Rivaroxaban (Xarelto®) Considerations for Use*
US/FDA Approved Indications: Stroke Prevention in Non-valvular Atrial Fibrillation
|Black Box Warning*||Discontinuing rivaroxaban in patients with atrial fibrillation increases the risk of thrombotic events. Epidural and spinal hematomas may occur in patients who are anticoagulated and are receiving neuraxial anesthesia or undergoing spinal punctures.|
Mechanism of Action
Direct factor Xa inhibitor
Adult: 20 mg PO daily with evening meal
Elderly: No dosage adjustment necessary
Hepatic Impairment: No dosage adjustment necessary
Active pathological bleeding
|Major Side Effects||
|Dosage forms and Strengths||
PO: 10, 15, 20 mg tablets
There is no rapid reversal agent for rivaroxaban
Surgery and interventions:
|Conversion to/from other drugs||
From rivaroxaban to warfarin:
From rivaroxaban to an anticoagulant with rapid onset:
From warfarin to rivaroxaban:
From low molecular weight heparin or non-warfarin oral anticoagulant to rivaroxaban:
From unfractionated heparin given by continuous infusion to rivaroxaban:
Has many potential drug interactions.
Only use if the potential benefit justifies the potential risk with CrCL 15 to 50 mL/min and concomitant combined P-gp and weak or m oderate CYP3A4 inhibitors (e.g., amiodarone, dronedarone, diltiazem, verapamil, quinidine, ranolazine, felodipine, erythromycin, azithromycin).
Take daily with evening meal.
Do not discontinue this medication without talking to the healthcare provider who prescribed it.
Consult healthcare professional prior to using new drug (prescription, OTC, herbal).
Report signs and symptoms of bleeding (e.g., unexpected bleeding or bleeding that lasts a long time; red or black, tarry stool; pink or brown urine; unusual bruising; coughing up blood; vomiting blood or vomit that looks like coffee grounds; unexplained pain, swelling, or joint pain; unusual headaches, dizziness, or weakness; recurring nose bleeds).
Tell your healthcare professional if you have had or will have surgery to place a prosthetic heart valve.
Tell your healthcare professional if you are pregnant or plan to become pregnant or are breastfeeding or plan to breastfeed during treatment.
*Refer to prescribing information for more complete information.
†Dosages given in the table may differ from those recommended by the manufacturers.
- Xarelto® Prescribing information, 11/2/12.
- Chest Supplement, Antithrombotic Therapy and Prevention of Thrombosis, 9th edition, American College of Chest Physicians.