What is the typical dosing regimen for rivaroxaban (Xarelto)?

From the Guidelines

Rivaroxaban dosing varies based on the condition being treated, with the most recent and highest quality study 1 supporting the use of 15 mg twice daily with food for 21 days, followed by 20 mg once daily with food for the remainder of treatment for deep vein thrombosis (DVT) or pulmonary embolism (PE).

Conditions and Dosing Regimens

• For atrial fibrillation, the standard dose is 20 mg once daily with food, with a reduced dose of 15 mg once daily with food for patients with reduced kidney function (creatinine clearance 15-50 mL/min) 1.
• For DVT/PE prevention after hip or knee replacement surgery, 10 mg once daily is recommended, starting 6-10 hours after surgery once hemostasis is established 1.
• For secondary prevention of cardiovascular events in patients with coronary artery disease or peripheral artery disease, 2.5 mg twice daily in combination with aspirin 75-100 mg is used 1.

Important Considerations

• Food significantly increases rivaroxaban absorption, so the medication should be taken with meals, particularly for doses above 10 mg 1.
• Rivaroxaban works by directly inhibiting Factor Xa in the coagulation cascade, preventing thrombin formation and subsequent clot development, with predictable anticoagulant effects that don't require routine monitoring like warfarin 1.

Interactions and Contraindications

• Rivaroxaban should be used with caution when given together with other drugs that strongly inhibit only CYP3A4 or only P-glycoprotein, such as clarithromycin and erythromycin 1.
• The concomitant administration of rivaroxaban with substrates of either CYP3A4 or P-glycoprotein, such as atorvastatin, digoxin, or midazolam, did not result in clinically relevant interactions 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Nonvalvular Atrial Fibrillation: 15 or 20 mg, once daily with food ( 2. 1) Treatment of DVT and/or PE: 15 mg orally twice daily with food for the first 21 days followed by 20 mg orally once daily with food for the remaining treatment ( 2.1) Reduction in the Risk of Recurrence of DVT and/or PE in patients at continued risk for DVT and/or PE: 10 mg once daily with or without food, after at least 6 months of standard anticoagulant treatment ( 2. 1) Prophylaxis of DVT Following Hip or Knee Replacement Surgery: 10 mg orally once daily with or without food ( 2.1) Prophylaxis of VTE in Acutely Ill Medical Patients at Risk for Thromboembolic Complications Not at High Risk of Bleeding: 10 mg once daily, with or without food, in hospital and after hospital discharge for a total recommended duration of 31 to 39 days ( 2.1) CAD or PAD: 2. 5 mg orally twice daily with or without food, in combination with aspirin (75–100 mg) once daily ( 2.1)

The typical dosing regimen for rivaroxaban (Xarelto) varies depending on the indication:

• Nonvalvular Atrial Fibrillation: 15 or 20 mg once daily with food
• Treatment of DVT and/or PE: 15 mg twice daily for 21 days, then 20 mg once daily
• Reduction in the Risk of Recurrence of DVT and/or PE: 10 mg once daily with or without food
• Prophylaxis of DVT Following Hip or Knee Replacement Surgery: 10 mg once daily with or without food
• Prophylaxis of VTE in Acutely Ill Medical Patients: 10 mg once daily with or without food
• CAD or PAD: 2.5 mg twice daily with or without food, in combination with aspirin 2

From the Research

Typical Dosing Regimen for Rivaroxaban

The typical dosing regimen for rivaroxaban (Xarelto) is as follows:

• 15 mg twice daily for 3 weeks, followed by 20 mg once daily for the treatment of deep-vein thrombosis and pulmonary embolism 3, 4, 5
• 15 mg twice daily for 21 days, followed by 20 mg once daily thereafter for the treatment of deep vein thrombosis and pulmonary embolism 6
• 20 mg once daily or 10 mg once daily for the extended prevention of recurrent venous thromboembolism, based on a patient's risk of recurrence, bleeding, and personal preferences 6

Key Considerations

Some key considerations for the dosing regimen of rivaroxaban include:

• The approved rivaroxaban dose schedule was derived based on pharmacological data from the clinical development programme to achieve a strong antithrombotic effect in the acute treatment phase and address the need to balance efficacy and bleeding risk for long-term treatment with a once-daily dose in the maintenance phase 4
• Rivaroxaban is generally well tolerated in patients with deep vein thrombosis or pulmonary embolism, with no significant between-group differences in clinically relevant bleeding between the rivaroxaban and enoxaparin-VKA groups 7
• Extended prophylaxis with rivaroxaban reduced the incidence of symptomatic recurrent venous thromboembolism to a greater extent than placebo, but was associated with a non-significant increase in the risk of clinically relevant bleeding compared with placebo 7