Published: 30 May 2016
Revised: 7 February 2017
30 May 2016
Monitoring finishes 31 December 2016
Medsafe is highlighting a possible risk of hair loss with the use of novel oral anticoagulants (NOACs). The NOACs available in New Zealand are rivaroxaban, dabigatran and apixaban.
In July 2015, the Centre for Adverse Reactions Monitoring (CARM) received a report of hair loss with the use of rivaroxaban. The patient experienced significant and continuously worsening hair loss which was noticed four days after starting rivaroxaban. The patient had no previous history of hair loss.
Review of World Health Organization (WHO) data also suggests that there may be a connection between NOACs and hair loss.
NOACs are used in a variety of conditions including:
Hair loss is not a known side effect of the NOACs rivaroxaban, dabigatran or apixaban. However, it is known to occur with the anticoagulants heparin and warfarin. The exact mechanism for hair loss with heparin and warfarin is unknown but is thought to occur through telogen effluvium. Further information on telogen effluvium is available from the DermNet NZ website.
Hair loss through telogen effluvium can be triggered by a variety of conditions as well as fever, surgery, haemorrhage (bleeding), childbirth and medicines. The effects are usually visible around two to four months after exposure to the trigger.
Patients who experience significant and/or worsening hair loss should continue to take their medicine and seek medical advice.
The overall benefit-risk balance of rivaroxaban, dabigatran and apixaban remains positive.
Advice on how to take this medicine and possible side effects can be found in the consumer medicine information (CMI) and data sheet
Medsafe is placing this safety concern on the medicines monitoring () scheme to obtain further information on these possible adverse reactions.
Please report any suspected adverse reactions, particularly hair loss, with rivaroxaban, dabigatran and apixaban. Please include information on time to onset of hair loss, the relevant medical history and course of the disease.
Consumers and healthcare professionals are encouraged to send reports of suspected adverse reactions to the Centre for Adverse Reactions Monitoring (CARM).
Medsafe cannot give advice about an individual’s medical condition. If you have any concerns about a medicine you are taking Medsafe encourages you to talk to your healthcare professional.
7 February 2017
Medsafe will re-investigate this concern should more information become available.