What is the typical dosage of Xarelto (Rivaroxaban) for anticoagulation?

From the Guidelines

The typical dosage of Xarelto (rivaroxaban) for anticoagulation is 20 mg once daily with food for patients with nonvalvular atrial fibrillation who are at moderate to high risk of stroke. For patients with renal impairment and nonvalvular atrial fibrillation who are at moderate or high risk of stroke, with a CrCl of 15 to 50 mL per minute per 1.73 m2, a reduced dose of 15 mg once daily may be considered 1. The dosage may vary based on the condition being treated, such as deep vein thrombosis (DVT) or pulmonary embolism (PE), where patients typically start with 15 mg twice daily with food for the first 21 days, followed by 20 mg once daily with food for continued treatment 1. It is essential to note that Xarelto should be taken at the same time each day to maintain consistent blood levels, and missing doses can reduce protection against clots, while doubling up on missed doses increases bleeding risk 1. The most recent guidelines from 2024 support the use of rivaroxaban for anticoagulation in patients with atrial fibrillation, with specific recommendations for dosing and reversal agents in cases of bleeding or urgent procedures 1. Key points to consider when prescribing Xarelto include:

• The patient's renal function and creatinine clearance
• The condition being treated, such as atrial fibrillation, DVT, or PE
• The potential for bleeding risks and the need for reversal agents
• The importance of adherence to the prescribed schedule to maintain consistent blood levels and prevent thrombus formation.

From the FDA Drug Label

For patients receiving 2.5 mg twice daily: if a dose is missed, the patient should take a single 2.5 mg XARELTO dose as recommended at the next scheduled time. For patients receiving 15 mg twice daily: The patient should take XARELTO immediately to ensure intake of 30 mg XARELTO per day. For patients receiving 20 mg, 15 mg or 10 mg once daily: The patient should take the missed XARELTO dose immediately

The typical dosage of Xarelto (Rivaroxaban) for anticoagulation is:

• 2.5 mg twice daily
• 15 mg twice daily (to ensure intake of 30 mg XARELTO per day)
• 20 mg once daily
• 15 mg once daily
• 10 mg once daily 2

From the Research

Typical Dosage of Xarelto (Rivaroxaban) for Anticoagulation

The typical dosage of Xarelto (Rivaroxaban) for anticoagulation varies depending on the indication and patient population.

• For the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation, the recommended dose is 20 mg once daily 3.
• For patients with non-valvular atrial fibrillation and moderate renal impairment (creatinine clearance 30-49 mL/min), the recommended dose is 15 mg once daily 3.
• For the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), the recommended dose is 15 mg twice daily for 21 days, followed by 20 mg once daily 4.
• For the prevention of recurrent DVT and PE, the recommended dose is 20 mg once daily 4.

Factors Influencing Dosage

Several factors can influence the dosage of Xarelto, including:

• Renal function: patients with moderate renal impairment may require a reduced dose of 15 mg once daily 3.
• Age: elderly patients may require a reduced dose due to decreased renal function and increased risk of bleeding 5.
• Concomitant medications: certain medications, such as strong CYP3A4 inhibitors, may increase the risk of bleeding and require a reduced dose of Xarelto 6.

Clinical Trials and Studies

Several clinical trials and studies have evaluated the efficacy and safety of Xarelto for anticoagulation, including:

• The ROCKET AF trial, which compared Xarelto with warfarin for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation 5, 3.
• The EINSTEIN-DVT and EINSTEIN-PE trials, which compared Xarelto with standard therapy for the treatment of DVT and PE 4.
• The XALIA study, which evaluated the safety and effectiveness of Xarelto for the treatment of DVT in routine clinical practice 7.