Xarelto dosage, forms, and strengths

Xarelto (rivaroxaban) is a brand-name prescription oral anticoagulant used to treat or prevent blood clot issues in adults and children. Taken as a tablet once or twice per day, Xarelto blocks one step in the blood-clotting process. For acute blood clots (venous thromboembolism), Xarelto stops the blood-clotting process so the clot does not get bigger, stabilizes it, and helps it dissolve. For preventive treatment, Xarelto prevents acute blood clots or even worse problems like stroke or heart attacks. 

Xarelto forms and strengths

Xarelto is available in two forms and a range of different strengths. 

• Tablets: 2.5 milligrams (mg), 10 mg, 15 mg, 20 mg

• Oral suspension: 1 mg/mL

Xarelto dosage for adults

Xarelto is used both to treat blood clots and to prevent them.  It is used to treat venous thromboembolism, blood clots in the legs or pelvis (deep vein thrombosis, or DVT), and blood clots in the lungs (pulmonary embolism, or PE). Healthcare professionals also use it to decrease the risk of forming clots: DVT, strokes, or PE in people at risk of recurrent blood clots or with other risk factors. Risk factors include people with atrial fibrillation, coronary artery disease, conditions causing being sedentary for a time (recent surgery or immobility) or peripheral artery disease.

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Xarelto dosage for venous thromboembolism

Venous thromboembolism (VTE) can be divided into two conditions: deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT occurs when a blood clot forms in a deep vein in the legs, pelvis, or arms. This blocks the flow of blood. Blood clots can stay where they are formed or they can travel. When that blood clot travels to the lungs, it becomes a life-threatening condition called pulmonary embolism (PE). Initial treatment of PE with Xarelto involves high doses for three weeks, followed by maintenance and then preventive doses.

Xarelto dosage for the prophylaxis of venous thromboembolism

Xarelto is used to decrease the risk of DVT and PE in people at risk of forming blood clots. Risk factors include a personal history of a blood clot at any time, recent hip or knee replacement surgery, and recent hospitalization with an acute illness. 

Xarelto prophylaxis dosage for nonvalvular atrial fibrillation, coronary artery disease (CAD), and peripheral artery disease (PAD)

People with nonvalvular atrial fibrillation (an irregular heart rhythm that does not involve the heart valves), coronary artery disease, or peripheral artery disease are more likely to develop blood clots in their circulatory system. Xarelto helps to prevent the formation of blood clots that can cause stroke or heart attack. 

Xarelto dosage for children

The FDA approved Xarelto for use in children as young as newborns to treat or prevent venous thromboembolism (VTE), including children with congenital heart disease who have undergone a surgery called the Fontan procedure. 

Pediatric dosages are based on body weight. Infants and very young children take three doses daily, and older children two doses daily. Only one daily dose is required for children weighing more than 110 pounds. Most children take Xarelto as an oral suspension, and once able to swallow pills, older children can take 15 or 20 mg Xarelto tablets.

Xarelto dosage restrictions

Xarelto is generally avoided or given at a reduced dosage in people with kidney problems. 

People with severe renal impairment (CrCl <15 milliliters (mL) per minute) may not be given Xarelto unless they are being treated for atrial fibrillation, coronary artery disease, or peripheral artery disease. 

People with mild to moderate impairment of renal function (CrCl >15 milliliters (mL) per minute) can take standard Xarelto doses. However, people with nonvalvular atrial fibrillation and a creatinine clearance lower than 50 mL/min will have a dose adjustment from 20 mg/day to 15 mg/day.

People with moderate to severe hepatic impairment (liver dysfunction) or liver disease that interferes with blood clotting (liver coagulopathy) should not get Xarelto because of the high risk of bleeding. 

Xarelto safety info

Xarelto is never used in people with active major bleeding or known allergies to the drug.

Excessive bleeding is Xarelto’s most common and potentially most serious side effect. Because of the increased risk of bleeding, anticoagulation therapy is stopped before surgery, spinal puncture, epidural catheter, or during any bleeding episode that won’t stop. 

Because of possible bleeding issues, Xarelto is not recommended for use in people with prosthetic heart valves. 

Drugs like Xarelto are not recommended in people with triple-positive antiphospholipid syndrome because of the increased risk of blood clots.

Healthcare professionals are cautious about using Xarelto in pregnant or breastfeeding women.

The most significant drug interactions with Xarelto include other blood thinners (e.g, warfarin, heparin), antiplatelet agents (e.g., clopidogrel), aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), SSRIs, SNRIs, the antibiotic erythromycin, the antiviral drug ritonavir, and the antifungal medications ketoconazole and itraconazole. Avoid St. John's wort supplements when taking Xarelto. 

RELATED: Xarelto side effects and how to avoid them

How to take Xarelto

Follow the dosing schedule given by the prescriber. Doses must be spaced evenly throughout the day.

Take the higher-dose tablets (15 mg and 20 mg) with food. Lower-dose tablets (2.5 mg and 10 mg) can be taken with or without food.

If swallowing the tablet is difficult, crush the tablet and mix it with a small amount of applesauce. Consume the applesauce immediately and completely. The tablet can also be crushed and mixed with water for administration through a feeding tube.

If taking xareltoin the suspension form, shake the oral suspension before measuring a dose. Always use the calibrated oral syringe that comes with the medicine to ensure accurate dosing. 

This medicine must be taken every day, so do not stop taking this medication unless directed by a healthcare provider. The early discontinuation of Xarelto could cause blood clots.

Unlike warfarin, Xarelto does not require regular blood tests to measure its effectiveness.

Store Xarelto tablets or oral suspension at room temperature (68°F to 77°F) in a closed container. Do not remove the bottle adapter from the oral suspension. Do not allow the oral suspension to freeze.

Xarelto dosage FAQs

How long does it take Xarelto to work?

Xarelto begins to affect coagulation about an hour after a dose is taken. The maximum effects of Xarelto occur within two to four hours. 

What happens if I miss a dose of Xarelto?

Ask a healthcare provider or pharmacist what to do if a dose is missed. Taking or skipping a missed dose will depend on the condition being treated. If a missed dose is taken, the next dose is usually taken at its regular time.

Can you overdose on Xarelto?

Taking too much Xarelto can cause bleeding problems. If an overdose is suspected, call a poison helpline or get emergency medical treatment.

Do you need to take Xarelto with food?

The 15 mg and 20 mg tablets of Xarelto should be taken with food. The 2.5 mg and 10 mg tablets can be taken with or without food.

Sources:

• Factor Xa inhibitors, Bayer

• Xarelto drug summary, Prescriber’s Digital Reference

• Xarelto rivaroxaban tablet/oral suspension prescribing information, DailyMed (NIH National Library of Medicine)

• Xarelto, Janssen