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| __NOTOC__
| | #REDIRECT [[Rivaroxaban#Adult Indications and Dosage]] |
| {{Rivaroxaban}}
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| {{CMG}}; {{AE}} {{AZ}}
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| == Dosage and Administration==
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| |[[image:riva2.png|800px|thumb]]
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| === Important Food Effect Information===
| | [[Category: Cardiovascular Drugs]] |
| The 15 mg and 20 mg XARELTO tablets should be taken with food, while the 10 mg tablet can be taken with or without food [see Clinical Pharmacology (12.3)].
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| In the nonvalvular atrial fibrillation efficacy study XARELTO was taken with the evening meal.
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| === Switching to and from XARELTO===
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| Switching from Warfarin to XARELTO - When switching patients from warfarin to XARELTO, discontinue [[warfarin ]]and start XARELTO as soon as the International Normalized Ratio ([[INR]]) is below 3.0 to avoid periods of inadequate anticoagulation.
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| Switching from XARELTO to [[Warfarin ]]- No clinical trial data are available to guide converting patients from XARELTO to [[warfarin]]. XARELTO affects [[INR]], so INR measurements made during coadministration with warfarin may not be useful for determining the appropriate dose of warfarin. One approach is to discontinue XARELTO and begin both a parenteral [[anticoagulant]] and [[warfarin ]]at the time the next dose of XARELTO would have been taken.
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| Switching from XARELTO to [[Anticoagulants]] other than [[[Warfarin]] - For patients currently taking XARELTO and transitioning to an anticoagulant with rapid onset, discontinue XARELTO and give the first dose of the other anticoagulant (oral or parenteral) at the time that the next XARELTO dose would have been taken [see [[Rivaroxaban drug interactions|Drug Interactions]]].
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| Switching from Anticoagulants other than Warfarin to XARELTO - For patients currently receiving an anticoagulant other than [[warfarin]], start XARELTO 0 to 2 hours prior to the next scheduled evening administration of the drug (e.g., [[low molecular weight heparin]] or non-warfarin oral anticoagulant) and omit administration of the other anticoagulant. For unfractionated heparin being administered by continuous infusion, stop the infusion and start XARELTO at the same time.
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| [[Link title]]
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| === Nonvalvular Atrial Fibrillation===
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| For patients with [[creatinine clearance]] (CrCl) >50 mL/min, the recommended dose of XARELTO is 20 mg taken orally once daily with the evening meal. For patients with CrCl 15 to 50 mL/min, the recommended dose is 15 mg once daily with the evening meal [see [[Rivaroxaban use in specific populations|Use in Specific Populations]]].
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| === Treatment of Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), and Reduction in the Risk of Recurrence of DVT and of PE===
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| The recommended dose of XARELTO for the initial treatment of acute [[DVT]] and/or [[PE]] is 15 mg taken orally twice daily with food for the first 21 days. After this initial treatment period, the recommended dose of XARELTO is 20 mg taken orally once daily with food, at approximately the same time each day. The recommended dose of XARELTO for reduction in the risk of recurrence of DVT or PE is 20 mg taken orally once daily with food at approximately the same time each day [see [[Rivaroxaban clinical studies|Clinical Studies ]]].
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| === Prophylaxis of Deep Vein Thrombosis Following Hip or Knee Replacement Surgery===
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| The recommended dose of XARELTO is 10 mg taken orally once daily with or without food. The initial dose should be taken 6 to 10 hours after surgery provided that [[hemostasis ]]has been established [see Dosage and Administration].
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| <br>
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| •For patients undergoing hip replacement surgery, treatment duration of 35 days is recommended.<br>
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| •For patients undergoing knee replacement surgery, treatment duration of 12 days is recommended.
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| === Discontinuation for Surgery and other Interventions===
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| If [[anticoagulation ]]must be discontinued to reduce the risk of bleeding with surgical or other procedures, XARELTO should be stopped at least 24 hours before the procedure to reduce the risk of bleeding [see [[Rivaroxaban warnings and precautions|Warnings and Precautions]]]. In deciding whether a procedure should be delayed until 24 hours after the last dose of XARELTO, the increased risk of bleeding should be weighed against the urgency of intervention. XARELTO should be restarted after the surgical or other procedures as soon as adequate [[hemostasis]] has been established, noting that the time to onset of therapeutic effect is short [see [[Rivaroxaban warnings and precautions|Warnings and Precautions]]]. If oral medication cannot be taken during or after surgical intervention, consider administering a parenteral [[anticoagulant]].
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| === Missed Dose===
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| If a dose of XARELTO is not taken at the scheduled time, administer the dose as soon as possible on the same day as follows:
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| •For patients receiving 15 mg twice daily: The patient should take XARELTO immediately to ensure intake of 30 mg XARELTO per day. In this particular instance, two 15 mg tablets may be taken at once. The patient should continue with the regular 15 mg twice daily intake as recommended on the following day.
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| •For patients receiving 20 mg, 15 mg or 10 mg once daily: The patient should take the missed XARELTO dose immediately.
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| === Administration Options===
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| For patients who are unable to swallow whole tablets, 15 mg or 20 mg XARELTO tablets may be crushed and mixed with applesauce immediately prior to use and administered orally. After the administration of a crushed XARELTO 15 mg or 20 mg tablet, the dose should be immediately followed by food [see Dosage and Administration and [[Rivaroxaban clinical pharmacology|Clinical Pharmacology]]].
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| Administration via nasogastric (NG) tube or gastric feeding tube: After confirming gastric placement of the tube, 15 mg or 20 mg XARELTO tablets may be crushed and suspended in 50 mL of water and administered via an NG tube or gastric feeding tube. Since rivaroxaban absorption is dependent on the site of drug release, avoid administration of XARELTO distal to the stomach which can result in reduced absorption and thereby, reduced drug exposure. After the administration of a crushed XARELTO 15 mg or 20 mg tablet, the dose should then be immediately followed by enteral feeding [see [[Rivaroxaban clinical pharmacology|Clinical Pharmacology]] ].
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| Crushed 15 mg or 20 mg XARELTO tablets are stable in water and in applesauce for up to 4 hours. An in vitro compatibility study indicated that there is no adsorption of rivaroxaban from a water suspension of a crushed XARELTO tablet to PVC or silicone nasogastric (NG) tubing. <ref name="dailymed.nlm.nih.gov">{{Cite web | last = | first = | title = XARELTO (RIVAROXABAN) TABLET, FILM COATED [JANSSEN PHARMACEUTICALS, INC.] |url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=10db92f9-2300-4a80-836b-673e1ae91610 | publisher = | date = | accessdate = }}</ref>
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| ==References==
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| {{Reflist}}
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| {{FDA}}
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| [[Category:Drugs]] | |