Xarelto Dosage

Generic name: rivaroxaban
Drug class: Factor Xa inhibitors

Medically reviewed by  A Ras MD.

 Recommended Adult Dosing

Dosage forms:  TAB: 2.5 mg, 10 mg, 15 mg, 20 mg; SUSP: 1 mg per mL

Thromboembolism/stroke prophylaxis

[20 mg PO qd]

Info: for non-valvular atrial fibrillation w/o mod-severe mitral stenosis or mechanical heart valve; give w/ evening meal; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <3; to convert from unfractionated heparin infusion, D/C unfractionated heparin, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled evening anticoagulant dose; consider holding tx >24h before surgery or invasive procedure; do not cut tab

DVT/PE tx

[20 mg PO qd]

Start: 15 mg PO bid x21 days, then 20 mg PO qd; Info: give 15 mg and 20 mg tabs w/ food; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <3; to convert from unfractionated heparin infusion, D/C unfractionated heparin, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled anticoagulant dose; consider holding tx >24h before surgery or invasive procedure; do not cut tab

DVT/PE prophylaxis, recurrent

[10 mg PO qd]

Info: to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <3; to convert from unfractionated heparin infusion, D/C unfractionated heparin, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled anticoagulant dose; consider holding tx >24h before surgery or invasive procedure; do not cut tab

DVT prophylaxis

[hip replacement]

Dose: 10 mg PO qd x35 days; Start: 6-10h postop once hemostasis established; do not cut tab

[knee replacement]

Dose: 10 mg PO qd x12 days; Start: 6-10h postop once hemostasis established; do not cut tab

VTE prophylaxis, acutely ill pts

[10 mg PO qd]

Info: for hospitalized pts w/ mod. or severe restricted mobility and other VTE risk factors, not at high bleeding risk; consider holding tx >24h before surgery or invasive procedure; continue tx x31-39 days total incl. post-discharge; do not cut tab

cardiovascular event risk reduction

[2.5 mg PO bid]

Info: for pts w/ CAD; give w/ aspirin 75-100 mg PO qd; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <3; to convert from unfractionated heparin infusion, D/C unfractionated heparin, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled evening anticoagulant dose; consider holding tx >24h before surgery or invasive procedure; do not cut tab

thrombotic event risk reduction

[2.5 mg PO bid]

Info: for pts w/ PAD, incl. symptomatic w/ recent lower extremity revascularization; give w/ aspirin 75-100 mg PO qd; start once hemostasis established in pts w/ revascularization; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <3; to convert from unfractionated heparin infusion, D/C unfractionated heparin, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled evening anticoagulant dose; consider holding tx >24h before surgery or invasive procedure; do not cut tab

VTE prophylaxis, cardioversion

[20 mg PO qd]

Start: at least 3wk before cardioversion; Info: for pts w/ afib/flutter duration >48h or unknown; continue tx x4wk after procedure; do not cut tab

Renal dosing

[thromboembolism/stroke prophylaxis]

CrCl <51: 15 mg qd

HD: 15 mg qd; no supplement after dialysis; PD: not defined

[cardiovascular event risk reduction or thrombotic event risk reduction]

renal impairment: no adjustment

HD: no adjustment; no supplement; PD: not defined

[VTE prophylaxis, cardioversion]

CrCl 30-49: 15 mg qd; CrCl <30: not defined

HD/PD: not defined

[all other indications]

CrCl <15: avoid use; Info: caution advised if CrCl 15-30

HD/PD: avoid use

Hepatic dosing

Child-Pugh Class B or C: avoid use; coagulopathy-assoc. hepatic dz: avoid use

SRC: NLM .