From the Guidelines
Xarelto (rivaroxaban) should be taken with food when prescribed at doses of 15 mg or 20 mg. For these higher doses, taking the medication with food significantly increases its absorption in the body, ensuring proper blood levels and effectiveness. However, lower doses of Xarelto (10 mg or less) can be taken with or without food as food does not substantially affect absorption at these doses. The reason food matters for higher doses is that it helps increase the bioavailability of the medication by approximately 39%, meaning more of the drug enters your bloodstream to provide its blood-thinning effect. If you're taking the higher doses without food, you may not get the full therapeutic benefit, potentially reducing the medication's ability to prevent blood clots.
Some key points to consider:
- Rivaroxaban absorption is significantly increased when administered with fatty food, so the manufacturer recommends that doses of 15–20 mg be taken with food, and, preferably, the largest meal of the day, to increase bioavailability 1.
- Food intake has an impact on the absorption and bioavailability of rivaroxaban, with area under the curve plasma concentrations increasing by 39% when taken with food 1.
- Always take Xarelto exactly as prescribed by your healthcare provider, and if you have questions about timing or food requirements for your specific dose, consult your doctor or pharmacist for personalized guidance.
It's essential to follow the prescribed dosage and administration instructions for Xarelto to ensure its effectiveness and minimize potential side effects. If you have any concerns or questions, consult your healthcare provider for personalized advice.
From the FDA Drug Label
Rivaroxaban 2. 5 mg and 10 mg tablets can be taken with or without food. Rivaroxaban tablets 20 mg administered in the fasted state has an absolute bioavailability of approximately 66 %. Coadministration of rivaroxaban tablets with food increases the bioavailability of the 20 mg dose (mean AUC and Cmax increasing by 39 % and 76 % respectively with food). Rivaroxaban 15 mg and 20 mg tablets should be taken with food [see Dosage and Administration (2. 1)].
Administration with food is recommended for Rivaroxaban 15 mg and 20 mg tablets, but it is not required for the 2.5 mg and 10 mg tablets.
- The 2.5 mg and 10 mg tablets can be taken with or without food.
- The 15 mg and 20 mg tablets should be taken with food to increase bioavailability. 2
From the Research
Food Effect on Xarelto (Rivaroxaban) Absorption
- The absorption of rivaroxaban, the active ingredient in Xarelto, is affected by food intake 3, 4.
- Studies have shown that taking rivaroxaban with food increases its bioavailability, particularly for doses of 15 mg and 20 mg 4.
- The pharmacokinetic parameters of rivaroxaban, such as area under the plasma concentration-time curve and maximum drug concentration, are improved when taken with food 4, 5.
- However, one study suggests that rivaroxaban has a wide therapeutic window and no food interactions, implying that it can be taken without regard to food 6.
Dosage and Food Interaction
- For doses up to 10 mg, rivaroxaban can be taken without regard to food, as its pharmacokinetic parameters are dose-proportional and have high oral bioavailability independent of food 4.
- However, for doses of 15 mg and 20 mg, it is recommended to take rivaroxaban with food to achieve high bioavailability (≥ 80%) 4.
- A study on the bioequivalence and food effect of two rivaroxaban formulations found that the geometric mean ratios of pharmacokinetic parameters were within the acceptable range under both fasted and fed conditions 5.
Clinical Implications
- The food effect on rivaroxaban absorption should be considered when administering the drug to patients, particularly those taking doses of 15 mg and 20 mg 4, 5.
- Clinicians should be aware of the potential for food-drug interactions and adjust the dosage regimen accordingly to optimize medication therapy 7.