Rivaroxaban, an anticoagulant, is prescribed for the treatment and prevention of deep vein thrombosis (DVT) that leads to pulmonary embolism.
Pharmacodynamics
Rivaroxaban inhibits Factor-Xa activity that results in impaired blood coagulation.
Pharmacokinetics
The pharmacokinetic activity of Rivaroxaban including bioavailability is dose dependent and not affected by food intake. Cmax of Rivaroxaban is 2-4 hours. The plasma protein binding capacity of Rivaroxaban is up to 95%, and Vss is approximately 50 L. The drug is mostly excreted in urine and feces as unmetabolized drug. The systemic renal clearance rate of Rivaroxaban is 10 L/hr. The terminal half-life of Rivaroxaban is 5-9 hours.
Precautions
Avoid outdoor activities such as games that may increase the risk of injury or bleeding. Rivaroxaban is contraindicated in patients with spinal surgery, genetic spinal defect, hemorrhagic stroke, GI bleeding, active bleeding, uncontrolled BP and bleeding disorders.
Other Drug Interactions
Rivaroxaban may interact with calcium-channel blockers, bosentan, conivaptan, St. John’s Wort, anti-fungal drugs, quinidine, barbiturates, anti-retroviral drugs, armodafinil, amiodarone, immunosuppressive drugs, carbamazepine, phenytoin. Rivaroxaban may increase the risk of the brain or spinal bleeding and hemorrhage, if anticoagulants are used concomitantly.
Dosage
For PE and DVT (Adults):
Consider administration of 15 mg, twice daily with food for first three weeks. After transition, consider administration of 20 mg dose, once daily with food.
To reduce the risk of DVT and PE recurrence (Adults):
Consider administration of 20 mg of Rivaroxaban once daily with food.
To reduce the risk of stroke and non-valvular atrial fibrillation (Adults):
Consider administration of 20 mg, once daily with evening meals for renal patients with CrCl>50 mL/min.
Consider administration of 15 mg, once daily with evening meals for renal patients with CrCl>50 mL/min.
Prophylaxis of DVT after hip or knee surgery (Adults):
For hip replacement patients, administer 10 mg of Rivaroxaban, 10 mg once daily for 35 days.
For knee replacement patients, administer 10 mg of Rivaroxaban, 10 mg once daily for 12 days.
Food(before/after)
Rivaroxaban can be taken before or after food intake
List of Contraindications
Rivaroxaban and Pregnancy
Contraindicated in pregnancy
USFDA pregnancy category C. May be or may not be harmful to an unborn fetus. Consult a physician if you are in gestation or planning to have a baby during Rivaroxaban treatment.
Rivaroxaban and Lactation
It is not known whether Rivaroxaban can pass through the breast milk or not. Lactating mothers should avoid breastfeeding while taking Rivaroxaban.
Storage
Store at room temperature away from moisture and heat
