Rivaroxaban (Xarelto, Bayer) is indicated for the ‘treatment of deep vein
thrombosis and pulmonary embolism, and prevention of recurrent deep vein
thrombosis and pulmonary embolism in adults’.

For the initial treatment of
acute pulmonary embolism, the recommended dosage of rivaroxaban is 15 mg
twice daily for the first 21 days followed by 20 mg once daily for continued
treatment and prevention of recurrent venous thromboembolism.

Rivaroxaban for the treatment of deep vein thrombosis and prevention of
recurrent deep vein thrombosis and pulmonary embolism (NICE
guidance 261) recommends rivaroxaban as an option for treating
deep vein thrombosis and preventing recurrent deep vein thrombosis and
pulmonary embolism after a diagnosis of acute deep vein thrombosis in adults.

The duration of treatment recommended in the summary of product
characteristics depends on bleeding risk and other clinical criteria.
Short-term
treatment (at least 3 months) is recommended for people with transient risk
factors such as recent surgery and trauma.

Longer treatment is recommended
for people with permanent risk factors, or idiopathic (unprovoked) deep vein
thrombosis or pulmonary embolism.

A reduced dosage of 15 mg twice daily for
21 days followed by 15 mg once daily should be used in people with moderate
(creatinine clearance 30–49 ml/min) or severe (creatinine clearance 15–29 ml/
min) renal impairment if their risk of bleeding outweighs the risk of recurrent
deep vein thrombosis or pulmonary embolism.

The summary of product characteristics lists the following adverse reactions for
rivaroxaban: anaemia, dizziness, headache, fainting, bleeding events,
tachycardia (rapid heartbeat), low blood pressure, haematoma, stomach pain,
dyspepsia (heartburn), nausea, constipation, diarrhoea, vomiting, pruritus
(itching), rash, bruising, pain in the extremities, fever, and swelling, especially
of the ankles and feet.

For full details of side effects and contraindications, see
the summary of product characteristics.

National Institute of Clinical Excellence-UK.

G Mohan.