Rivaroxaban

DOAC·Haematology - Anticoagulants & Haemostatics

Stroke prevention in non-valvular AF, treatment and prevention of DVT/PE

Authority requiredPBSDOACXarelto2.5 mg tablet+2

Max Dose

20 mg OD

Half-life

5–13 h

Bleeding Risk

HIGH

Food

TAKE WITH FOOD

Rapid Summary

Overview

Direct Oral Anticoagulant (DOAC) inhibiting Factor Xa. Offers the massive convenience of once-daily dosing with no INR monitoring, but requires strict adherence to food instructions.

Maximum Dose

Max 20 mg OD (Standard AF/VTE dose).

Clinical Focus

The 15 mg and 20 mg tablets MUST be taken with a substantial meal. If taken on an empty stomach, absorption drops by 40% and the patient will clot.

Bottom Line

Rivaroxaban is a convenient once-daily DOAC for AF and VTE, but has no specific reversal agent as effective as idarucizumab (for Dabigatran) and requires dose adjustment in renal impairment.

Formulation & Access

Brand Names

Xarelto

Oral Routes

Tablets (2.5 mg, 10 mg, 15 mg, 20 mg).

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Stroke prevention in non-valvular AF, treatment and prevention of DVT/PE.

Off-Label

PBS

VTE prophylaxis post orthopaedic surgery.

Clinical Place

Excellent choice for patients who prefer once-daily dosing and have good baseline renal function.

Quick reference

Class & Role

DOAC — Direct Oral Anticoagulant (DOAC) inhibiting Factor Xa.

Route / Formulation

Tablets (2.5 mg, 10 mg, 15 mg, 20 mg). (Xarelto)

Usual Dose & Max

PO 20 mg OD with evening meal. Max 20 mg OD (Standard AF/VTE dose).

Key Indication Doses

Non-Valvular AF: PO 20 mg OD with evening meal. Acute VTE / DVT / PE: PO 15 mg BD with food for 21 days, then 20 mg OD with food. Renal Impairment: If eGFR 30-49, dose is 15 mg OD. Avoid if eGFR < 30 (Use warfarin or apixaban depending on exact clearance).

Best Uses

Rivaroxaban is a convenient once-daily DOAC for AF and VTE, but has no specific reversal agent as effective as idarucizumab (for Dabigatran) and requires dose adjustment in renal impairment.

Avoid / Cautions

Mechanical heart valves, moderate-to-severe mitral stenosis, active bleeding. Pregnancy Category C. Do not use.

Key Risks

Haematological: Major haemorrhage (GI, intracranial). Slightly higher GI bleeding risk compared to Apixaban. Neurological: Dizziness, headache.

Key Interactions

Strong combined inhibitors of CYP3A4 and P-gp (e.g., Ketoconazole, Ritonavir, Clarithromycin) massively increase bleeding risk. NSAIDs, SSRIs, Aspirin.

Monitoring

U&E and eGFR at baseline and annually. Standard coagulation tests (INR/aPTT) are unreliable and should not be used to assess DOAC efficacy. Monitor for bleeding.

Clinical Pearl

The 10mg tablet can be taken with or without food. The 15mg and 20mg tablets MUST be taken in the middle of a large meal. Failure to do so is the #1 cause of 'DOAC failure' and recurrent PE.

Access

Authority requiredXarelto2.5 mg tablet

Brand: Xarelto
PBS status: Authority required
Formulation: Tablets (2

Rivaroxaban

DOAC·Haematology - Anticoagulants & Haemostatics

Stroke prevention in non-valvular AF, treatment and prevention of DVT/PE

Authority requiredPBSDOACXarelto2.5 mg tablet+2

Max Dose

20 mg OD

Half-life

5–13 h

Bleeding Risk

HIGH

Food

TAKE WITH FOOD

Rapid Summary

Overview

Direct Oral Anticoagulant (DOAC) inhibiting Factor Xa. Offers the massive convenience of once-daily dosing with no INR monitoring, but requires strict adherence to food instructions.

Maximum Dose

Max 20 mg OD (Standard AF/VTE dose).

Clinical Focus

The 15 mg and 20 mg tablets MUST be taken with a substantial meal. If taken on an empty stomach, absorption drops by 40% and the patient will clot.

Bottom Line

Rivaroxaban is a convenient once-daily DOAC for AF and VTE, but has no specific reversal agent as effective as idarucizumab (for Dabigatran) and requires dose adjustment in renal impairment.

Formulation & Access

Brand Names

Xarelto

Oral Routes

Tablets (2.5 mg, 10 mg, 15 mg, 20 mg).

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Stroke prevention in non-valvular AF, treatment and prevention of DVT/PE.

Off-Label

PBS

VTE prophylaxis post orthopaedic surgery.

Clinical Place

Excellent choice for patients who prefer once-daily dosing and have good baseline renal function.

Quick reference

Class & Role

DOAC — Direct Oral Anticoagulant (DOAC) inhibiting Factor Xa.

Route / Formulation

Tablets (2.5 mg, 10 mg, 15 mg, 20 mg). (Xarelto)

Usual Dose & Max

PO 20 mg OD with evening meal. Max 20 mg OD (Standard AF/VTE dose).

Key Indication Doses

Best Uses

Rivaroxaban is a convenient once-daily DOAC for AF and VTE, but has no specific reversal agent as effective as idarucizumab (for Dabigatran) and requires dose adjustment in renal impairment.

Avoid / Cautions

Mechanical heart valves, moderate-to-severe mitral stenosis, active bleeding. Pregnancy Category C. Do not use.

Key Risks

Haematological: Major haemorrhage (GI, intracranial). Slightly higher GI bleeding risk compared to Apixaban. Neurological: Dizziness, headache.

Key Interactions

Strong combined inhibitors of CYP3A4 and P-gp (e.g., Ketoconazole, Ritonavir, Clarithromycin) massively increase bleeding risk. NSAIDs, SSRIs, Aspirin.

Monitoring

U&E and eGFR at baseline and annually. Standard coagulation tests (INR/aPTT) are unreliable and should not be used to assess DOAC efficacy. Monitor for bleeding.

Clinical Pearl

The 10mg tablet can be taken with or without food. The 15mg and 20mg tablets MUST be taken in the middle of a large meal. Failure to do so is the #1 cause of 'DOAC failure' and recurrent PE.

Access

Authority requiredXarelto2.5 mg tablet

Brand: Xarelto
PBS status: Authority required
Formulation: Tablets (2