Rivaroxaban

Trade names

XARELTO

Actions

• Direct factor Xa inhibitor

Route of Administration

Oral

Bioavailability

80%

Plasma protein binding

92-95%

Time to peak plasma concentration

1–3 h

Half-life

7–10 h

Duration of action

24 h

Metabolism

Hepatic

Enzymes involved

• CYP3A4
• CYP3A5
• CYP2J2

Elimination

Hepatic 50%, Renal 50%

Interactions

P-glycoprotein inhibitors increase intestinal absorption.

Strong CYP3A4 inhibitors or inducers can increase or decrease serum levels respectively.

Recommended dose

Stroke prophylaxis in non-valvular AF:

20 mg once daily.

Treatment for LE, DVT:

15 mg twice daily for 21 days followed by 20 mg once daily for the rest of the treatment.

Renal impairment

No dose adjustment is needed in patients with mild to moderate renal impairment (creatinine clearance >30 ml/min)

Use with caution in patients with creatinine clearance 15-29 ml/min.

Rivaroxaban is not recommended in patients with creatinine clearance <15 ml/min or patients in dialysis.

Discontinuation before invasive procedures

Stop rivaroxaban at least 24 hours before an invasive procedure.