Dosing & Administration

NOTE: For efficient and timely infusion, it is recommended that the IV bolus dose of Andexxa be prepared first and administered to the patient. The continuous IV infusion dose can then be prepared while the bolus dose is being administered to the patient, so that it is ready for administration immediately (within 2 minutes) following the bolus dose.

Dosing of Andexxa

Dosage recommendations differ for patients on apixaban vs rivaroxaban; watch video on Andexxa dosing

Reconstitution of Andexxa*

Gloved hand holding vial of clear liquid being penetrated by a syringe to show the first step in Andexxa reconstitution

IV Bolus Preparation
200 mg vials: Reconstitute the 200 mg vial of ANDEXXA with 20 mL of Sterile Water for Injection USP (SWFI).

  • Use a 20-mL (or larger) syringe and 20-gauge (or higher) needle.
  • Slowly inject the SWFI directing the solution onto the inside wall of the vial to minimize foaming.
  • To reduce the total reconstitution time needed during preparation, reconstitute all required vials in succession.
Two gloved hands encasing an Andexxa vial overlaid with directional arrows to show how to swirl the mixture without foamingGloved hand holding Andexxa vial between thumb and forefinger with up, down arrows overlaid with red X to show wrong way
  • To ensure dissolution of the cake or powder, gently swirl each vial until complete dissolution of powder occurs (A). Do not shake (B); shaking could lead to foaming. Typical dissolution time for each vial is approximately 3 to 5 minutes. If dissolution is incomplete, discard the vial and do not use the product.
  • Upon reconstitution, the parenteral drug product should be inspected visually for particulate matter and discoloration prior to administration.
Two gloved hands, one holding a syringe, the other holding an IV bag. The syringe is being injected into the bag
  • Use 60-mL or larger syringe with a 20-gauge (or higher) needle to withdraw the reconstituted ANDEXXA solution from each of the vials until the required dosing volume is achieved. Note the total volume withdrawn into the syringe.
  • Transfer the ANDEXXA solution from the syringe into an empty polyolefin or polyvinyl chloride IV bag with a volume of 250 mL or less.
  • Discard the syringe and needle.
  • Discard the vials, including any unused portion.
Second step in Andexxa therapy is a continuous IV infusion following the IV bolus
  • Follow the same procedure outlined above for IV bolus preparation. Reconstitute the total number of vials needed based on the dose requirements. More than one 40 to 60-mL syringe, or an equivalent 100-mL syringe, may be used for transfer of reconstituted solution to the IV bag.
  • Infusion will require a 0.2 or 0.22 micron in-line polyethersulfone or equivalent low protein-binding filter.

Administration of Andexxa

Single syringe line art to represent the administration of Andexxa through first a bolus IV injection followed by a continuous IV infusion
  • Upon reconstitution, the parenteral drug product should be inspected visually for particulate matter and discoloration prior to administration.
  • Administer ANDEXXA intravenously, using a 0.2 or 0.22 micron in-line polyethersulfone or equivalent low protein-binding filter.
  • Start the bolus at a target rate of approximately 30 mg/min.
  • Within two minutes following the bolus dose, administer the continuous IV infusion for up to 120 minutes.

Storage of Andexxa*

Single vial line art to represent Andexxa, with guidance on how the reconstituted solution works
  • The reconstituted solution contains coagulation factor Xa (recombinant), inactivated-zhzo at a concentration of 10 mg/mL.
  • Start the bolus at a target rate of approximately 30 mg/min.
  • Within two minutes following the bolus dose, administer the continuous IV infusion for up to 120 minutes.

Restarting Antithrombotic Therapy

Single capsule line art to visualize guidance on re-starting antithrombotic therapy to treat underlying disease
  • Patients treated with FXa inhibitor therapy have underlying disease states that predispose them to thromboembolic events.
  • Reversing FXa inhibitor therapy exposes patients to the thrombotic risk of their underlying disease.
  • To reduce the risk of thrombosis, resume anticoagulant therapy as soon as medically appropriate following treatment with ANDEXXA.

*Note: Andexxa does not need to be brought to room temperature before reconstitution or administration to the patient.