What is the dosage of rivaroxaban (Xarelto) for Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)?

Rivaroxaban Dosage for Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)

For the treatment of DVT and PE, rivaroxaban should be administered at 15 mg orally twice daily with food for the first 21 days followed by 20 mg once daily with food for the remainder of the treatment period. 1

Initial Treatment Phase

• Rivaroxaban 15 mg twice daily with food for the first 21 days 1
• This initial higher-dose regimen provides strong antithrombotic effect during the acute treatment phase when the risk of recurrent VTE is highest 2
• Unlike dabigatran and edoxaban, rivaroxaban does not require a parenteral anticoagulant lead-in period 1
• The twice-daily dosing in the initial phase was derived from pharmacokinetic modeling to ensure adequate 24-hour coverage during this critical period 2

Maintenance Phase

• After the initial 21 days, transition to rivaroxaban 20 mg once daily with food 1
• The maintenance dose should be taken with food to optimize absorption 3
• This dose has been shown to be non-inferior to standard therapy (enoxaparin/VKA) for preventing recurrent VTE 4, 5

Extended Secondary Prevention

• For patients requiring extended treatment beyond 6 months, either 20 mg once daily with food or 10 mg once daily with or without food can be considered 1
• The reduced dose of 10 mg daily has been shown to be effective for secondary prevention of VTE after the initial 6-month treatment period 6

Important Administration Considerations

• Rivaroxaban must be taken with food to maximize absorption, particularly for the 15 mg and 20 mg doses 3
• For patients who cannot swallow tablets whole, rivaroxaban tablets may be crushed and mixed with applesauce immediately prior to use 3
• If a dose is missed during the twice-daily treatment phase (first 21 days), the patient should take the missed dose immediately to ensure intake of 30 mg total per day 3

Safety Considerations

• Rivaroxaban has demonstrated a favorable bleeding profile compared to standard therapy, with significantly lower rates of major bleeding in pooled analyses (1.0% vs 1.7%, HR 0.54) 5
• No routine coagulation monitoring is required 7
• Rivaroxaban should be used with caution in patients with severe renal impairment (CrCl 15-30 mL/min) and is not recommended in patients with CrCl <15 mL/min 3
• Drug interactions should be considered, particularly with combined P-gp and strong CYP3A4 inhibitors or inducers 3

Clinical Benefits

• The single-drug approach with rivaroxaban simplifies treatment compared to traditional therapy 7
• Rivaroxaban treatment has been associated with shorter hospital length of stay compared to standard therapy with enoxaparin/VKA 1
• The fixed-dose regimen eliminates the need for routine coagulation monitoring required with vitamin K antagonists 2, 7