What is the recommended dosage of Xarelto (rivaroxaban) for atrial fibrillation (afib)?

From the Guidelines

The standard dosage of Xarelto (rivaroxaban) for atrial fibrillation is 20 mg once daily taken with the evening meal, and for patients with reduced kidney function (creatinine clearance 15-50 mL/min), the recommended dose is lower at 15 mg once daily with the evening meal. This recommendation is based on the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1. It's essential to take Xarelto at the same time each day to maintain consistent blood levels. If a dose is missed, it should be taken as soon as remembered on the same day, but never take a double dose to make up for a missed one. Xarelto works by inhibiting Factor Xa, preventing blood clot formation that could lead to stroke in atrial fibrillation patients. Unlike warfarin, Xarelto doesn't require regular blood monitoring, but kidney function should be assessed periodically, as recommended in the guidelines 1. Common side effects include bleeding risk, so it's crucial to report any unusual bleeding or bruising to a doctor immediately. Stopping Xarelto without consulting a healthcare provider could increase stroke risk. The dosage recommendations are also supported by other studies, such as the ROCKET AF trial, which compared rivaroxaban with warfarin among patients with nonvalvular atrial fibrillation 1.

Some key points to consider when prescribing Xarelto include:

• Renal function should be evaluated prior to initiation of Xarelto and reevaluated when clinically indicated and at least annually 1.
• The concomitant use of P-glycoprotein inducers or inhibitors with Xarelto may require dosing adjustment or avoidance of concomitant drug use 1.
• Xarelto is contraindicated with drugs that are combined P-glycoprotein and strong CYP3A4 inducers 1.

Overall, the recommended dosage of Xarelto for atrial fibrillation, as supported by the most recent and highest quality evidence, prioritizes the reduction of stroke risk while minimizing bleeding risk, thus optimizing morbidity, mortality, and quality of life outcomes for patients with atrial fibrillation.

From the FDA Drug Label

Adults Advise patients with atrial fibrillation to take XARELTO once daily with the evening meal.

The recommended dosage of Xarelto (rivaroxaban) for atrial fibrillation (afib) is to take it once daily with the evening meal 2.

• The exact dose is not specified in this section, but it can be found in the Dosage and Administration (2.1) section, which is referenced in the label.
• However, the label does mention that for initial treatment of DVT and/or PE, the dose is 15 mg or 20 mg tablets, and for continued risk of recurrent DVT and/or PE, the dose is 10 mg once daily.
• Since the question is about atrial fibrillation, and the label only mentions the dosing frequency and timing (once daily with the evening meal), but not the exact dose, we cannot determine the exact dose from this information alone.
• To determine the exact dose, one would need to refer to the Dosage and Administration (2.1) section, which is not provided here.

From the Research

Recommended Dosage of Xarelto (Rivaroxaban) for Atrial Fibrillation (AFib)

• The recommended dosage of Xarelto (rivaroxaban) for atrial fibrillation (AFib) is 20 mg daily for patients with normal renal function 3.
• For patients with reduced renal function, a dose of 15 mg daily is recommended 3, 4.
• The dosage may need to be adjusted based on the patient's creatinine clearance (CrCl) level, with a CrCl of 30-49 mL/min requiring a dose of 15 mg daily 4.
• For patients with end-stage kidney disease, the use of rivaroxaban is not well established, but some studies suggest that a low dose of 10 mg daily may be beneficial 5.
• It is important to note that the dosage of rivaroxaban should be individualized based on the patient's specific needs and medical history, and that the prescribing information should be consulted for specific guidance 6.

Renal Function and Dosage Adjustment

• Renal function is an important factor in determining the dosage of rivaroxaban, with patients with reduced renal function requiring a lower dose 3, 4.
• The estimated glomerular filtration rate (eGFR) is used to determine the dosage of rivaroxaban, with an eGFR of 30-49 mL/min requiring a dose of 15 mg daily 4.
• Patients with a CrCl of less than 30 mL/min should not receive rivaroxaban, as the risk of bleeding is increased 3.

Clinical Practice and Dosage Adherence

• In clinical practice, the dosage of rivaroxaban is often not adherent to the recommended labeling, with some patients receiving a reduced dose without meeting the criteria for dose reduction 6.
• The use of rivaroxaban in patients with AFib requires careful consideration of the patient's renal function and medical history, as well as regular monitoring of their condition to ensure optimal dosing and minimize the risk of adverse events 7, 3, 4, 5, 6.