For rivaroxaban, what is the dosing recommendation for CrCl between 15-50 mL/min?

• A. Reduce the dose
• B. Avoid entirely
• C. No adjustment
• D. Increase the dose

Answer: (A)

Renal function affects rivaroxaban clearance; when CrCl is in the 15–50 mL/min range, the drug is cleared more slowly, leading to higher drug exposure and a greater risk of bleeding. To balance efficacy with safety, a downward dose adjustment is recommended rather than continuing the full standard dose. For example, in atrial fibrillation, the usual 20 mg daily dose is reduced to 15 mg daily (taken with an evening meal). The exact reduced dose can depend on the indication, but the unifying principle is to lower the dose in moderate renal impairment to account for decreased clearance. It is not appropriate to avoid the medication entirely at this level of impairment, nor to increase the dose or keep it unchanged, because doing so would raise bleeding risk.