FACTOR Xa INHIBITOR DOSING









Apixaban (Eliquis®)

Dosage forms

Tablet
  • 2.5 mg
  • 5 mg
30-day starter pack for VTE treatment
  • Contains seventy-four 5 mg tablets
  • Has 2 blister cards with dosing instructions

Dosing

Atrial fibrillation
  • 5 mg twice a day
  • The recommended dose of apixaban is 2.5 mg twice daily in patients with any 2 of the following characteristics:
    • Age ≥ 80 years
    • Body weight ≤ 132 pounds (60 kg)
    • Serum creatinine ≥ 1.5 mg/dl
  • May take without regard to food
VTE treatment
  • 10 mg twice a day for 7 days, then 5 mg twice a day
  • No dose adjustment recommended in kidney disease
  • May take without regard to food
VTE secondary prevention
  • 2.5 mg twice a day after at least 6 months of treatment
  • No dose adjustment recommended in kidney disease
  • May take without regard to food
DVT prophylaxis following hip or knee surgery
  • 2.5 mg twice a day starting 12 - 24 hours after surgery
  • Hip replacement: 35 days of therapy
  • Knee replacement: 12 days of therapy
  • No dose adjustment recommended in kidney disease
  • May take without regard to food

Generic / Price

- NO/$$$$

Other


Betrixaban (Bevyxxa®)

Dosage forms

Capsule
  • 40 mg
  • 80 mg

Dosing

Prophylaxis of VTE in adult patients hospitalized for an acute medical illness
  • CrCl > 30 ml/min: Initial single dose of 160 mg, followed by 80 mg once daily
  • CrCl 15 - 30 ml/min: Initial single dose of 80 mg followed by 40 mg once daily
  • Recommended duration of therapy is 35 - 42 days
  • Take at the same time each day with food. Food decreases absorption.
  • If a dose is missed, the dose should be taken as soon as possible on the same day. The dose should not be doubled to make up for a missed dose.

Generic / Price

- NO/$$$$

Edoxaban (Savaysa®)

Dosage forms

Tablet
  • 15 mg
  • 30 mg
  • 60 mg

Dosing

Atrial fibrillation
  • CrCl > 95 ml/min: Not recommended
  • CrCl 51 - 95 ml/min: 60 mg once daily
  • CrCl 15 - 50 ml/min: 30 mg once daily
  • CrCl < 15 ml/min: DO NOT USE
  • May take without regard to food
  • In the ENGAGE study, edoxaban 60 mg once daily was not as effective in patients with CrCl > 95 ml/min
VTE treatment (after 5 - 10 days of parenteral anticoagulant)
  • CrCl > 50 ml/min: 60 mg once daily
  • CrCl 15 - 50 ml/min: 30 mg once daily
  • CrCl < 15 ml/min: - DO NOT USE
  • Weight ≤ 132 lbs (60 kg): 30 mg once daily
  • With certain P-gp inhibitors (see drug interactions below): 30 mg once daily
  • May take without regard to food
  • Before starting Edoxaban, patients should be treated for 5 - 10 days with a parenteral anticoagulant

Generic / Price

- NO/$$$$

Other


Rivaroxaban (Xarelto®)

Dosage forms

Tablet
  • 2.5 mg
  • 10 mg
  • 15 mg
  • 20 mg
30-day starter pack for VTE treatment
  • Contains 42 tablets of 15 mg and 9 of 20 mg
Oral suspension
  • 155 mg bottle
  • 1 mg/ml after reconstitution
  • Store at room temp

Dosing

NOTE: All dosing presented here is for adults. See Xarelto PI [sec 2.2] for pediatric dosing
Atrial fibrillation
  • CrCl > 50 ml/min: 20 mg once daily with evening meal
  • CrCl ≤ 50 ml/min: 15 mg once daily with evening meal
VTE treatment
  • CrCl ≥ 15 ml/min: 15 mg twice a day with food for 21 days, then 20 mg once daily with food
  • CrCl < 15 ml/min: DO NOT USE
  • Take at the same time each day
VTE secondary prevention
  • CrCl ≥ 15 ml/min: 10 mg once daily, after at least 6 months of standard anticoagulant treatment
  • CrCl < 15 ml/min: DO NOT USE
  • May take without regard to food
DVT prophylaxis following hip or knee surgery
  • CrCl ≥ 15 ml/min: 10 mg once daily starting 6 - 10 hours after surgery once hemostasis has been established
  • CrCl < 15 ml/min: DO NOT USE
  • Hip replacement: 35 days of therapy
  • Knee replacement: 12 days of therapy
  • May take without regard to food
VTE prevention in acutely ill medical patients not at high risk for bleeding
  • CrCl ≥ 15 ml/min: 10 mg once daily in hospital and after hospital discharge, for a total recommended duration of 31 to 39 days
  • CrCl < 15 ml/min: DO NOT USE
  • May take without regard to food
  • High risk for bleeding defined as any of the following: history of bronchiectasis, pulmonary cavitation, or pulmonary hemorrhage, active cancer (i.e. undergoing acute, in-hospital cancer treatment), active gastroduodenal ulcer in the three months prior to treatment, history of bleeding in the three months prior to treatment, or dual antiplatelet therapy
Reduction of risk of major cardiovascular events in patients with CAD
  • 2.5 mg twice daily
  • Should be given with aspirin 75 - 100 mg once daily
  • No dose adjustment necessary in kidney disease
  • May take without regard to food
Reduction of risk of major thrombotic vascular events in PAD, including patients after lower extremity revascularization due to symptomatic PAD
  • 2.5 mg twice daily
  • Should be given with aspirin 75 - 100 mg once daily
  • No dose adjustment necessary in kidney disease
  • When starting therapy after a successful lower extremity revascularization procedure, initiate once hemostasis has been established
  • May take without regard to food
Missed doses
  • 2.5 mg twice daily dosing: take a single 2.5 mg dose as recommended at the next scheduled time
  • 15 mg twice daily dosing: take missed dose immediately to ensure intake of 30 mg/day. Two 15 mg tablets may be taken at once.
  • 20 mg, 15 mg, or 10 mg once daily dosing: take missed dose immediately. The dose should not be doubled within the same day to make up for a missed dose.

Generic / Price

- NO/$$$$

Other

  • See switching between other anticoagulants for recommendations on changing to and from rivaroxaban
  • Tablets may be crushed and mixed with applesauce. 15 mg and 20 mg tablets should be followed with food.
  • Tablets may be crushed and suspended in 50 ml of water for administration via gastric tube. 15 mg and 20 mg tablets should be followed with enteral feedings.
  • Crushed and suspended tablets (in water or applesauce) are stable for up to 4 hours.






Liver disease dosing recommendations
Child-Pugh class
Drug A B C
Apixaban No adjustment necessary Use with caution. No dosage recommendation given. Do not use
Betrixaban No adjustment necessary Do not use Do not use
Edoxaban No adjustment necessary Do not use Do not use
Rivaroxaban No adjustment necessary Do not use Do not use



  • Reference Manufacturer's PI
Metabolism and elimination
Drug P-glycoprotein CYP3A4 CYP2J2 ABCG2 (BCRP) transporter Other
Apixaban Substrate Major substrate Minor substrate Substrate CYP1A2, CYP2C8, CYP2C9, and CYP2C19 minor substrate
Betrixaban Substrate - - - -
Edoxaban Substrate Minor substrate - - -
Rivaroxaban Substrate Substrate Substrate Substrate -



Pricing legend
  • $ = 0 - $50
  • $$ = $51 - $100
  • $$$ = $101 - $150
  • $$$$ = > $151
  • Pricing based on one month of therapy at standard dosing in an adult
  • Pricing based on information from GoodRX.com®
  • Pricing may vary by region and availability

Patient Assistance Programs for Factor Xa Inhibitors
Drug Manufacturer Ships to PAP info Application
Apixaban (Eliquis®) Bristol-Myers Squibb Patient or doctor Link Link
Betrixaban (Bevyxxa®) Portola N/A N/A N/A
Edoxaban (Savaysa®) Daiichi-Sankyo Use at pharmacy Savings card program N/A
Rivaroxaban (Xarelto®) Johnson and Johnson Pharmacy Link Link