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The Figure illustrates the important details of the pharmacologic characteristics of rivaroxaban.[97][113][114]For physicians and patients, an important feature of rivaroxaban is that it can be dosed once daily. Rivaroxaban has predictable pharmacokinetics and pharmacodynamics,[97] but its absorption is dependent on taking it with food, particularly with the largest meals.[113] This is why the drug’s package insert says that it should be taken with the evening meal, once daily. Rivaroxaban has a dual mode of clearance, via both renal and hepatic metabolism; the metabolites, however, are partially renally excreted, and so physicians should be aware that renal function is important in these patients.[97]
Reiffel JA. Am J Med 2013; 126: 00-00.
[97] Patel MR, Mahaffey KW, Garg J, et al; the ROCKET AF Steering Committee, for the ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365:883-891.
[113] Perzborn E, Roehrig S, Straub A, Kubitza D, Misselwitz F. The discovery and development of rivaroxaban, an oral, direct factor Xa inhibitor. Nat Rev Drug Discov. 2011;10:61-75.
[114] Kubitza D, Becka M, Voith B, Zuehlsdorf M, Wensing G. Safety, pharmacodynamics, and pharmacokinetics of single doses of BAY 59-7939, an oral, direct factor Xa inhibitor. Clin Pharmacol Ther. 2005;78:412-421.