Rivaroxaban

Anticoagulant Drug

Drug class: Direct Factor Xa inhibitor

Rivaroxaban (XARELTO)（中文：利伐沙班）

Common Strengths of Rivaroxaban

Rivaroxban are available in the following strengths:

• 2.5 mg, 10 mg, 15 mg, and 20 mg tablets
• 1 mg/mL oral suspension

Drug Trade Names of Rivaroxaban

Xarelto

Drug Usage

• Prevent blood clots in adults after hip or knee replacement surgery
• Treat and prevent deep vein thrombosis (DVT) and pulmonary embolism (PE)
• Reduce risk of stroke in adults with nonvalvular atrial fibrillation
• Reduce risk of major cardiovascular events in patients with coronary artery disease or peripheral artery disease
• Prevent blood clots in children 2 years and older after heart surgery

Mechanism of Action

Selectively inhibits factor Xa, preventing the formation of blood clots.

Route of Administration

Oral

Dosages

• For atrial fibrillation: 20 mg orally once daily with the evening meal
• For deep vein thrombosis (DVT) and pulmonary embolism (PE) treatment:
  • 15 mg orally twice daily for the first 21 days
  • Then transition to 20 mg orally once daily

T*o reduce the risk of recurrent DVT and PE: 10 mg orally once daily

• For coronary artery disease or peripheral arterial disease: 2.5 mg orally twice daily
• With severe and moderate renal impairment (Creatinine clearance: 15-49 mL/min): 15 mg once daily

Side Effects

Frequency	Adverse reactions
Common	Easy bruising
	Anemia
	Nausea and vomiting
	Diarrhoea
	Constipation
	Dyspepsia
	Abdominal pain

Pharmacokinetics

• Absorption
  • Rapidly absorbed after oral administration
  • Peak plasma concentration reached in 2-4 hours
• Metabolism
  • Metabolized by CYP3A4, CYP3A5, CYP2J2, and CYP-independent mechanisms
• Elimination
  • About two-thirds excreted in urine and the remaining third excreted in faeces.
• Half-life
  • 5 to 9 hours in adults; 11 to 13 hours in elderly patients.

Drug Precautions

Pregnancy

Not recommended

Breastfeeding

Not recommended

9.4 Renal Impairment

Dose adjustment required (see renal dosing)

Monitoring Requirements

• Renal function test
• Signs and symptoms of bleeding:
  • Unexpected bleeding or bleeding that lasts a long time
  • Unusual bruising, nosebleeds, bleeding gums
  • Pink/brown urine, red/black stools
  • Coughing up blood or blood clots
  • Vomiting blood or vomit that looks like coffee grounds

Drug Interactions

Anticoagulants, NSAIDs, antiplatelet drugs

Caution

Use with caution in patients at risk of bleeding, or taking concomitant drugs that increase risk of bleeding.

FAQ

How Should I Take the Tablet?

• 10 mg tablet can be taken with or without food
• 15 mg and 20 mg tablets should be taken with food
• Can be crushed and mixed with apple sauce if unable to swallow whole

What Should I Avoid While Taking?

Avoid activities with a high risk of injury or bleeding

What Happens if I Miss a Dose?

Take the missed dose as soon as you remember. Skip the missed dose if it's almost time for your next scheduled dose