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Atrial fibrillation anticoagulation adherence — GPhC CRA MCQ

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ModerateCardiovascular TherapeuticsAtrial fibrillation anticoagulation adherenceGPhC CRA

A patient takes rivaroxaban 20 mg once daily for atrial fibrillation at bedtime, usually three hours after the evening meal. They report no missed doses. Which counselling change is most important?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Take each 20 mg dose with food rather than on an empty stomach

Take each 20 mg dose with food rather than on an empty stomach: Rivaroxaban 15 mg and 20 mg tablets require administration with food to achieve reliable bioavailability. Move each dose to the morning but continue taking it before breakfast: Changing the clock time does not correct administration without food. Crush each tablet into water and take it between meals: Crushing does not remove the requirement that a 20 mg dose be followed by food. Split the 20 mg tablet into 10 mg twice-daily doses with no meals: The AF regimen should not be divided without prescriber direction and both proposed doses omit the food requirement. Alternate 20 mg with 10 mg on successive nights to improve absorption: Alternating doses under-anticoagulates the patient and has no valid pharmacokinetic rationale.

Reference: BNF: rivaroxaban: https://bnf.nice.org.uk/drugs/rivaroxaban/