What is the dosing for Rivaroxaban (Xarelto) in the treatment of Deep Vein Thrombosis (DVT)?

From the Guidelines

For deep vein thrombosis (DVT) treatment, Xarelto (rivaroxaban) is typically dosed at 15 mg twice daily with food for the first 21 days, followed by 20 mg once daily with food for the remainder of treatment, as recommended by the most recent guidelines 1. This dosing regimen is based on the latest evidence from the NCCN guidelines, which prioritize the use of direct oral anticoagulants (DOACs) such as rivaroxaban for the treatment of DVT. The guidelines recommend this specific dosing regimen for rivaroxaban, which has been shown to be effective in preventing recurrent VTE and reducing the risk of major bleeding 1. Some key points to consider when prescribing rivaroxaban for DVT treatment include:

• The importance of taking the medication with food to ensure optimal absorption
• The need to maintain consistent dosing and not miss doses to minimize the risk of thrombotic events
• The potential for increased bleeding risk when taking rivaroxaban, particularly in patients with certain comorbidities or concomitant medications
• The lack of need for routine monitoring of blood levels, unlike warfarin It's also important to note that the total duration of therapy with rivaroxaban for DVT treatment generally ranges from 3 to 6 months, though this may be extended based on individual patient risk factors for recurrence 1. Overall, the use of rivaroxaban for DVT treatment has been shown to be effective and safe, and its convenience and lack of need for monitoring make it a popular choice for patients and clinicians alike.

From the FDA Drug Label

Adults Advise patients for initial treatment of DVT and/or PE to take XARELTO 15 mg or 20 mg tablets with food at approximately the same time every day [see Dosage and Administration (2. 1)] .

Starter Pack for treatment of deep vein thrombosis and treatment of pulmonary embolism: NDC 50458-584-5130-day starter blister pack containing 51 tablets: 42 tablets of 15 mg and 9 tablets of 20 mg

The dosing for Rivaroxaban (Xarelto) in the treatment of Deep Vein Thrombosis (DVT) is:

• Initial treatment: 15 mg or 20 mg tablets with food at approximately the same time every day.
• Starter Pack: 30-day starter blister pack containing 51 tablets, with 42 tablets of 15 mg and 9 tablets of 20 mg. 2

From the Research

Dosing for Rivaroxaban (Xarelto) in the Treatment of Deep Vein Thrombosis (DVT)

• The dosing for Rivaroxaban (Xarelto) in the treatment of DVT is as follows:
  • Twice daily 15 mg for 3 weeks, followed by 20 mg once daily 3, 4, 5
• This dosing regimen has been shown to be effective in the treatment of DVT, with a similar efficacy to standard therapy consisting of subcutaneous enoxaparin sodium overlapping with and followed by an oral dose-adjusted vitamin K antagonist (enoxaparin-VKA) 6, 4, 5
• The safety profile of Rivaroxaban has also been evaluated, with a significantly lower rate of major bleeding compared to enoxaparin-VKA 6, 5

Key Studies

• The EINSTEIN-DVT and EINSTEIN-PE trials, which included over 8,000 patients with DVT and/or PE, demonstrated the efficacy and safety of Rivaroxaban in the treatment of DVT 6, 5
• The study by 4 also evaluated the efficacy and safety of Rivaroxaban in the treatment of acute, symptomatic DVT, and found it to be noninferior to standard therapy

Pharmacokinetics and Pharmacodynamics

• The pharmacokinetics of Rivaroxaban in patients with DVT have been found to be consistent and predictable across all doses studied 7
• The area under the plasma concentration-time curve (AUC) increases dose dependently, and the same total daily doses given once daily achieve higher maximum plasma concentration (C(max)) values and lower trough (minimum) plasma concentration (C(trough)) values than when given twice daily 7