Xarelto Administration with Food
Yes, Xarelto (rivaroxaban) 15 mg and 20 mg doses must be taken with food, specifically with the evening meal, to ensure adequate absorption and consistent anticoagulant effect. 1
Dose-Specific Food Requirements
The food requirement for Xarelto depends entirely on the dose strength:
- 15 mg and 20 mg tablets: MUST be taken with food (preferably the evening meal) 2, 3, 1
- 10 mg and lower doses (2.5 mg, 10 mg): Can be taken with or without food 3, 1
Why Food Matters for Higher Doses
The pharmacokinetic profile of rivaroxaban changes dramatically with food intake for higher doses:
- Without food: The 20 mg dose has only 66% bioavailability 1, 4
- With food: Bioavailability increases to 80-100%, with AUC increasing by 39% and peak concentration (Cmax) by 76% 1, 4
- Lower doses (≤10 mg): Maintain 80-100% bioavailability regardless of food intake 1, 4, 5
Food intake reduces interindividual variability in drug absorption, providing more consistent anticoagulant effects across patients. 6 The type of meal does not significantly affect absorption—this effect is attributed to prolonged gastric retention time related to rivaroxaban's lipophilicity. 6
Specific Timing Recommendations for Atrial Fibrillation
For atrial fibrillation patients, the FDA label explicitly states to take Xarelto once daily with the evening meal. 1 This applies to:
- Standard dose (CrCl >50 mL/min): 20 mg once daily with evening meal 7, 2
- Reduced dose (CrCl 30-49 mL/min): 15 mg once daily with evening meal 7, 2
The American College of Cardiology guidelines reinforce this evening meal timing for consistent absorption and adherence. 2, 3
Common Pitfalls to Avoid
- Do not assume all anticoagulants have the same food requirements—this is unique to higher-dose rivaroxaban 4
- Do not take 15 mg or 20 mg doses on an empty stomach—this results in subtherapeutic drug levels with only 66% absorption 1, 4
- Gastric pH-altering medications (H2 blockers, antacids, PPIs) do NOT affect rivaroxaban absorption, so these can be used concomitantly without concern 6, 1
- The evening meal timing is not arbitrary—it improves adherence with once-daily dosing and ensures consistent therapeutic levels 2
Alternative Administration Methods
If patients cannot swallow tablets whole: