Xarelto

Adult Dosing .

Dosage forms:  TAB: 2.5 mg, 10 mg, 15 mg, 20 mg; SUSP: 1 mg per mL

thromboembolism/stroke prevention

[20 mg PO qd]

Info: for non-valvular atrial fibrillation w/o moderate-severe mitral stenosis or mechanical heart valve; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled evening dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <3; depending on bleeding risk, consider holding tx 1-2 days before surgery or invasive procedure if CrCl >30 or 2-5 days if CrCl <30; resume tx >24h postop; do not split tab, but may crush tab; give 20 mg tab w/ evening meal

DVT/PE tx

[15 mg PO bid x21 days, then 20 mg PO qd]

Info: to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <3; depending on bleeding risk, consider holding tx 1-2 days before surgery or invasive procedure if CrCl >30 or 2-5 days if CrCl <30; resume tx >24h postop; do not split tab, but may crush tab; give 15 mg or 20 mg tab w/ food

DVT/PE prophylaxis, recurrent

[10 mg PO qd]

Info: to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <3; depending on bleeding risk, consider holding tx 1-2 days before surgery or invasive procedure if CrCl >30 or 2-5 days if CrCl <30; resume tx >24h postop; do not split tab, but may crush tab

DVT prophylaxis

[hip replacement]

Dose: 10 mg PO qd x35 days; Start: 6-10h postop once hemostasis established; Info: do not split tab, but may crush tab

[knee replacement]

Dose: 10 mg PO qd x12 days; Start: 6-10h postop once hemostasis established; Info: do not split tab, but may crush tab

VTE prophylaxis, acutely ill pts

[10 mg PO qd]

Info: for hospitalized pts w/ moderate-severe restricted mobility and other VTE risk factors, not at high bleeding risk; continue tx x31-39 days total incl. post-discharge; do not split tab, but may crush tab

cardiovascular event risk reduction

[2.5 mg PO bid]

Info: for pts w/ CAD; give w/ aspirin 75-100 mg PO qd; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <3; do not split tab, but may crush tab

thrombotic event risk reduction

[2.5 mg PO bid]

Info: for pts w/ symptomatic peripheral arterial dz and w/ or w/o recent lower extremity revascularization; give w/ aspirin 75-100 mg PO qd; start once hemostasis established in pts w/ revascularization; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <3; do not split tab, but may crush tab

VTE prophylaxis, cardioversion (off-label)

[afib/flutter duration <48h]

Dose: 20 mg PO qd; Start: ASAP before or immediately after cardioversion; Info: for pts w/ CHA2DS2-VASc score >2; continue tx for at least 4wk after procedure; refer to ACC/AHA/HRS guidelines; do not split tab, but may crush tab; give 20 mg tab w/ evening meal

[afib/flutter duration >48h or unknown]

Dose: 20 mg PO qd; Start: at least 3wk before cardioversion; Info: continue tx for at least 4wk after procedure; refer to ACC/AHA/HRS guidelines; do not split tab, but may crush tab; give 20 mg tab w/ evening meal

renal dosing

[thromboembolism/stroke prevention]

CrCl <51: 15 mg qd

HD: 15 mg qd; no supplement after dialysis; PD: not defined

[cardiovascular event risk reduction or thrombotic event risk reduction]

renal impairment: no adjustment

HD: no adjustment; no supplement; PD: not defined

[VTE prophylaxis, cardioversion]

CrCl 30-49: 15 mg qd; CrCl <30: not defined

HD/PD: not defined

[all other indications]

CrCl <15: avoid use; Info: caution advised if CrCl 15-30

HD/PD: avoid use

hepatic dosing

[see below]

Child-Pugh Class B or C: avoid use; coagulopathy-assoc. hepatic dz: avoid use

Peds Dosing .

Dosage forms:  TAB: 2.5 mg, 10 mg, 15 mg, 20 mg; SUSP: 1 mg per mL

venous thromboembolism tx

[<18 yo, 2.6-2.9 kg]

Dose: 0.8 mg PO tid; Start: after at least 5 days of parenteral anticoagulant tx; Info: cont. tx for at least 1mo in pts <2 yo w/ catheter-assoc. thrombosis, otherwise cont. tx for at least 3mo; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; give w/ food; use oral suspension only

[<18 yo, 3-3.9 kg]

Dose: 0.9 mg PO tid; Start: after at least 5 days of parenteral anticoagulant tx; Info: cont. tx for at least 1mo in pts <2 yo w/ catheter-assoc. thrombosis, otherwise cont. tx for at least 3mo; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; give w/ food; use oral suspension only

[<18 yo, 4-4.9 kg]

Dose: 1.4 mg PO tid; Start: after at least 5 days of parenteral anticoagulant tx; Info: cont. tx for at least 1mo in pts <2 yo w/ catheter-assoc. thrombosis, otherwise cont. tx for at least 3mo; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; give w/ food; use oral suspension only

[<18 yo, 5-6.9 kg]

Dose: 1.6 mg PO tid; Start: after at least 5 days of parenteral anticoagulant tx; Info: cont. tx for at least 1mo in pts <2 yo w/ catheter-assoc. thrombosis, otherwise cont. tx for at least 3mo; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; give w/ food; use oral suspension only

[<18 yo, 7-7.9 kg]

Dose: 1.8 mg PO tid; Start: after at least 5 days of parenteral anticoagulant tx; Info: cont. tx for at least 1mo in pts <2 yo w/ catheter-assoc. thrombosis, otherwise cont. tx for at least 3mo; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; give w/ food; use oral suspension only

[<18 yo, 8-8.9 kg]

Dose: 2.4 mg PO tid; Start: after at least 5 days of parenteral anticoagulant tx; Info: cont. tx for at least 1mo in pts <2 yo w/ catheter-assoc. thrombosis, otherwise cont. tx for at least 3mo; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; give w/ food; use oral suspension only

[<18 yo, 9-9.9 kg]

Dose: 2.8 mg PO tid; Start: after at least 5 days of parenteral anticoagulant tx; Info: cont. tx for at least 1mo in pts <2 yo w/ catheter-assoc. thrombosis, otherwise cont. tx for at least 3mo; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; give w/ food; use oral suspension only

[<18 yo, 10-11.9 kg]

Dose: 3 mg PO tid; Start: after at least 5 days of parenteral anticoagulant tx; Info: cont. tx for at least 1mo in pts <2 yo w/ catheter-assoc. thrombosis, otherwise cont. tx for at least 3mo; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; give w/ food; use oral suspension only

[<18 yo, 12-29.9 kg]

Dose: 5 mg PO bid; Start: after at least 5 days of parenteral anticoagulant tx; Info: cont. tx for at least 1mo in pts <2 yo w/ catheter-assoc. thrombosis, otherwise cont. tx for at least 3mo; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; give w/ food; use oral suspension only

[<18 yo, 30-49.9 kg]

Dose: 15 mg PO qd; Start: after at least 5 days of parenteral anticoagulant tx; Info: cont. tx for at least 1mo in pts <2 yo w/ catheter-assoc. thrombosis, otherwise cont. tx for at least 3mo; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; do not split tab, but may crush tab; give oral suspension or 15 mg tab w/ food

[<18 yo, >50 kg]

Dose: 20 mg PO qd; Start: after at least 5 days of parenteral anticoagulant tx; Info: cont. tx for at least 1mo in pts <2 yo w/ catheter-assoc. thrombosis, otherwise cont. tx for at least 3mo; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; do not split tab, but may crush tab; give oral suspension or 20 mg tab w/ food

venous thromboembolism prophylaxis, recurrent

[<18 yo, 2.6-2.9 kg]

Dose: 0.8 mg PO tid; Start: after at least 5 days of parenteral anticoagulant tx; Info: cont. tx for at least 1mo in pts <2 yo w/ catheter-assoc. thrombosis, otherwise cont. tx for at least 3mo; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; give w/ food; use oral suspension only

[<18 yo, 3-3.9 kg]

Dose: 0.9 mg PO tid; Start: after at least 5 days of parenteral anticoagulant tx; Info: cont. tx for at least 1mo in pts <2 yo w/ catheter-assoc. thrombosis, otherwise cont. tx for at least 3mo; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; give w/ food; use oral suspension only

[<18 yo, 4-4.9 kg]

Dose: 1.4 mg PO tid; Start: after at least 5 days of parenteral anticoagulant tx; Info: cont. tx for at least 1mo in pts <2 yo w/ catheter-assoc. thrombosis, otherwise cont. tx for at least 3mo; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; give w/ food; use oral suspension only

[<18 yo, 5-6.9 kg]

Dose: 1.6 mg PO tid; Start: after at least 5 days of parenteral anticoagulant tx; Info: cont. tx for at least 1mo in pts <2 yo w/ catheter-assoc. thrombosis, otherwise cont. tx for at least 3mo; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; give w/ food; use oral suspension only

[<18 yo, 7-7.9 kg]

Dose: 1.8 mg PO tid; Start: after at least 5 days of parenteral anticoagulant tx; Info: cont. tx for at least 1mo in pts <2 yo w/ catheter-assoc. thrombosis, otherwise cont. tx for at least 3mo; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; give w/ food; use oral suspension only

[<18 yo, 8-8.9 kg]

Dose: 2.4 mg PO tid; Start: after at least 5 days of parenteral anticoagulant tx; Info: cont. tx for at least 1mo in pts <2 yo w/ catheter-assoc. thrombosis, otherwise cont. tx for at least 3mo; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; give w/ food; use oral suspension only

[<18 yo, 9-9.9 kg]

Dose: 2.8 mg PO tid; Start: after at least 5 days of parenteral anticoagulant tx; Info: cont. tx for at least 1mo in pts <2 yo w/ catheter-assoc. thrombosis, otherwise cont. tx for at least 3mo; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; give w/ food; use oral suspension only

[<18 yo, 10-11.9 kg]

Dose: 3 mg PO tid; Start: after at least 5 days of parenteral anticoagulant tx; Info: cont. tx for at least 1mo in pts <2 yo w/ catheter-assoc. thrombosis, otherwise cont. tx for at least 3mo; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; give w/ food; use oral suspension only

[<18 yo, 12-29.9 kg]

Dose: 5 mg PO bid; Start: after at least 5 days of parenteral anticoagulant tx; Info: cont. tx for at least 1mo in pts <2 yo w/ catheter-assoc. thrombosis, otherwise cont. tx for at least 3mo; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; give w/ food; use oral suspension only

[<18 yo, 30-49.9 kg]

Dose: 15 mg PO qd; Start: after at least 5 days of parenteral anticoagulant tx; Info: cont. tx for at least 1mo in pts <2 yo w/ catheter-assoc. thrombosis, otherwise cont. tx for at least 3mo; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; do not split tab, but may crush tab; give oral suspension or 15 mg tab w/ food

[<18 yo, >50 kg]

Dose: 20 mg PO qd; Start: after at least 5 days of parenteral anticoagulant tx; Info: cont. tx for at least 1mo in pts <2 yo w/ catheter-assoc. thrombosis, otherwise cont. tx for at least 3mo; to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; do not split tab, but may crush tab; give oral suspension or 20 mg tab w/ food

thromboembolism prophylaxis, post-Fontan procedure

[2 yo and older, 7-7.9 kg]

Dose: 1.1 mg PO bid; Info: to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; use oral suspension only

[2 yo and older, 8-9.9 kg]

Dose: 1.6 mg PO bid; Info: to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; use oral suspension only

[2 yo and older, 10-11.9 kg]

Dose: 1.7 mg PO bid; Info: to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; use oral suspension only

[2 yo and older, 12-19.9 kg]

Dose: 2 mg PO bid; Info: to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; use oral suspension only

[2 yo and older, 20-29.9 kg]

Dose: 2.5 mg PO bid; Info: to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; use oral suspension only

[2 yo and older, 30-49.9 kg]

Dose: 7.5 mg PO qd; Info: to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; use oral suspension only

[2 yo and older, >50 kg]

Dose: 10 mg PO qd; Info: to convert from UFH infusion, D/C UFH, then start rivaroxaban immediately; to convert from other anticoagulants, D/C other anticoagulant, then start rivaroxaban 0-2h before next scheduled dose; to convert from warfarin, D/C warfarin, then start rivaroxaban when INR <2.5; depending on bleeding risk, consider holding tx >24h before surgery or invasive procedure; resume tx once hemostasis established; do not split tab, but may crush tab

renal dosing

[<1 yo]

Cr >97.5th percentile: avoid use; Info: see pkg insert for Cr reference values

HD/PD: not defined

[1 yo and older]

eGFR <50: avoid use

HD/PD: not defined

hepatic dosing

[not defined]