Rivaroxaban (Xarelto®)

Rivaroxaban is an oral Xa inhibitor indicated (1) to reduce the risk of stroke and systemic embolism in patients with nonvalvular AF, (2) for the prevention of DVT in patients undergoing knee or hip replacement surgery and (3) for the treatment of acute DVT and/or PE.

Important administration considerations:

  1. For nonvalvular AF
    • 20mg once daily with the evening meal if CrCl >50 mL/min
    • 15mg once daily with the evening meal if CrCl is 15-50 mL/min
    • More expensive than warfarin and dabigatran
  2. For DVT prophylaxis
    • After knee replacement: 10mg daily (with or without food) for 12 days
    • After hip replacement: 10mg daily (with or without food) for 35 days
    • Less expensive than enoxaparin
  3. For DVT and PE treatment 
    • 15 mg twice daily with food for the first 21 days then 20 mg once daily with food for a total of 6 months
    • After the first 6 months, to reduce the risk of recurrent DVT or PE, continue 20 mg once daily with food
  4. When transitioning from warfarin to rivaroxaban, discontinue warfarin and start rivaroxaban as soon as INR <3.0
  5. Avoid concomitant administration with ketoconazoke, itraconazole, lopinavir/ritonavir, ritonavir, indinavir/ritonavir, conivaptan, carbemazepine, phenytoin, rifampin and St. John’s wort
  6. More expensive than warfarin
  7. No reversal agent
  8. No INR monitoring required

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