rivaroxaban oral suspension — Medica
Treatment or prevention of other thromboembolic-related conditions (e.g., superficial vein thrombosis, splanchnic vein thrombosis, hepatic vein thrombosis, or prophylaxis of VTE in high-risk patient)
Preferred products
- warfarin
- fondaparinux
- low molecular weight heparin (enoxaparin, dalteparin)
Initial criteria
- Patient has tried warfarin, fondaparinux, or a low molecular weight heparin (e.g., enoxaparin, dalteparin) OR patient has been started on Xarelto for treatment of an acute thromboembolic condition
- If rivaroxaban oral suspension requested: patient is unable to have Xarelto tablets appropriately administered OR prescribed dose cannot be achieved by Xarelto 10 mg, 15 mg, or 20 mg tablets
Approval duration
6 months