Home Drug Guide Rivaroxaban

Drug Guide

Generic Name

Rivaroxaban

Brand Names Xarelto

Classification

Therapeutic: Anticoagulant

Pharmacological: Factor Xa inhibitor

FDA Approved Indications

  • Prevention of stroke and systemic embolism in non-valvular atrial fibrillation
  • Treatment of deep vein thrombosis (DVT)
  • Treatment of pulmonary embolism (PE)
  • Prevention of DVT and PE in patients undergoing knee or hip replacement surgery

Mechanism of Action

Rivaroxaban selectively inhibits factor Xa, thereby impeding thrombin formation and thrombus development.

Dosage and Administration

Adult: Dosing varies based on indication; typically, 20 mg once daily for atrial fibrillation, with dose adjustments based on renal function. For DVT/PE treatment, initial doses may be higher with subsequent reduction. Follow specific prescribing information.

Pediatric: Not approved for pediatric use.

Geriatric: Adjust dose based on renal function and bleeding risk; increased caution advised.

Renal Impairment: Adjust dose or avoid in severe impairment; dose adjustments based on creatinine clearance.

Hepatic Impairment: Contraindicated in severe hepatic impairment; caution in mild to moderate impairment.

Pharmacokinetics

Absorption: Rapid, with peak plasma concentrations in 2-4 hours.

Distribution: Approximately 95% bound to plasma proteins.

Metabolism: Metabolized mainly by CYP3A4/5 and CYP2J2.

Excretion: Excreted via renal and fecal routes.

Half Life: 7-13 hours, depending on age and renal function.

Contraindications

  • Active bleeding
  • Severe hepatic impairment
  • Known hypersensitivity

Precautions

  • Use with caution in patients with bleeding disorders, recent surgery, or compromised renal function. Monitor renal function periodically.

Adverse Reactions - Common

  • Bleeding (Common)
  • Anemia (Uncommon)

Adverse Reactions - Serious

  • Major bleeding including intracranial hemorrhage (Rare)
  • Thrombocytopenia (Rare)

Drug-Drug Interactions

  • Other anticoagulants, antiplatelet drugs, NSAIDs, serotonergic drugs

Drug-Food Interactions

  • Limited data, but avoid excessive alcohol intake.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor bleeding signs, renal function, and complete blood counts.

Diagnoses:

  • Risk for bleeding
  • Risk for thrombosis if therapy is interrupted

Implementation: Administer as prescribed, monitor for bleeding, educate patient on bleeding precautions.

Evaluation: Assess for signs of bleeding, efficacy in preventing thromboembolic events.

Patient/Family Teaching

  • Do not discontinue medication without medical advice.
  • Report any signs of bleeding or bruising immediately.
  • Use of other drugs or supplements should be discussed with healthcare provider.
  • Avoid activities that may cause injury.

Special Considerations

Black Box Warnings:

  • Risk of bleeding; discontinue at first sign of bleeding.
  • Sudden discontinuation increases risk of thrombotic events.

Genetic Factors: N/A

Lab Test Interference: May affect PT and aPTT results but not suitable for monitoring anticoagulation effect.

Overdose Management

Signs/Symptoms: Excessive bleeding, anemia, hypotension, shock.

Treatment: Discontinue drug, provide supportive care, and consider administration of activated charcoal if ingestion is recent. Specific reversal agents like andexanet alfa may be used in severe cases.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F).

Stability: Stable through the expiration date when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.