Half-Life of Rivaroxaban
The terminal elimination half-life of rivaroxaban is 5 to 9 hours in healthy adults aged 20 to 45 years with normal renal function. 1
Half-Life Variations by Population
The half-life of rivaroxaban varies based on patient characteristics:
- Young healthy adults (20-45 years): 5-9 hours 1
- Elderly patients (60-76 years): 11-13 hours 1, 2
- Healthy adults in pharmacokinetic studies: 7-17 hours (terminal half-life range) 3
- Multiple dosing regimens: 4-6 hours on first day, extending to 6-9 hours at steady state 3
Pharmacokinetic Profile
Peak plasma concentrations occur rapidly at 2-4 hours after oral administration, making rivaroxaban one of the faster-acting oral anticoagulants. 3, 1, 2
Key absorption and distribution characteristics include:
- Oral bioavailability: 80-100% for the 10 mg dose (not affected by food) 1, 2
- Protein binding: 92-95% bound to plasma proteins, primarily albumin 3, 4, 1
- Volume of distribution: Approximately 50 L at steady state 1
Elimination Pathways
Rivaroxaban has dual elimination with significant renal involvement:
- 66% excreted via kidneys (36% as unchanged drug) 3
- 28% excreted in feces (7% unchanged) 3
- Systemic clearance: Approximately 10 L/hr in healthy volunteers 1
The renal elimination pathway makes rivaroxaban a low-clearance drug despite its relatively short half-life. 4, 1
Clinical Implications of Half-Life
The half-life of rivaroxaban directly impacts clinical decision-making:
- Duration of anticoagulant effect: The biologic half-life of factor Xa inhibition is 6-7 hours, with factor Xa activity not returning to normal until after 24 hours with lower doses 3
- Neuraxial procedures: An indwelling epidural catheter should not be removed before at least 2 half-lives have elapsed (approximately 10-18 hours in young adults, 22-26 hours in elderly) 1
- Non-dialyzable: Due to high plasma protein binding (92-95%), rivaroxaban cannot be removed by hemodialysis 1
Important Caveats
The half-life is significantly prolonged in elderly patients, increasing from 5-9 hours in young adults to 11-13 hours in those aged 60-76 years. 1, 2 This age-related prolongation occurs even with normal renal function and reflects age-related changes in drug clearance.
Renal impairment further extends the half-life, as 66% of the drug undergoes renal elimination. 3 Patients with creatinine clearance 30-49 mL/min require dose reduction due to increased drug exposure. 1
The half-life is shorter than apixaban (12 hours) but comparable to other direct oral anticoagulants in its class. 5 This intermediate half-life allows for once-daily dosing in most indications while maintaining predictable anticoagulation throughout the 24-hour dosing interval.