. Drugs.com is the most popular, comprehensive and up-to-date source of drug information online. Providing free, peer-reviewed, accurate and independent data on more than 24,000 prescription drugs, over-the-counter medicines & natural products. By combining two common cancer drugs, researchers have found a more effective way to treat colorectal cancer and reduce unpleasant side effects.
If you have one of those conditions you can continue taking the drug to prevent these dangerous blood clots from developing again. Xarelto was tested in a Phase 3 clinical trial for people with recent acute coronary syndrome (ACS); they were given a twice-daily low dose of rivaroxaban as part of their treatment plan. Results of the trial, published in the New England Journal of Medicine, suggested the drug could play an effective role. However, an FDA advisory committee repeatedly voted against expanding Xarelto's uses. In 2012 and 2014, the committee concluded that the risk for bleeding was too high to approve the drug for people with ACS.
Xarelto Warnings If you get a cut or an injury while on Xarelto, the bleeding may take longer than usual to stop. You may also bruise or bleed more easily.
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Call your doctor immediately if you have abnormal bleeding or bruising while on Xarelto because it could be a serious, even life-threatening, condition. After you stop taking Xarelto, you're at greater risk for stroke. You shouldn't stop taking the drug without consulting your doctor. If you receive an epidural, spinal anesthesia, or a spinal puncture while you're taking Xarelto, you're at increased risk for a blood clot around your spine that could lead to paralysis. Xarelto has side effects and can interfere with some medications. If you have any of the medical conditions noted below, use this drug with caution:.
Heart valve replacement. Bleeding disorders or bleeding problems. Liver disease. Kidney problems. Any other medical conditions Always tell your doctor if you have to any medications, and discuss all the risks and benefits of Xarelto before you begin treatment. Finally, if you are taking Xarelto, be sure to talk to your doctor before you have surgery or medical or dental procedures, as it can cause excess bleeding.
Xarelto and Pregnancy Tell your doctor if you are pregnant, may become pregnant, are breastfeeding, or plan to breastfeed. It's not clear whether Xarelto is safe to take during pregnancy, so pregnant women should take the drug only if the potential benefits outweigh the risks to the fetus. It's also unknown whether Xarelto passes into breast milk, so nursing women should not take Xarelto or should discontinue breastfeeding while on Xarelto treatment.
It's not known whether Xarelto is safe or effective in children. Many drugs may affect the way Xarelto works. Xarelto can also interfere with other drugs you are taking. It's very important to let your doctor know about everything you take, including illegal or recreational drugs, over-the-counter medications, herbs or herbal preparations, or dietary and nutritional supplements. Xarelto is available in 10, 15, and 20 milligram (mg) tablets that you take by mouth. For treating DVT or PE, the typical dose is 15 mg twice daily with food for the first 21 days.
After that, people usually take 20 mg once a day for the remainder of their treatment. For nonvalvular atrial fibrillation, the typical starting dose is either 15 or 20 mg once in the evening, with a meal. To prevent or PE, people usually take 10 mg of Xarelto once a day, with or without food. After hip or knee replacement surgery, the usual recommendation is to start treatment at least 6 to 10 hours after surgery.
People who've had a generally are prescribed 10 mg of the drug for 35 days. If you've had a knee replacement procedure, you can take Xarelto for 12 days following surgery. Be sure to take Xarelto at about the same time each day. If you have difficulty swallowing the tablets, you can crush them and mix them with applesauce. Eat the mixture right away, followed by additional food.
Xarelto Overdose If you take too much Xarelto, you could bleed internally, or hemorrhage. Symptoms of an overdose may include:. Abnormal bleeding or bruising.
Bloody or black stools. Blood in urine. Coughing up blood or vomiting blood If you or someone else has symptoms of an overdose, call your doctor right away or go to the nearest emergency room. If someone taking Xarelto collapses or isn't breathing, call 911. Xarelto Missed Dose Be sure to take the drug as prescribed by your doctor, even if you feel well.
Don't stop taking Xarelto without talking to your doctor first because you're at greater risk of stroke after you stop taking this medication. If you're supposed to take Xarelto once a day but miss a dose, take the missed dose as soon as you remember that day. Go back to your normal treatment schedule the next day. If you take Xarelto twice a day, take the missed dose as soon as you remember it on the same day. You can take even two doses of the medication at the same time to make up for the missed dose. The next day, stick to your usual dosing schedule.
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Background Drug repurposing (defined as discovering new indications for existing drugs) could play a significant role in drug development, especially considering the declining success rates of developing novel drugs. Typically, new indications for existing medications are identified by accident. However, new technologies and a large number of available resources enable the development of systematic approaches to identify and validate drug-repurposing candidates. Patients today report their experiences with medications on social media and reveal side effects as well as beneficial effects of those medications. Introduction New drug development costs US $500 million to $2 billion and takes 10-15 years.
A well-known approach to reduce risk and cost of new drug development is drug repurposing (or drug repositioning). Drug repurposing (defined as discovering new indications for existing drugs) could play a significant role in drug development, considering the declining success rates of developing novel drugs. From 2007-2009, 30-40% of newly approved drugs were repurposed medications. Considering the high cost of launching a new drug, this emphasis on repurposing could markedly affect drug development. Typically, a new indication for an available drug is identified by chance.
However, new technologies and a large number of available resources enable the development of systematic approaches to identify and validate drug repurposing candidates with considerably lower costs. Drug repurposing has been exhaustively studied, and various approaches have been used - to identify novel drug repurposing candidates, using clinical data , genetic information -, and scientific literature -.
Grau and Serbedzija named two types of drug repurposing: (1) identification of off-target drug actions and (2) identification of relevance of a known drug target to a new disease. From an informatics perspective, freely available and relevant resources such as scientific literature, clinical trials, and biological resources can be used to conduct drug-repurposing studies. The compound database PubChem has been used in several drug-repurposing studies. Hoehndorf et al implemented a system that inferred novel associations between drugs and diseases by linking drug-gene associations in the PharmGKB database to phenotype studies and animal models of disease. Moriaud et al presented a computational method that mined the Protein Data Bank to identify drug repositioning candidates. Several studies , considered literature mining for drug repurposing; this approach has been comprehensively reviewed elsewhere ,. Social media provides a platform for patients to share their experiences with illnesses, medications, and also medical centers.
Patient posts, usually written in an informal language, contain hidden and valuable information. Owing to the massive amount of data derived from social media, computerized systems are needed to analyze and extract useful information from patient experience. Unlike scientific literature, these comments are usually written by non-experts users who do not have any obligation to follow proper grammar in their comments or report accurate observation. These differences make mining social media more complicated and challenging compared to scientific literature. Nevertheless, there have been several attempts to extract knowledge from social media.
Leaman et al examined comments posted in a medical forum to identify reported adverse drug events. After manually annotating a corpus of patient posts, they used natural language processing methods to develop a system that extracted adverse drug reactions from the text. Chee et al studied patient posts on Health and Wellness Yahoo!
Groups and applied common natural language processing methods to predict adverse drug events and identify medications that might require further scrutiny by the Food and Drug Administration. Freifeld et al evaluated the correlation between adverse drug events reported in Twitter (where statements are limited to 140 characters) and spontaneous reports received by a regulatory agency. Rastegar et al implemented a binary classifier to identify adverse drug reactions in tweets.
Sharif et al proposed a sentiment classification framework to detect adverse drug reactions in medical blogs and forums. Recently, Karimi et al provided a corpus of 1321 medical forum posts on patient-reported adverse drug events, which allows researchers to develop and evaluate pharmacovigilance systems.
Although patients mostly use medically oriented social media to describe adverse events associated with drugs , their experiences may help others to conceive of new indications for existing medications if their descriptions also include beneficial effects. A well-known example is Zolpidem, an insomnia medication that, through social media and patient reviews, was subsequently used for brain injury. Leaman at el identified 157 beneficial effects, in 3600 patient posts that could lead to drug repurposing.
The accuracy of these reported beneficial effects in social media may be questionable, but considering the value of drug repurposing and huge amount of available social media data, it is worthwhile to study this type of information and investigate the possibility of identifying potential drug-repurposing candidates. In this study, we assessed the feasibility of using social media data in identifying potential drug repurposing candidates. Our hypothesis is that this imperfect resource could lead to drug repurposing. Data Sources In this study, we used data from four public resources: WebMD , DrugBank , SIDe Effect Resource (SIDER) , and Unified Medical Language System (UMLS).
Below are brief descriptions of the resources and their uses in this research. WebMD is an US corporation that provides Web-based health-related services, including a forum for patients to share their experiences with medications. The comments are entered as free text, and the length of comments is not subject to a character or word count limit. WebMD allows users to score three different aspects of the medication in their reviews: (1) effectiveness, (2) ease of use, and (3) satisfaction.
WebMD provides some basic information about the users such as age, sex, and duration of treatment. The patient comments from WebMD were the main material used in this study. DrugBank is a bioinformatics and cheminformatics resource that provides drug information, such as indication, synonyms, gene target, drug interactions, and structure. This database was used to identify known indications of drugs.
SIDER, developed by Kuhn et al , contains information about 1430 marketed medications and 5880 side effects (140,064 drug-side effect pairs) extracted from public documents and package inserts. SIDER retrieved adverse drug reaction and disease names from UMLS to generate a dictionary of side effects. We used SIDER to detect known side effects of drugs mentioned in the comments. UMLS integrates medical terminology and coding standards to help researchers and developers create interoperable biomedical information systems. We used UMLS resources to create a dictionary of disease names.
The dictionary contains all spelling variants of diseases provided in UMLS. The dictionary includes 239,227 entries for 86,839 unique diseases. Method In the first step, we generated a list of the top 180 most frequently searched medications on WebMD. All patient comments pertaining to these drugs were retrieved. Through DrugBank, we collected known and approved indications related to those medications. To locate the drugs in DrugBank, we searched synonyms and brand name entries in addition to drug name entry.
In the next step, a list of known side effects for each drug is retrieved from SIDER. We next developed a natural language processing system to identify beneficial or adverse effects. Any mention of disorders in the reviews was tagged by using two disease named entity recognition (NER) approaches: (1) dictionary-based and (2) machine learning. In the dictionary-based approach, a list of disease names from UMLS was retrieved and a string-matching technique was applied to identify diseases mentioned in the comments. The dictionary-based approach did not consider any grammatical or semantic reasoning or spelling errors. For the machine-learning NER approach, we used MetaMap , a tool to recognize UMLS concepts (eg, diseases) in the text. Unlike the dictionary-based method, MetaMap uses natural language processing and computational linguistic techniques to incorporate semantic and grammatical reasoning in the identification task.
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We discarded comments that contained only known indications or adverse effects for related medication. We then manually reviewed some of the remaining comments to develop a list of textual patterns commonly used to report beneficial effects or indications. We developed a rule-based system to tag the comments containing at least one of those patterns. In the final step, the tagged comments were manually reviewed to identify potential drug repurposing candidates. Results We retrieved 64,616 patient posts from the top 180 most commonly searched drugs in WebMD (mean number of posts per drug was 358).
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Lisinopril (an angiotensin-converting enzyme inhibitor used to treat high blood pressure and heart failure) had the most comments (n=2931), whereas metoclopramide (used to treat gastric esophageal reflux disease) had the fewest comments (n=8). Shows the top 10 reviewed medications and includes the three most frequently named diseases in the respective comments.
The dictionary-based NER approach identified 2178 disease names in the comments, whereas MetaMap identified 6171 disease mentions. Shows the 10 most commonly named diseases in the comments (after disambiguated terms were removed manually). Of the 180 drugs, 164 (91.1%) were listed in DrugBank but only 74 (41.1%) were listed in SIDER. We filtered comments to remove text describing known indications and adverse drug events from the list of recognized disease names; frequently named diseases from the text that remained are shown in (note the overlap with ). Pattern Count Example drugs and comments a I use.
for 307 Methadone: I use this for diabetic neuopathy. Works well with very little side effects. Percocet: I use this for M.S. Pain Percocet: I use this med for peripheral neuropathy pain. I use it for 42 Cymbalta: My use of Cymbalta is two fold.
I use it for depression and fibromyalgia pain. Spironolactone: I use it for acne. Go figure it works Promethazine: I use it for gastroparesis. I also use it for sleep 4 or 5 times a month It helps with 131 Nucynta: It helps with my pain from surgery Percocet: it helps with my back pain, better then any drug Klonopin: I like this medication it helps with my anxiety. It help with 11 OxyContin: it help with muscle spasms Neurontin: i had drop foot and much pain. It help with the pain along with the 3 epidurals i receiveed in my spine. Cymbalta: i started this medication years ago.
Not only did it help my depression, it help with my auto immune, muscle and nerve pain. I take it 1,161 Nucynta: I take it for severe headache and neck pain from arthritis, bulging disks, and bone spur in my neck (cervical spine) Methadone: I take it for chronic pain it helps a lot Flexeril: I take it for muscle spasms related to fibromyalgia. I take it for 91 Methadone: I take it for chronic pain it helps a lot Methadone: I take it for degenertive disk deteration in my neck. Hydrocodone-acetaminophen: i take it for my scholiosis of my back It works for 258 Methocarbamol: It works for my muscle tension, but gives me a headache. Diazepam: it works for my pain weal good Tramadol: It works for my Arthritis Pain. It is useful for 0 Useful for 18 Methadone: very useful for chronic and severe pain associated with fibromyalgia/rheumatoid arthritis.
Effexor: I have been reading the reviews of this med. I have been using it for 1.5 yrs and has been very useful for my depression. Ultram: this med has been very useful for my hip and back pain. Prescribed for 319 Percocet: I was prescribed for kidney stones. Definately took the pain away and very high.
Zoloft: I feel like the antidepressant is used in conjunction with my cymbalta which I am prescribed for both depression and fibromayalgia. Celebrex: I was prescribed for knee pain following surgery for torn muniscus. Pattern Count Example drugs and comments a I use. for 171 Flector: it’s not so bad. I use them for stress headaches only if I have a mild headache Hydroxyzine: I use this drug for itching attacks and it works fast and effective for me.
Elavil: I use this medication for restless leg syndrom I use it for 23 Promethazine: I use it for gastroparesis.i also use it for sleep 4 or 5 times a month Amitriptyline: I use it for ic Seroquel: I m in love with seroquel its amazing! I use it for sleep and I wake up refreshed It helps with 72 Neurontin: it helps with numbness in my legs and arms Neurontin: I was diagnosed with rsd in from a fall on the ice. It helps with controlling the pain; Seroquel: although it helps with my depression I have gained over 50lbs It help with 6 Oxycontin: it help with muscle spasms Hydrocodone-acetaminophen: it is ok I think and it help with my back pian. Neurontin: I had drop foot and much pain. It help with the pain along with the 3 epidurals I receiveed in my spine.
I take it 729 Methadone: I take it for chronic pain it helps alot Pristiq: I take it for depression and ptsd as well as for chronic pain from failed cervical fusion. Zoloft: I have taken it for three years almost and when I take it my depression worsens rather in the summer when I wouldnt take it I was the happiest I take it for 48 Percocet: I take it for pain after a shoulder surgery and it works Buspar: I take it for stress. Effexor: I take it for depression. It works for 155 Pristiq: I do not think it works for me makes me very consipated and I think it makes the back of my legs hurt in the muscle part. Metformin: I take it before bed no sideeffect so for taking one month hope it works for me yes I am scared Flexeril: back problems healed up then came right back. Overall it works for a little while.
Useful for 13 Effexor: I have been reading the reviews of this med. I have been using it for 1.5 yrs and has been very useful for my depression. Hydrocodone-acetaminophen: this med. Is useful for short term relief of pain. Ultram: this med has been very useful for my hip and back pain. Prescribed for 0. Medication Indication Adverse effect Patient comments a Methadone Dry cough, drug withdrawal syndrome, opioid type drug dependence, and pain Amenorrhea, phlebitis, sneezing, suffering, withdrawn, hypomagnesemia, urticaria, rhinorrhea, fever, spasm, I use this for diabetic neuopathy.
Works well with very little side effects. Elavil Depression, chronic pain, irritable bowel syndrome, sleep disorders, diabetic neuropathy, agitation and insomnia, and migraine prophylaxis None in SIDER elavil is an old school antidepressant that is now considered a dirty drug because of its undesired side effects. One of the unintended side effects is to relax the skeletal muscle tissue. I use elavil off label to treat my tmj Spironolactone Low-renin hypertension, hypokalemia, and Conn syndrome Hyperkalemia, amenorrhea, urticaria, epidermal necrolysis, anaphylaxis, fever, toxic epidermal necrolysis, lethargy, nausea, I use it for acne. Go figure it works Strattera Attention-deficit/hyperactivity disorder, alone or in combination with behavioral treatment None in SIDER I was prescribed this medication for slight adhd with off label anxiety help.
Viibryd Acute episodes of major depression None in SIDER It even helps my migraines somewhat (maybe it will be off label in the future for migraine prophylaxis). Comparison of MetaMap Versus Dictionary-Based Approach MetaMap is a sophisticated tool that uses natural language processing and machine learning methods; thus, it is more accurate than the dictionary-based approach.
MetaMap, to some extent, tackled some general concerns such as disambiguation, misspelling, and word normalization, but none of these is addressed in the dictionary-based approach. For example, in the phrase “My stomach and back hurts to sit, lay down, or stand,” the dictionary-based approach would tag “down” as a disease because of overlap with the “genetic disorder down syndrome.” As shows, MetaMap recognized about three times the number of disease names than the dictionary-based approach.
The main reason for this difference is word normalization in MetaMap. The dictionary-based approach is limited by its requirement for exact matches—for example, a dictionary that contains only “dizzy” would not detect “dizziness” as a relevant word.
In contrast, MetaMap uses stemming and lemmatization to normalize words. The main advantage of dictionary-based mapping over MetaMap is speed (the dictionary-based approach is considerably faster). Using Patient Comments for Drug Repurposing The reviews commonly described general disorders such as pain, itching, and headache. This is expected because comments usually are not authored by medical experts. We observed that patients tend to report adverse drug events instead of beneficial effects, as some of the previous studies reported a similar trend. For example, in the corpus provided by Leaman et al , they annotated 157 beneficial effects in 3600 posts, while they found 1260 adverse drug events. Nevertheless, some patient comments contain beneficial effects of medication, which makes social media a useful resource for drug repurposing.
This imbalance distribution makes identifying beneficial effects more difficult, especially for training a classifier. Our results (see, and 6) suggest that an effective approach for this task is to recognize the textual patterns that people used to report beneficial effects (eg, “I use drug for disease”). For example, in a review of Viibryd, a user mentioned, “It even helps my migraines somewhat,” clearly noting a beneficial effect of the drug, which could be captured by our rule-based system. Similar to other computational drug repurposing approaches, these findings need to be reviewed manually by experts and then confirmed or rejected by laboratory tests or clinical trials. But as these reviews provided by non-expert users, compared to other drug repurposing studies, which use resources provided or generated by experts such as clinical data or biomedical literature, our findings need more validation before going through clinical trials or laboratory tests. Limitations We acknowledge some limitations to this study.
Analysis of the patient comments, which are written in an informal manner, obviously needs a system that can handle spelling and grammatical errors. Our current implementation does not address these issues.
Our system covered only simple textual patterns, although examples in and highlight the need to decode complex patterns. A simple pattern-matching system obviously is insufficient for a statement such as “I use it for nose allergies and it does not clear up my nostrils.” A system should be able to handle negation and coreference. Another limitation of this study was that comments originated from only one forum.
Other social media sites such as Yahoo! Answers, PatientsLikeMe , and even Twitter have similar information, which can be studied and added to our corpus. In addition, using only one resource for known side effects and one for indication was another limitation. In, there are several known indications and adverse drug events, which highlight this limitation. In this study, we were not able to evaluate our system precisely and provide common performance metrics because of the lack of an annotated corpus. As future work, we plan to annotate a corpus of comments from various forums, to allow us to explore this valuable resource extensively and implement and evaluate different approaches.
Conclusion We assessed the feasibility of using social media to identify drug-repurposing candidates. After collecting patient reviews of medications from WebMD, we used dictionary-based and MetaMap approaches to identify disorders mentioned in the reviews. Reviews describing known indications or known adverse drug events were excluded, and the remaining reviews were searched for textual patterns commonly used to report beneficial effects. Although the most commonly reported disorders were nonspecific (eg, pain, itching, headache), we nevertheless showed that consumer comments contain beneficial effects of medication and have the potential to be used for drug repurposing. Our textual patterns were able to capture some beneficial effects, but there is a need for a more complex and sophisticated system to identify beneficial effects in social media.