Limited Coverage Drugs - Rivaroxaban for the treatment of deep vein thrombosis (DVT) or pulmonary embolism (PE)

Generic Name

rivaroxaban for deep vein thrombosis (DVT) or pulmonary embolism (PE) treatment

Strength

15 mg and 20 mg
Form tablet
Special Authority Criteria Approval Period
For the treatment of patients with DVT or PE. Up to 6 months total

Practitioner Exemptions

  • None

Special Notes

  1. The recommended dose of rivaroxaban for patients initiating DVT or PE treatment is 15 mg twice daily for three weeks, followed by 20 mg once daily.
  2. PharmaCare coverage of rivaroxaban for the treatment of DVT or PE is an alternative to heparin/warfarin for up to six months. When used for longer than six months, rivaroxaban is more costly than heparin/warfarin. As such, patients with an intended duration of therapy longer than six months should be considered for initiation on heparin/warfarin.
  3. Since renal impairment can increase bleeding risk, it is important to monitor renal function regularly. Other factors that increase bleeding risks should also be assessed and monitored (see product monograph).

Additional Information:

Special Authority Request Form