Accidental Rivaroxaban Overdose in a Patient with Pulmonary Embolism: Some Lessons for Managing New Oral...

Area of Science:

• Pharmacology
• Internal Medicine
• Clinical Pharmacy

Background:

• Rivaroxaban is an oral direct factor Xa inhibitor prescribed for venous thromboembolism at 15 mg twice daily.
• Accurate dosing is crucial for anticoagulants to balance efficacy and safety.

Observation:

• A patient with pulmonary thromboembolism received two 150 mg doses of rivaroxaban, 10 times the prescribed 15 mg dose, 12 hours apart.
• The dispensing error was identified shortly after the second dose, prompting immediate intervention.

Findings:

• The patient was administered 50 gm of oral activated charcoal within minutes of the overdose recognition.
• Rivaroxaban levels, INR, and APTT were closely monitored; the overdose was managed without complications.
• The patient resumed the correct 15 mg twice-daily rivaroxaban dose on the second day.

Implications:

• This case highlights the potential for significant medication errors in anticoagulant prescribing and dispensing.
• Misinterpretation of dosing schedules, such as confusing rivaroxaban with dabigatran doses, can lead to dangerous overdoses.
• Timely administration of activated charcoal and therapeutic drug monitoring are vital for managing rivaroxaban overdose effectively.