Can Rivaroxaban Tablets Be Crushed?
Yes, rivaroxaban tablets can be safely crushed for patients with dysphagia without altering bioavailability, but the 15 mg and 20 mg doses must be administered with food immediately after crushing. 1, 2
Administration Methods for Crushed Rivaroxaban
Oral Administration with Applesauce
- Rivaroxaban tablets (all strengths) may be crushed and mixed with applesauce immediately prior to use and administered orally. 2
- After administering a crushed 15 mg or 20 mg tablet, food must be given immediately to ensure proper absorption (bioavailability increases by 39% with food for these higher doses). 1, 2
- The 2.5 mg and 10 mg tablets do not require food administration after crushing. 2
- Crushed tablets are stable in applesauce for up to 4 hours. 2
Nasogastric or Gastric Feeding Tube Administration
- Rivaroxaban tablets can be crushed and suspended in 50 mL of water for administration via nasogastric (NG) or gastric feeding tube. 1, 2
- Critical: Confirm gastric placement of the tube before administration - avoid administration distal to the stomach as rivaroxaban absorption is site-dependent and distal administration results in reduced absorption and drug exposure. 2
- After administering crushed 15 mg or 20 mg tablets via tube, immediately follow with enteral feeding. 2
- Enteral feeding is not required for 2.5 mg or 10 mg tablets. 2
- There is no adsorption of rivaroxaban to PVC or silicone NG tubing. 2
Bioavailability Evidence
The bioavailability of crushed rivaroxaban is equivalent to whole tablets, supporting this practice. 3
- A pharmacokinetic study in 55 healthy adults demonstrated that crushed rivaroxaban tablets administered orally in applesauce or via NG tube in water suspension had similar bioavailability compared to whole tablets. 3
- The area under the curve (AUC) and maximum concentration (Cmax) were within bioequivalence limits (80-125%) for crushed tablets given orally. 3
- Crushed tablet suspensions showed >98.4% recovery of non-degraded rivaroxaban over 4 hours, confirming stability. 3
- Recovery after NG tube exposure was 99.1% for silicone and 98.9% for PVC tubes. 3
Critical Distinction from Dabigatran
Unlike rivaroxaban, dabigatran capsules must never be opened or crushed as this results in a substantial (75%) increase in drug bioavailability, leading to dangerous overdose risk. 1 This is a common pitfall - ensure you are crushing the correct direct oral anticoagulant.
Practical Considerations
- Crushed rivaroxaban tablets are stable in water for up to 4 hours, allowing preparation in advance if needed. 2
- For the 15 mg and 20 mg doses, the requirement for food intake applies whether the tablet is whole or crushed - this is non-negotiable for proper absorption. 1
- The rapid onset of action (therapeutic effect within 2-4 hours) is maintained with crushed tablets. 4