Difference between revisions of "Rivaroxaban"

(Text replacement - "Category:Drugs" to "Category:Pharmacology")
(Administration)
 
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==Administration==
 
==Administration==
*Type: Anticoagulant, Factor Xa Inhibitor
+
*Type: [[Anticoagulant]], Factor Xa Inhibitor
 
*Dosage Forms: 10, 15, 20
 
*Dosage Forms: 10, 15, 20
 
*Routes of Administration:
 
*Routes of Administration:
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==Adult Dosing==
 
==Adult Dosing==
*Thromboembolism/stroke prophylaxis: 20 mg PO qd
+
*Thromboembolism/[[stroke]] prophylaxis: 20mg PO QD
*DVT Prophylaxis: 10 mg PO qd x35 days; Start: 6-10h postop once hemostasis established
+
*[[DVT]] Prophylaxis: 10mg PO QD x35 days; Start: 6-10h post-op once hemostasis established
*DVT/PE Prophylaxis, recurrent: 20 mg PO qd
+
*[[DVT]]/[[PE]] Prophylaxis, recurrent: 20mg PO QD
*DVT/PE Treatment: 20 mg PO qd
+
*[[DVT]]/[[PE]] Treatment: 20mg PO QD
 +
*[[Atrial fibrillation]] and new stent<ref>Gibson CM et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med 2016 Nov 14.</ref>:
 +
**Rivaroxaban 15 mg/day plus [[clopidogrel]] for 12 months post-stenting just as efficacious to current standard
 +
**Reduces clinically significant bleeds from ~27% to 17% as compared to warfarin plus DAPT
  
 
==Special Populations==
 
==Special Populations==
*Pregnancy Risk Factor: C
+
*[[Drug ratings in pregnancy|Pregnancy Risk Factor]]: C
  
 
===Renal Dosing===
 
===Renal Dosing===
*Thromboembolism/stroke prophylaxis
+
*Thromboembolism/[[stroke]] prophylaxis
**CrCl 15-50: 15 mg qd; CrCl <15: avoid use
+
**CrCl 15-50: 15mg QD; CrCl <15: avoid use
*DVT prophylaxis
+
*[[DVT]] prophylaxis
 
**CrCl 30-50: caution advised; CrCl <30: avoid use
 
**CrCl 30-50: caution advised; CrCl <30: avoid use
*DVT/PE prophylaxis, recurrent
+
*[[DVT]]/[[PE]] prophylaxis, recurrent
 
**CrCl <30: avoid use
 
**CrCl <30: avoid use
*DVT/PE tx
+
*[[DVT]]/[[PE]] treatment
 
**CrCl <30: avoid use
 
**CrCl <30: avoid use
  
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*Hepatic impairment, Child-Pugh Class B or C
 
*Hepatic impairment, Child-Pugh Class B or C
 
*Coagulopathy-assoc. hepatic disease
 
*Coagulopathy-assoc. hepatic disease
*CrCl <30 (DVT prophylaxis, recurrent DVT/PE prophylaxis, DVT/PE tx use)
+
*CrCl <30 (DVT prophylaxis, recurrent DVT/PE prophylaxis, DVT/PE treatment use)
 
*CrCl <15 (thromboembolism/stroke prophylaxis use)
 
*CrCl <15 (thromboembolism/stroke prophylaxis use)
*Acute PE w/ hemodynamic instability
+
*Acute [[PE]] with hemodynamic instability
*Acute PE requiring thrombolysis or pulmonary embolectomy
+
*Acute [[PE]] requiring thrombolysis or pulmonary embolectomy
  
 
==Adverse Reactions==
 
==Adverse Reactions==
 
===Serious===
 
===Serious===
*Bleeding, severe
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*[[Anticoagulant reversal for life-threatening bleeds|Bleeding, severe]]
*Epidural/spinal hematoma
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**[[Andexanet alfa]]
*Thrombocytopenia
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*Epidural/[[spinal hematoma]]
 +
*[[Thrombocytopenia]]
 
*Agranulocytosis
 
*Agranulocytosis
*Hypersensitivity rxn
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*Hypersensitivity reaction
*Stevens-Johnson syndrome
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*[[Stevens-Johnson syndrome]]
*Hepatitis
+
*[[Hepatitis]]
 +
 
 
===Common===
 
===Common===
 
*Bleeding
 
*Bleeding
*Back pain
+
*[[Back pain]]
*Pruritus
+
*[[Pruritus]]
 
*Elevated ALT  
 
*Elevated ALT  
*Thrombocytopenia
+
*[[Thrombocytopenia]]
*Decreased platelets
 
  
 
==Pharmacology==
 
==Pharmacology==
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*Inhibits platelet activation and fibrin clot formation via direct, selective and reversible inhibition of factor Xa in both the intrinsic and extrinsic coagulation pathways  
 
*Inhibits platelet activation and fibrin clot formation via direct, selective and reversible inhibition of factor Xa in both the intrinsic and extrinsic coagulation pathways  
  
 +
==See Also==
 +
*[[Anticoagulant reversal for life-threatening bleeds]]
 +
*[[Andexanet alfa]]
  
 
==References==
 
==References==
<UpToDate, Epocrates>
+
*UpToDate
 +
*Epocrates
 +
<references/>
 
[[Category:Pharmacology]]
 
[[Category:Pharmacology]]

Latest revision as of 17:57, 19 September 2019

Administration

  • Type: Anticoagulant, Factor Xa Inhibitor
  • Dosage Forms: 10, 15, 20
  • Routes of Administration:
  • Common Trade Names: Xarelto

Adult Dosing

  • Thromboembolism/stroke prophylaxis: 20mg PO QD
  • DVT Prophylaxis: 10mg PO QD x35 days; Start: 6-10h post-op once hemostasis established
  • DVT/PE Prophylaxis, recurrent: 20mg PO QD
  • DVT/PE Treatment: 20mg PO QD
  • Atrial fibrillation and new stent[1]:
    • Rivaroxaban 15 mg/day plus clopidogrel for 12 months post-stenting just as efficacious to current standard
    • Reduces clinically significant bleeds from ~27% to 17% as compared to warfarin plus DAPT

Special Populations

Renal Dosing

  • Thromboembolism/stroke prophylaxis
    • CrCl 15-50: 15mg QD; CrCl <15: avoid use
  • DVT prophylaxis
    • CrCl 30-50: caution advised; CrCl <30: avoid use
  • DVT/PE prophylaxis, recurrent
    • CrCl <30: avoid use
  • DVT/PE treatment
    • CrCl <30: avoid use

Hepatic Dosing

  • Avoid Use In:
    • Child-Pugh Class B or C
    • Coagulopathy-assoc. hepatic disease

Contraindications

  • Active major bleeding
  • Hepatic impairment, Child-Pugh Class B or C
  • Coagulopathy-assoc. hepatic disease
  • CrCl <30 (DVT prophylaxis, recurrent DVT/PE prophylaxis, DVT/PE treatment use)
  • CrCl <15 (thromboembolism/stroke prophylaxis use)
  • Acute PE with hemodynamic instability
  • Acute PE requiring thrombolysis or pulmonary embolectomy

Adverse Reactions

Serious

Common

Pharmacology

  • Half-life: 5-9 hours
  • Metabolism: CYP450
  • Excretion: 66% Urine, 28% Feces

Mechanism of Action

  • Inhibits platelet activation and fibrin clot formation via direct, selective and reversible inhibition of factor Xa in both the intrinsic and extrinsic coagulation pathways

See Also

References

  • UpToDate
  • Epocrates
  1. Gibson CM et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med 2016 Nov 14.