Rivaroxaban

From Anvita Health Wiki

Contents 1 Indications 2 Contraindications 3 Dosage 4 Pharmacokinetics 5 Adverse-effects 6 Drug-interactions 7 Mechanism-of-action 8 More General Terms 9 Additional Terms 10 Internet Database 11 References

Indications

• DVT prophylaxis after arthroplasty
• superior to enoxaparin for DVT prophylaxis after total knee arthroplasty or total hip arthroplasty [2,6]
• prevention of stroke in patients with atrial fibrillation [4,8,10]
• acute deep vein thrombosis (DVT) [5]
• secondary prevention of myocardial infarction in conjunction with dual anti- platelet therapy [11]
• pulmonary embolism

Contraindications

• hypersensitivity
• active bleeding
• not recommended if creatinine clearance < 30 mL/min
• severe liver disease
  

• Pregnancy category: C

Dosage

• 10 mg PO QD (start 6-8 hours after surgery)
• continue for 30-35 days after surgery
• 20 mg PO QD [4]
• DVT: 15 mg PO BID for 3 weeks, then 20 mg PO QD [5]
• 2.5 mg PO BID (secondary prevention of MI) [11]
  

• Tabs: 10 mg

Pharmacokinetics

• substrate of both CYP3A4 & P-glycoprotein

Adverse-effects

• bleeding most common adverse effect
• major bleeding < 1% of patients

• stop rivaroxaban
• administer fresh frozen plasma until bleeding stops [13]
• prothombin complex concentrate reverses anticoagulant effect of rivaroxaban [12]

Drug-interactions

• inhibitors of CYP3A4 may increase levels of rivaroxaban
• inducers of CYP3A4 may decrease levels of rivaroxaban
• rivaroxaban itself neither induces or inhibits CYP3A4

Mechanism-of-action

• small molecule inhibitor of factor Xa

More General Terms

• anticoagulant

Additional Terms

• apixaban

Internet Database

PubChem: 6433119
PubChem: 9875401

References

1. Eriksson BI et al, Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthriplasty. N Engl J Med 2008, 358:2765 PMID: [1]
   - Lassen MR et al, Rivaroxaban for thromboprophylaxis after total knee arthroplasty. N Engl J Med 2008, 358:2776 PMID: [2]
2. Lassen MR et al Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty N Engl J Med 2008 Jun 26; 358:2776 PMID: [3]
   - Kakkar AK et al Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: A double-blind, randomised controlled trial. Lancet 2008 Jul 5; 372:31. PMID: &dopt=Abstract
   - Eriksson BI et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med 2008 Jun 26; 358:2765. PMID: [4]
3. Prescriber's Letter 15(8): 2008 New Drugs on the Horizon: Pradaxa (Dabigatran) and Xarelto (Rivaroxaban) Detail-Document#: [5] (subscription needed) [6]
4. American Heart Association News Release Rivaroxaban comparable to warfarin in preventing stroke and other complications of irregular heartbeat American Heart Association Annual Meeting. Abstract 21839 Chicago, IL Nov. 15, 2010 [7]
5. The EINSTEIN Investigators Oral Rivaroxaban for Symptomatic Venous Thromboembolism N Engl J Med December 3, 2010 <PubMed> PMID: [8] <Internet> [9]
6. FDA NEWS RELEASE July 5, 2011 [10]
7. Prescriber's Letter 18(8): 2011 New Drug: Xarelto (Rivaroxaban) Detail-Document#: [11] (subscription needed) [12]
8. Patel MR et al. for the ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011 Aug 10 PMID: [13]
9. Prescriber's Letter 18(9): 2011 Reversing Dabigatran and Rivaroxaban Detail-Document#: [14] (subscription needed) [15]
10. FDA NEWS RELEASE: Nov. 4, 2011 FDA approves Xarelto to prevent stroke in people with common type of abnormal heart rhythm [16]
11. Mega JL et al. for the ATLAS ACS 2-TIMI 51 Investigators. Rivaroxaban in patients with a recent acute coronary syndrome. N Engl J Med 2011 Nov 13 <PubMed> PMID: [17] <Internet> [18]
    - Roe MT and Ohman EM. A new era in secondary prevention after acute coronary syndrome. N Engl J Med 2011 Nov 13 <PubMed> PMID: [19] <Internet> [20]
12. Eerenberg ES et al. Reversal of rivaroxaban and dabigatran by prothrombin complex concentrate: A randomized, placebo-controlled, crossover study in healthy subjects. Circulation 2011 Oct 4; 124:1573. PMID: [21]
    - Battinelli EM. Reversal of new oral anticoagulants. Circulation 2011 Oct 4; 124:1508. PMID: [22]
13. Prescriber's Letter 19(1): 2012 Reversing Dabigatran and Rivaroxaban Detail-Document#: [23] (subscription needed) [24]
14. Buller HR et al. for the EINSTEIN–PE Investigators. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med 2012 Mar 26 <PubMed> PMID: [25] <Internet> [26]

rivaroxaban (Xarelto)