From the Guidelines
Rivaroxaban dosing for atrial fibrillation is 20 mg once daily with food, and for patients with reduced kidney function (CrCl 15-50 mL/min), the dose is reduced to 15 mg once daily with food, as recommended by the most recent guidelines 1. The dosing of Rivaroxaban (Xarelto) varies based on the condition being treated.
Key Considerations
- For atrial fibrillation, the standard dose is 20 mg once daily with food.
- Patients with reduced kidney function (CrCl 15-50 mL/min) should receive a reduced dose of 15 mg once daily with food.
- The medication works by inhibiting Factor Xa, preventing the formation of blood clots.
Administration
- Xarelto should be taken at the same time each day to maintain consistent blood levels.
- If a dose is missed, it should be taken as soon as possible on the same day.
Side Effects
- Common side effects include bleeding, and patients should report any unusual bleeding or bruising to their doctor immediately.
- Patients should not stop taking Xarelto without consulting their healthcare provider as this could increase stroke or clotting risk. According to the 2016 update on antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention, Rivaroxaban is a reasonable alternative to warfarin for stroke prevention in nonvalvular atrial fibrillation, with a dose of 20 mg once daily 1. The 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation also recommends Rivaroxaban as a treatment option, with a dose of 20 mg once daily with the evening meal 2. However, for patients with reduced kidney function, the dose should be adjusted to 15 mg once daily with food, as recommended by the guidelines 3.
From the FDA Drug Label
In the EINSTEIN trials, patients with CrCl values <30 mL/min at screening were excluded from the studies, but administration of XARELTO is expected to result in serum concentrations of rivaroxaban similar to those in patients with moderate renal impairment (CrCl 30 to <50 mL/min) For patients receiving 2.5 mg twice daily: if a dose is missed, the patient should take a single 2.5 mg XARELTO dose as recommended at the next scheduled time. For patients receiving 15 mg twice daily: The patient should take XARELTO immediately to ensure intake of 30 mg XARELTO per day. For patients receiving 20 mg, 15 mg or 10 mg once daily: The patient should take the missed XARELTO dose immediately
The dosing for Rivaroxaban (Xarelto) is as follows:
- Treatment of DVT and/or PE and Reduction in the Risk of Recurrence of DVT and/or PE: 15 mg twice daily for 21 days, followed by 20 mg once daily 4
- Prophylaxis of DVT Following Hip or Knee Replacement Surgery: 10 mg once daily 4
- Prophylaxis of Venous Thromboembolism in Acutely Ill Medical Patients at Risk for Thromboembolic Complications: 10 mg once daily 4
- Reduction of Risk of Major Cardiovascular Events in Patients with CAD and Reduction of Risk of Major Thrombotic Vascular Events in Patients with PAD: 2.5 mg twice daily 4
- Missed Dose:
- For patients receiving 2.5 mg twice daily: take a single 2.5 mg XARELTO dose as recommended at the next scheduled time
- For patients receiving 15 mg twice daily: take XARELTO immediately to ensure intake of 30 mg XARELTO per day
- For patients receiving 20 mg, 15 mg or 10 mg once daily: take the missed XARELTO dose immediately 5
From the Research
Rivaroxaban Dosing
The dosing for Rivaroxaban (Xarelto) varies depending on the indication. Some key points to consider are:
- Rivaroxaban is administered at a fixed oral dose and does not require routine coagulation monitoring 6, 7.
- The dose and frequency of administration vary depending on the indication, such as prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, treatment of deep vein thrombosis and pulmonary embolism, and reduction in risk of recurrence of deep vein thrombosis and pulmonary embolism 7.
- For the treatment of deep vein thrombosis and pulmonary embolism, rivaroxaban can be used as a single-drug approach, with a fixed dose administered orally 6.
- In obese patients up to 150 kg, standard doses of rivaroxaban are appropriate 8.
Specific Dosing Regimens
Some specific dosing regimens for rivaroxaban include:
- For the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, the dose is typically 20 mg once daily 9.
- For the treatment of deep vein thrombosis and pulmonary embolism, the dose is typically 15 mg twice daily for the first 21 days, followed by 20 mg once daily 6.
- For the prevention of recurrent deep vein thrombosis and pulmonary embolism, the dose is typically 20 mg once daily 6.
Special Considerations
Some special considerations for rivaroxaban dosing include:
- Patients with renal insufficiency may require dose adjustments, as rivaroxaban is primarily excreted renally 9, 7.
- Patients with hepatic impairment may require dose adjustments, as rivaroxaban is metabolized in the liver 7.
- Rivaroxaban has a lower potential for drug interactions compared to warfarin, but drug interactions can still occur and should be monitored 7.