Rivaroxaban Dosage

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for Deep Vein Thrombosis Prophylaxis after Hip Replacement Surgery

Prevention of venous thromboembolism in patients undergoing hip or knee replacement surgery:
10 mg orally once a day starting 6 to 10 hours after surgery.

Duration of therapy is 35 days for hip replacement surgery and 12 days for knee replacement surgery.

Usual Adult Dose for Deep Vein Thrombosis Prophylaxis after Knee Replacement Surgery

Prevention of venous thromboembolism in patients undergoing hip or knee replacement surgery:
10 mg orally once a day starting 6 to 10 hours after surgery.

Duration of therapy is 35 days for hip replacement surgery and 12 days for knee replacement surgery.

Usual Adult Dose for Atrial Fibrillation

Nonvalvular Atrial Fibrillation:
20 mg orally, once daily with the evening meal.

Usual Adult Dose for Deep Vein Thrombosis

Treatment of DVT and PE:
Initial dose: 15 mg orally twice daily with food, for first 21 days.
Maintenance dose: 20 mg orally once daily with food, for remaining treatment.

Usual Adult Dose for Pulmonary Embolism

Treatment of DVT and PE:
Initial dose: 15 mg orally twice daily with food, for first 21 days.
Maintenance dose: 20 mg orally once daily with food, for remaining treatment.

Usual Adult Dose for Deep Vein Thrombosis - Recurrent Event

Reduction in the Risk of Recurrence of DVT and of PE:
20 mg orally once daily with food.

Usual Adult Dose for Pulmonary Embolism - Recurrent Event

Reduction in the Risk of Recurrence of DVT and of PE:
20 mg orally once daily with food.

Renal Dose Adjustments

Prophylaxis of Deep Vein Thrombosis:
Avoid the use of rivaroxaban in patients with severe renal impairment (creatinine clearance less than 30 mL/min) due to an expected increase in rivaroxaban exposure and pharmacodynamic effects in this patient population. Observe closely and promptly evaluate any signs or symptoms of blood loss in patients with moderate renal impairment (CrCl 30 to 50 mL/min). Patients who develop acute renal failure while on rivaroxaban should discontinue the treatment.

Nonvalvular Atrial Fibrillation:
For patients with CrCl 15 to 50 mL/min: 15 mg orally, once daily with the evening meal.
Avoid use in patients with CrCl less than 15 mL/min. Periodically assess renal function as clinically indicated (i.e., more frequently in situations in which renal function may decline) and adjust therapy accordingly. Discontinue in patients who develop acute renal failure while on rivaroxaban.

Treatment of DVT, PE, and Reduction in Risk of Recurrence of DVT or PE:
Avoid in patients with CrCl less than 30 mL/min due to an expected increase in rivaroxaban exposure and pharmacodynamic effects.

Liver Dose Adjustments

Avoid use in patients with moderate (Child-Pugh B) or severe Child-Pugh C) liver dysfunction or any hepatic disease associated with coagulopathy.

Dose Adjustments

SWITCHING TO AND FROM RIVAROXABAN:

Switching from warfarin to rivaroxaban: Discontinue warfarin and start rivaroxaban as soon as the International Normalized Ratio (INR) is below 3.0.

Switching from rivaroxaban to warfarin: No data available. Manufacturer suggests discontinuing rivaroxaban and beginning both a parenteral anticoagulant and warfarin at the time the next dose of rivaroxaban would have been taken.

Switching from rivaroxaban to anticoagulants with rapid onset: Discontinue rivaroxaban and give the first dose of the other anticoagulant (oral or parenteral) at the time that the next rivaroxaban dose would have been taken.

Switching from anticoagulants other than warfarin to rivaroxaban: Start rivaroxaban 0 to 2 hours prior to the next scheduled evening administration of the other anticoagulant and omit the other anticoagulant. For unfractionated heparin being administered by continuous infusion, stop the infusion and start rivaroxaban at the same time.

Precautions

Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).

Dialysis

Data not available

Other Comments

ADMINISTRATION ADVICE:
-The 10 mg tablets can be taken with or without food. The 15 and 20 mg tablets should be taken with food at same time every day.

RECONSTITUTION/PREPARATION TECHNIQUES:
-For Patients Unable to Swallow Tablets: Crush the 15 mg or 20 mg tablets and mix with applesauce immediately prior to use. Follow the administration of the crushed tablets with food.
-For Patients with Nasogastric (NG) tube or Gastric feeding tube: Confirm the gastric placement of the tube. Administration distal to the stomach can result in reduced absorption and drug exposure. Crush the 15 mg or 20 mg tablets and suspend in 50 mL of water and administer through the NG or gastric feeding tubes. Follow the administration of the crushed tablet in water by an enteral feeding. In vitro studies showed no adsorption of the rivaroxaban in water suspension to PVC or silicone NG tubing.
-The crushed tablets are stable in water and applesauce for up to 4 hours.

GENERAL:
Missed Dose:
For patients receiving 15 mg twice daily: Take immediately to ensure a 30 mg daily dose. Two 15 mg tablets can be taken at the same time.
For patients receiving 10, 15 or 20 mg once daily: Take the missed dose immediately.

MONITORING: If monitoring is necessary for bleeding or emergency surgery, prothrombin time (PT) or the anti-FXa are best suited for measuring rivaroxaban's anticoagulation effect.

Hide
(web5)