Rivaroxaban
Unchecked
From Pharmacopedia
More actions
Rivaroxaban
Xarelto
Experience
No personal reports yet
No clinical reports yet
Log in to add your own experience.
Problems
No problems yet. Be the first to suggest one.
+ Add a problemTitration strategies
No titration strategies yet. Be the first to suggest one.
Effects
No effects listed yet. Be the first to suggest one.
Relevant anecdote
No anecdotes yet. Share a relevant one.
Relevant Literature
No literature entries yet.
Log in to submit relevant literature.
Summary
Common uses
Stroke prevention in nonvalvular atrial fibrillation0, VTE treatment0, VTE prophylaxis after hip/knee replacement0, Low-dose with aspirin in stable CAD/PAD0
Pharmacy
Starting dose
NVAF: 20 mg PO once daily with the evening meal (15 mg if CrCl 15-50); acute VTE: 15 mg BID for 21 days, then 20 mg daily; CAD/PAD: 2.5 mg BID with aspirin
Preparations
2.5, 10, 15, 20 mg tablets
US FDA Max
30 mg/d (acute VTE first 21 days as 15 mg BID); otherwise 20 mg/d
Pharmacology
Routes
Oral
Onset
Peak anticoagulant effect 2-4 hours
Duration
24 hours
Half-life
5-9 hours (elderly: 11-13 hours)[1]
Bioavailability
~80-100% with food at 15-20 mg doses (10 mg dose: ~80% without food); must be taken with food at therapeutic doses[1]
Pregnancy
Avoid in pregnancy; switch to LMWH. Crosses placenta; warfarin-class concerns about fetal hemorrhage and teratogenicity make heparins the preferred class.[citation needed]
Legal status
Rx-only in US
Purported mechanism
Rivaroxaban is a selective reversible direct inhibitor of activated factor X (Xa); blocking Xa interrupts thrombin generation at a stoichiometrically efficient point in the coagulation cascade, producing predictable anticoagulation without routine monitoring.0 CYP3A4 (primary) and P-glycoprotein substrate; strong dual inhibitors or inducers materially shift exposure. Reversal: andexanet alfa for life-threatening bleeding; 4F-PCC commonly used off-label when andexanet unavailable[1].
References
edit- ↑ 1.0 1.1 1.2 FDA Prescribing Information, Xarelto (rivaroxaban), Janssen, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/202439s037lbl.pdf