Can Rivaroxaban (Xarelto) be taken with or without food?

From the Guidelines

Rivaroxaban (Xarelto) should be taken with food when prescribed at doses of 15 mg or 20 mg, but the 10 mg dose can be taken with or without food. For patients taking the 15 mg or 20 mg doses, taking the medication with food significantly increases its absorption by approximately 39%, which is necessary to achieve proper therapeutic levels in the bloodstream 1. The presence of food, particularly meals containing fat, enhances the dissolution and absorption of the drug in the gastrointestinal tract. Some key points to consider:

• If you're taking the 10 mg dose, food is not required as this lower dose achieves adequate absorption regardless of food intake.
• It's essential to be consistent with your approach - if you start taking it with meals, continue doing so throughout your treatment course.
• If you miss a dose, take it as soon as you remember on the same day, but never take a double dose to make up for a missed one. The most recent and highest quality study, published in 2018, supports the recommendation that rivaroxaban 15 mg/20 mg for stroke prevention in AF should be taken with food, as the area under the curve (AUC) plasma concentrations increases by 39% to a very high bioavailability of almost 100% 1.

From the FDA Drug Label

XARELTO 2.5 mg and 10 mg tablets can be taken with or without food. XARELTO 15 mg and 20 mg tablets should be taken with food [see Dosage and Administration (2.1)]. For the 10 mg dose, take XARELTO with or without food. For the 15 mg and 20 mg doses, take XARELTO with food at the same time each day Hip or knee replacement surgery: Take XARELTO 1 time a day with or without food. Blood clots in people hospitalized for an acute illness: Take XARELTO 1 time a day, with or without food, while you are in the hospital and after you are discharged as prescribed by your doctor. Reducing the risk of serious heart problems, heart attack and stroke in coronary artery disease: Take XARELTO 2.5 mg 2 times a day with or without food. Reducing the risk of a sudden decrease in blood flow to the legs, major amputation, serious heart problems or stroke in people with peripheral artery disease including those who have recently had a procedure to improve blood flow to the legs: Take XARELTO 2.5 mg 2 times a day with or without food.

Rivaroxaban (Xarelto) Administration with Food:

• 2.5 mg and 10 mg tablets: can be taken with or without food.
• 15 mg and 20 mg tablets: should be taken with food.
• Hip or knee replacement surgery: can be taken with or without food.
• Blood clots in people hospitalized for an acute illness: can be taken with or without food.
• Coronary artery disease and peripheral artery disease: can be taken with or without food. 2 2

From the Research

Rivaroxaban Administration with Food

• Rivaroxaban can be taken with or without food, but its bioavailability is higher when taken with food 3, 4.
• The US prescribing guidelines recommend that 15- and 20-mg doses of rivaroxaban be administered with food for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) and for reduction in the risk of recurrence of DVT and PE 3.
• A study found that high bioavailability (≥ 80%) of 15 mg and 20 mg rivaroxaban was achieved when taken with food, independent of formulation 4.
• Another study found that rivaroxaban has a wide therapeutic window, predictable anticoagulant effect, and no food interactions 5.

Pharmacokinetics of Rivaroxaban

• The pharmacokinetics of rivaroxaban are not significantly affected by meal timing or meal content 3.
• A study found that pharmacokinetic parameters of doses up to 10 mg rivaroxaban were dose proportional and had high oral bioavailability (≥ 80%) independent of food or formulation 4.
• Another study found that rivaroxaban has a predictable anticoagulant effect and no significant interactions with food 5.

Special Considerations

• For patients with difficulty swallowing a whole tablet, a crushed rivaroxaban tablet can be administered orally or via nasogastric tube with similar relative bioavailability to a whole tablet 6.
• A precision dosing strategy for rivaroxaban has been proposed, taking into account renal function and creatinine clearance 7.