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QuickView for Rivaroxaban (compound)

Name: rivaroxaban
PubChem Compound ID: 11524901
Molecular formula: C19H18ClN3O5S
Molecular weight: 435.882 g/mol
Name: rivaroxaban
Name (isomeric): DB06228
Drug Type: small molecule
BAY 59-7939
Brand: Xarelto
CAS number: 366789-02-8
Indication: Rivaroxaban is indicated for the prevention of venous thromboembolic events (VTE) in patients who have undergone total hips replacements and total knee replacement surgery. Due to a lack of safety studies, it is not recommended for use in those under 18 years old. Its use is also not recommended in those with severe renal impairment (<30mL/min).
Rivaroxaban is an anticoagulant which binds directly to factor Xa. Thereafter, it effectively blocks the amplification of the coagulation cascade, preventing the formation of thrombus. Rivaroxaban is a unqiue anticoagulant for two reasons. First of all, it is does not involve antithrombin III (ATIII) to exert its anticoagulant effects. Secondly, it...
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Mechanism of Action:
Rivaroxaban competitively inhibits free and clot bound factor Xa. Factor Xa is needed to activate prothrombin (factor II) to thrombin (factor IIa). Thrombin is a serine protease that is required to activate fibrinogen to fibrin, which is the loose meshwork that completes the clotting process. Since one molecule of factor Xa can generate more than 1...
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Absorption: Following oral administration, the absolute bioavailability is about 100%
Protein binding: Plasma protein binding is about 92% to 95%
Biotransformation: Approximately 2/3 of the dose is metabolized. It is metabolized by CYP3A4, CYP2J2 and CYP-independant mechanisms
Route of elimination: About 1/3 of the administered dose is excreted unchanged via the kidneys, 1/3 is metabolized to inactive metabolites and then excreted by the kidneys and 1/3 is metabolized to inactive metabolites and excreted fecally.
Half Life: The terminal half life is 5-9 hours in young individuals and 11-13 hours in the elderly.
Clearance: Systemic clearance is about 10L/h, so rivaroxaban is considered a drug with low clearance. Renal clearance is about 3-4L/h.
Toxicity: Excessive bleeding. Overdosages should be treated using activated charcoal and supportive measures such as mechanical compression and hemodynamic support. If bleeding is not controlled, the following procoagulants can be administered: activated prothrombin complex concentrate, prothrombin complex concentrate and recombinant factor VIIa. There is also a higher chance of post procedural hemorrhage compared to enoxaparin (1.55% vs. 1.39% respectively).
Food interaction:
St. John's Wort
Foods with antiplatelet/anticoagulants properties such as horseradish, gingko, ginger, garlic, feverfew
Drug interaction:
TamoxifenTamoxifen may increase serum concentrations of Rivaroxaban increasing the risk of bleeding. Concomitant therapy should be avoided.
BivalirudinAnticoagulants may enhance the anticoagulant effect of rivaroxaban. Avoid concurrent use of rivaroxaban with other anticoagulants whenever possible, other than during transition periods, due to the possible increased for bleeding.
ConivaptanCYP3A4 Inhibitors (Strong) may increase the serum concentration of Rivaroxaban. Consider avoiding use of rivaroxaban with any strong CYP3A4 inhibitors as many such agents are inhibitors of both CYP3A4 and P-glycoprotein. Use of rivaroxaban concomitantly with drugs that are strong inhibitors of both CYP3A4 and P-glycoprotein is specifically contraindicated.
RitonavirUse of rivaroxaban with agents that are strong inhibitors of both CYP3A4 like ritonavir and P-glycoproteins are contraindicated.
ClopidogrelAntiplatelet agents such as clopidogrel may enhance the anticoagulant effect of rivaroxaban. Avoid concurrent use of clopidogrel with rivaroxaban unless the anticipated benefits outweigh the risks of bleeding. Canadian rivaroxaban labeling recommends avoiding concurrent use with any antiplatelet agent, while the U.S. rivaroxaban labeling recommends caution and increased monitoring if used with any other antiplatelet agent. Any combined use should only be undertaken with increased monitoring for evidence of bleeding.
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