From the Guidelines
Xarelto (rivaroxaban) should be taken with food, particularly for the 15 mg and 20 mg doses, as food significantly enhances its absorption in the body, increasing the amount of drug absorbed by approximately 39% compared to taking it on an empty stomach, which is crucial for ensuring the medication reaches effective levels in the bloodstream to prevent blood clots 1. The importance of taking Xarelto with food cannot be overstated, as it directly impacts the drug's efficacy in preventing blood clots. According to the most recent and highest quality study, rivaroxaban absorption is significantly increased when administered with fatty food, which is why the manufacturer recommends taking doses of 15–20 mg with food, and preferably with the largest meal of the day, to increase bioavailability 1. Key points to consider when taking Xarelto include:
- The 10 mg dose can be taken with or without food, as absorption is not significantly affected at this lower dose.
- If a dose is missed, it should be taken as soon as possible with food, but never take a double dose to make up for a missed one.
- Consistently taking Xarelto with meals helps maintain steady drug levels in the system, which is essential for its anticoagulant effect.
- The food effect occurs because the medication is more soluble in the digestive environment created after eating, particularly with meals containing fat. It's also worth noting that rivaroxaban is metabolized by the liver and is a substrate for P-gp, which can lead to clinically relevant drug interactions 1. However, the primary concern is ensuring adequate absorption of the medication, which is achieved by taking it with food. The 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation also supports the administration of rivaroxaban with the evening meal to ensure adequate absorption 1.
From the FDA Drug Label
XARELTO 15 mg and 20 mg tablets should be taken with food [see Dosage and Administration (2. 1)] . Coadministration of XARELTO with food increases the bioavailability of the 20 mg dose (mean AUC and C max increasing by 39% and 76% respectively with food).
Xeralto needs to be taken with food because food increases its bioavailability, specifically for the 15 mg and 20 mg doses. The presence of food increases the mean AUC and C max of the 20 mg dose by 39% and 76%, respectively 2.
From the Research
Xeralto Administration with Food
- Xeralto, also known as rivaroxaban, is a medication that requires administration with food for certain doses, as indicated by studies on its pharmacokinetics and bioavailability 3.
- The study found that doses of 15 mg and 20 mg of rivaroxaban had high bioavailability (≥ 80%) when taken with food, but not under fasting conditions 3.
- This suggests that taking Xeralto with food is necessary to achieve optimal bioavailability and efficacy for these doses.
- Other studies have compared the efficacy and safety of rivaroxaban with other novel oral anticoagulants, but do not provide direct information on the need for administration with food 4, 5, 6.
- A study on apixaban, another novel oral anticoagulant, found that extended treatment with a reduced dose was effective in preventing recurrent venous thromboembolism, but does not provide information on the administration of Xeralto with food 7.