Xarelto (Rivaroxaban)
Also sold as: Xarelto, Rivarox, Rivaro, Rolarix, Clotinib
Pregnancy
Cat X
Lactation
Avoid
Schedule
H
Forms
Tablet 2.5mg, 10mg, 15mg, 20mg
Indications
- Non-valvular atrial fibrillation — stroke prevention
- DVT treatment and prevention of recurrence
- Pulmonary embolism (PE) treatment
- VTE prophylaxis after hip or knee replacement surgery
- Acute coronary syndrome — secondary prevention (2.5 mg BD with aspirin)
- CAD / PAD — cardiovascular event reduction (2.5 mg BD)
Adult Dosing
AF (stroke prevention)
20 mg PO once daily with evening meal
Reduce to 15 mg OD if CrCl 15-49 mL/min. Take WITH food — bioavailability increases by 39%.
DVT / PE treatment
15 mg PO BD with food × 21 days, then 20 mg OD with food
After 6 months: consider 10 mg OD for extended prevention
DVT/VTE prophylaxis (post-surgical)
10 mg PO OD
2 weeks (knee); 5 weeks (hip). Start 6-10 hours post-surgery.
ACS / CAD / PAD (with aspirin)
2.5 mg PO BD
Combined with aspirin 75-100 mg daily (COMPASS trial)
Pediatric Dosing
Not routinely used in children; specialist use only for VTE
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl > 50 mL/min | 20 mg OD (AF); 20 mg OD (VTE) |
| CrCl 15-49 mL/min | 15 mg OD (AF); 15 mg OD (VTE extended); 15 mg BD × 21 days then 15 mg OD (DVT/PE) |
| CrCl < 15 mL/min | AVOID — insufficient data |
Hepatic Adjustment
AVOID in hepatic disease with coagulopathy (Child-Pugh B/C)
Pregnancy & Lactation
Pregnancy: Category X
CONTRAINDICATED — crosses placenta; embryotoxic and fetotoxic in animal studies. Use LMWH (enoxaparin) throughout pregnancy.
Lactation: Avoid
Excreted in animal breast milk. Avoid — use LMWH if anticoagulation needed during breastfeeding.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Combined P-gp and CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir, clarithromycin) | Significantly increase rivaroxaban levels — increased bleeding risk; AVOID | Major |
| Combined P-gp and CYP3A4 inducers (rifampicin, carbamazepine, phenytoin, St John's Wort) | Significantly reduce rivaroxaban levels — loss of anticoagulant effect; AVOID | Major |
| NSAIDs / Aspirin (except low-dose) / Antiplatelets | Increased bleeding risk | Major |
| Other anticoagulants | Additive bleeding risk — avoid concomitant use | Major |
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Side Effects
Common
- Bleeding (any site — most common)
- Nausea
- Elevated LFTs
- Anaemia
- Dizziness
Serious / Discontinue If
- Major bleeding: GI, intracranial, retroperitoneal (NO specific antidote available in India — andexanet alfa unavailable; activated charcoal if < 8 hrs)
- Spinal/epidural haematoma (with neuraxial anaesthesia — timing critical)
Contraindications
- Active major bleeding
- Hepatic disease with coagulopathy
- CrCl < 15 mL/min
- Prosthetic heart valves (use warfarin)
- Pregnancy
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Xarelto 20mg | Bayer | 14 tab ₹1,285 |
| Rivarox 20mg | Sun Pharma | 14 tab ₹685 |
| Rivaro 20mg | Cipla | 14 tab ₹645 |
| Rolarix 20mg | Lupin | 14 tab ₹625 |
Monitoring Required
- Renal function (CrCl) — at baseline and annually (or with illness)
- CBC (anaemia, thrombocytopenia)
- LFTs (annually)
- Signs of bleeding
- No routine anticoagulation monitoring required (unlike warfarin)
Patient Counseling Points
- Take 15 mg and 20 mg tablets WITH the main meal — absorption is critical with food
- 2.5 mg tablets can be taken with or without food
- Do NOT stop without discussing with doctor — serious clot risk
- Inform all doctors/dentists — increased bleeding with procedures
- Report: unusual bleeding (urine, stool, coughing up blood), prolonged bleeding from cuts
- Avoid NSAIDs (ibuprofen, diclofenac) — bleeding risk
- If dose missed: take same day if remembered, skip if next day due — NEVER double dose
Stop Googling drug references mid-consultation
EasyClinic auto-flags Xarelto interactions, renal cutoffs, and pregnancy warnings the moment you write the prescription. Built-in safety net for every Indian doctor.
Clinically reviewed by: Dr. Priya Sharma, DM (Cardiology), Senior Cardiologist
Last reviewed: 2026-04-01
References
- BNF — Rivaroxaban
- ROCKET-AF Trial
- EINSTEIN DVT/PE Trials
- COMPASS Trial
- ESC AF Guidelines 2023