Top 300 Pharmacy Drug Cards

RIVAROXABAN: Xarelto

Class: Anticoagulant

Dosage Forms. Tablet: 10 mg, 15 mg, 20 mg

Image

Common FDA Label Indication, Dosing, and Titration.

1. Prevention of thromboembolism in patients after orthopedic surgery: 10 mg po daily beginning at least 6 h after surgery × 12 d for knee replacement or 35 d for hip replacement

2. Prevention of thromboembolism in patients with atrial fibrillation: 20 mg po daily if CrCl >50 mL/min; 15 mg po daily if CrCl 15-50 mL/min; do not use if CrCl <15 mL/min

3. Treatment and secondary prevention of deep vein thrombosis or pulmonary embolism: 15 mg po bid × 21 d, then 20 mg po daily

Off-Label Uses.

1. Prevention of cardiovascular events in patients with acute coronary syndrome: 5 mg po bid

MOA. Rivaroxaban is an orally bioavailable factor Xa inhibitor that selectively blocks the active site of factor Xa and does not require a cofactor (such as anti-thrombin III) for activity. Activation of factor X to factor Xa via the intrinsic and extrinsic pathways plays a central role in the cascade of blood coagulation.

Drug Characteristics: Rivaroxaban

Image

Medication Safety Issues: Rivaroxaban

Image

Drug Interactions: Rivaroxaban

Image

Adverse Reactions: Rivaroxaban

Image

Efficacy Monitoring Parameters. Prevention of clotting or recurrence of clotting. Routine monitoring of anticoagulation tests is not necessary with rivaroxaban. If used, anti-Xa activity is the preferred test.

Toxicity Monitoring Parameters. Monitor for signs and symptoms of bleeding. Monitor renal function for potential dose adjustment. Monitor CBC, vital signs.

Key Patient Counseling Points. Administer with the evening meal. Warn of risks of epidural (spinal) anesthesia while taking rivaroxaban.

Clinical Pearls. Detailed dosing conversion protocols are used to convert patients from warfarin or parenteral anticoagulants to rivaroxaban are available in the product package insert. Many drug-drug interactions; monitor concurrent drug use carefully. Tablets may be crushed and mixed with apple sauce immediately prior to administration; may mix with water for NG tube administration.