From the Guidelines
The recommended dosage of Xarelto (rivaroxaban) for patients with non-valvular atrial fibrillation is 20 mg once daily with food, as supported by the highest quality evidence from the ROCKET-AF trial 1. For patients with reduced kidney function (creatinine clearance 15-50 mL/min), the dosage should be reduced to 15 mg once daily with food. This medication should be taken at the same time each day to maintain consistent blood levels. Patients should not stop taking Xarelto without consulting their healthcare provider as this could increase the risk of stroke. If a dose is missed, it should be taken as soon as possible on the same day. Xarelto works by inhibiting Factor Xa, a key component in the blood clotting process, thereby reducing the risk of stroke and systemic embolism in patients with atrial fibrillation. Unlike warfarin, Xarelto does not require routine blood monitoring of INR levels, but kidney function should be assessed periodically, as recommended by the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1. Common side effects include bleeding, which can be serious, so patients should report any unusual bleeding or bruising to their healthcare provider immediately. Key considerations for the use of Xarelto in patients with non-valvular atrial fibrillation include:
- The medication should be taken with food to ensure adequate absorption
- Patients with severe kidney impairment (creatinine clearance <15 mL/min) were not studied in the ROCKET-AF trial and should be treated with caution
- The risk of bleeding should be carefully weighed against the benefits of stroke prevention in each individual patient.
From the FDA Drug Label
In the ROCKET AF trial, patients with CrCl 30 to 50 mL/min were administered XARELTO 15 mg once daily resulting in serum concentrations of rivaroxaban and clinical outcomes similar to those in patients with better renal function administered XARELTO 20 mg once daily Patients with CrCl >50 mL/min received 20 mg once daily with the evening meal The primary endpoint was the time to first occurrence of stroke (any type) or non-CNS systemic embolism.
The recommended dosage of Xarelto (rivaroxaban) for patients with non-valvular atrial fibrillation is:
- 20 mg once daily with the evening meal for patients with CrCl >50 mL/min
- 15 mg once daily with the evening meal for patients with CrCl 30 to 50 mL/min 2
From the Research
Xarelto Dosage for Atrial Fibrillation
The recommended dosage of Xarelto (rivaroxaban) for patients with non-valvular atrial fibrillation (NVAF) can vary depending on the patient's renal function and other factors.
- For patients with NVAF and no severe renal impairment, the typical dosage is 20 mg once daily 3.
- For patients with NVAF and severe renal impairment (creatinine clearance < 30 mL/min), a reduced dosage of 15 mg once daily may be recommended 3.
- For patients with NVAF and end-stage kidney disease, a low-dose rivaroxaban (10 mg, once a day) may be beneficial compared to warfarin 3.
Factors Influencing Dosage
Several factors can influence the dosage of Xarelto for patients with NVAF, including:
- Renal function: Patients with severe renal impairment may require a reduced dosage of Xarelto 3, 4.
- Age: Older patients may be more susceptible to the effects of Xarelto and may require a reduced dosage 5.
- Concomitant medications: Patients taking certain medications, such as antiplatelet agents, may require a reduced dosage of Xarelto 6.
Comparison with Warfarin
Xarelto has been compared to warfarin in several studies, with mixed results:
- One study found that Xarelto was associated with a lower risk of gastrointestinal bleeding and all-cause death compared to warfarin in patients with NVAF and stage 4-5 chronic kidney disease or on dialysis 6.
- Another study found that Xarelto was not significantly different from warfarin in terms of the risk of ischemic stroke/systemic embolism and major bleeding in patients with NVAF and stage IV-V chronic kidney disease 5.
- A third study found that Xarelto was associated with lower risks of undesirable renal outcomes, including acute kidney injury and development of stage 5 chronic kidney disease or need for hemodialysis, compared to warfarin in diabetic patients with NVAF 7.