From the Guidelines
The loading dose of rivaroxaban is 15 mg twice daily for the first 21 days, followed by 20 mg once daily for continued treatment in patients with acute deep vein thrombosis or pulmonary embolism. This dosing regimen is based on the most recent and highest quality study available, which demonstrated the efficacy and safety of rivaroxaban in the treatment of venous thromboembolism 1.
Key Considerations
- The loading dose of rivaroxaban is indication-specific, and the dose may vary depending on the patient's condition and renal function.
- For patients with atrial fibrillation, no loading dose is needed, and the typical starting dose is 20 mg once daily (or 15 mg once daily if creatinine clearance is 15-49 mL/min).
- For prophylaxis after hip or knee replacement surgery, no loading dose is used, and the typical dose is 10 mg once daily.
- Rivaroxaban should be taken with food to enhance absorption, and patients should be counseled about bleeding risks and the importance of adherence to the prescribed regimen.
Dosing Regimens
- Acute deep vein thrombosis or pulmonary embolism: 15 mg twice daily for the first 21 days, followed by 20 mg once daily for continued treatment 1.
- Atrial fibrillation: 20 mg once daily (or 15 mg once daily if creatinine clearance is 15-49 mL/min) 1.
- Prophylaxis after hip or knee replacement surgery: 10 mg once daily 1.
Important Safety Information
- Renal function should be assessed before initiating therapy, and dose adjustments are necessary for patients with renal impairment.
- Patients should be counseled about bleeding risks and the importance of adherence to the prescribed regimen.
- Rivaroxaban is contraindicated in patients with severe renal failure and a creatinine clearance of 15 mL/min, in patients with hepatic disease associated with coagulopathy, and in patients receiving concomitant systemic treatment with azole-antimycotics or HIV protease inhibitors 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)
The loading dose of Rivaroxaban (Xarelto) is 15 mg orally twice daily for the first 21 days in the treatment of DVT and/or PE 2.
From the Research
Rivaroxaban Loading Doses
- The provided studies do not specifically mention loading doses of Rivaroxaban (Xarelto) 3, 4, 5, 6, 7.
- However, the studies discuss the various dosing regimens of Rivaroxaban for different indications, such as:
- 10 mg once daily for patients with creatinine clearance (CrCl) 15-29 ml/min 3
- 15 mg once daily for patients with CrCl 30-69 ml/min 3
- 10 mg twice daily for patients with CrCl 70-159 ml/min 3
- 15 mg twice daily for patients with CrCl 160-250 ml/min 3
- 20 mg once daily as a standard dose for patients with non-valvular atrial fibrillation 5
- 15 mg once daily as a reduced dose for patients with renal impairment 5
- 10 mg once daily for patients undergoing elective knee or hip replacement surgery 6
- 20 mg once daily for patients with non-valvular atrial fibrillation 6
- 15 mg twice daily for 3 weeks, followed by 20 mg once daily for the treatment of deep vein thrombosis (DVT) 6
- 2.5 mg twice daily for patients with a recent acute coronary syndrome 6
Indications and Dosing Regimens
- Rivaroxaban is approved for various indications, including:
- Prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation 4, 5, 6, 7
- Prevention of deep vein thrombosis (DVT) in patients undergoing total hip replacement and total knee replacement 4, 6, 7
- Treatment of DVT and pulmonary embolism (PE) 4, 6, 7
- Reduction in risk of recurrence of DVT and PE 4, 6, 7
- The dosing regimens of Rivaroxaban vary depending on the indication and patient characteristics, such as renal function and age 3, 4, 5, 6, 7.