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Dosing and Administration for DVT and PE Treatment and Risk Reduction

A single-agent treatment approach

XARELTO® offers the convenience of a single, oral agent with no routine coagulation monitoring1-3 for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) and for extended risk reduction.

XARELTO® Starter Pack for DVT and/or PE treatment

This convenient pack provides treatment for the first 30 days for a seamless transition of care from diagnosis to follow-up. Learn more

Convenient dosing: 15 mg twice daily with food for first 21 days followed by 20 mg once daily with food to treat DVT and PE, and 20 mg once daily with food for extended treatment to reduce risk of recurrence

Renal dosing considerations

  • DVT and PE and reduction in risk of recurrence: Avoid using XARELTO® in patients with CrCl <30 mL/min

 

Please see full Prescribing Information for additional dosing considerations.

Temporary discontinuation for surgery and other procedures

If XARELTO® must be discontinued for a procedure, follow these guidelines:

Before procedure:

  • Stop XARELTO® at least 24 hours before the procedure

  • 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

After procedure:

  • Restart XARELTO® as soon as adequate hemostasis is established, noting that the time to onset of therapeutic effect is short

  • If oral medication cannot be taken during or after surgical procedures, consider a parenteral anticoagulant

Note that the half-life of XARELTO® is 5 to 9 hours in healthy subjects aged 20 to 45 years and 11 to 13 hours in the elderly.

Other administration options

For patients who are unable to swallow whole tablets:

  • Crush and mix a 15-mg or 20-mg XARELTO® tablet with applesauce immediately prior to use and administer orally

  • Immediately follow the 15-mg or 20-mg dose with food

For administration via NG tube or gastric feeding tube:

  • Confirm gastric placement of the tube, then crush a 15-mg or 20-mg XARELTO® tablet, suspend in 50 mL of water, and administer via an NG tube or gastric feeding tube

  • Avoid administering XARELTO® distal to the stomach, which can result in reduced absorption and, thereby, reduced drug exposure

  • Immediately follow the 15-mg or 20-mg dose with enteral feeding

CrCl = creatinine clearance.

 

Indications

 

IMPORTANT SAFETY INFORMATION

 

Indication and Important saftey Information

 

  • Reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (AF). There are limited data on the relative effectiveness of XARELTO® (rivaroxaban) and warfarin in reducing the risk of stroke and systemic embolism when warfarin therapy is well controlled.
  • Treatment of deep vein thrombosis (DVT).
  • Treatment of pulmonary embolism (PE).
  • Reduction in the risk of recurrence of DVT and of PE following initial 6 months treatment for DVT and/or PE.
  • Prophylaxis of DVT, which may lead to PE in patients undergoing knee replacement surgery.
  • Prophylaxis of DVT, which may lead to PE in patients undergoing hip replacement surgery.

References:

  1. The EINSTEIN Investigators. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010;363(26):2499-2510.
  2. The EINSTEIN–PE Investigators. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med. 2012;366(14):1287-1297.
  3. Mueck W, Eriksson BI, Bauer KA, et al. Population pharmacokinetics and pharmacodynamics of rivaroxaban – an oral, direct Factor Xa inhibitor – in patients undergoing major orthopaedic surgery. Clin Pharmacokinet. 2008;47(3):203-216.