Rivaroxaban

Revision as of 18:03, 23 March 2016 by Rossdonaldson1 (talk | contribs) (Adult Dosing)

Administration

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

Adult Dosing

  • Thromboembolism/stroke prophylaxis: 20 mg PO qd
  • DVT Prophylaxis: 10 mg PO qd x35 days; Start: 6-10h post-op once hemostasis established
  • DVT/PE Prophylaxis, recurrent: 20 mg PO qd
  • DVT/PE Treatment: 20 mg PO qd

Special Populations

  • Pregnancy Risk Factor: C

Renal Dosing

  • Thromboembolism/stroke prophylaxis
    • CrCl 15-50: 15 mg 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 tx
    • 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 tx use)
  • CrCl <15 (thromboembolism/stroke prophylaxis use)
  • Acute PE with hemodynamic instability
  • Acute PE requiring thrombolysis or pulmonary embolectomy

Adverse Reactions

Serious

  • Bleeding, severe
  • Epidural/spinal hematoma
  • Thrombocytopenia
  • Agranulocytosis
  • Hypersensitivity rxn
  • Stevens-Johnson syndrome
  • Hepatitis

Common

  • Bleeding
  • Back pain
  • Pruritus
  • Elevated ALT
  • Thrombocytopenia
  • Decreased platelets

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


References

<UpToDate, Epocrates>