From the Guidelines
Rivaroxaban can be administered via a gastric tube by crushing the tablet and suspending it in 50 mL of water, with administration to be completed within 4 hours of preparation. When administering the 15 mg and 20 mg tablets through a gastric tube, it is crucial to follow the administration immediately with enteral feeding to ensure proper absorption, as indicated in the NCCN clinical practice guidelines in oncology 1. The guidelines specify that crushed rivaroxaban tablets are stable in water for up to 4 hours, but bioavailability may be reduced if administered distal to the stomach 1. Key considerations for administration include:
- Crushing the tablet to facilitate suspension in water
- Using 50 mL of water for suspension
- Completing administration within 4 hours of preparation
- Administering the 15 mg and 20 mg tablets with immediate enteral feeding to maintain bioavailability
- Avoiding administration distal to the stomach to prevent reduced absorption. It's also worth noting that a commercially prepared oral suspension formulation is available for pediatric patients, but the guidelines provided do not specify its use in adults 1.
From the FDA Drug Label
After confirming gastric placement of the tube, XARELTO tablets (all strengths) may be crushed and suspended in 50 mL of water and administered via an NG tube or gastric feeding tube Administration of XARELTO suspension via NG tube or gastric feeding tube: XARELTO oral suspension may be given through NG or gastric feeding tube. Administration via gastric tube is allowed. The tablets may be crushed and suspended in water, or the oral suspension may be used.
- Crushed tablets should be suspended in 50 mL of water.
- The dose should be immediately followed by enteral feeding for 15 mg or 20 mg tablets.
- For other doses, enteral feeding is not required. 2
From the Research
Rivaroxaban Administration via Gastric Tube
- The administration of rivaroxaban via a gastric tube is a consideration for patients who have difficulty swallowing whole tablets.
- A study published in 2014 3 investigated the relative bioavailability of a crushed 20 mg rivaroxaban tablet and of 2 alternative crushed tablet dosing strategies, including administration via a nasogastric (NG) tube.
- The results showed that a crushed rivaroxaban tablet was stable and when administered orally or via NG tube, displayed similar relative bioavailability compared to a whole tablet administered orally.
- However, it is essential to note that the study used a nasogastric tube, not a gastric tube, but the findings may be applicable to gastric tube administration as well.
- Another study published in 2013 4 discussed the pharmacokinetics and pharmacodynamics of rivaroxaban, but did not specifically address administration via a gastric tube.
- Other studies 5, 6 focused on the safety and effectiveness of rivaroxaban in various clinical settings, but did not provide information on administration via a gastric tube.
- A study on medication absorption considerations in patients with postpyloric enteral feeding tubes 7 highlighted the importance of considering the site of absorption for medications administered via enteral feeding tubes, but did not specifically address rivaroxaban administration via a gastric tube.