Section 13 · Monograph
Rivaroxaban
Reviewed Nov 2026FDA label
XareltoFactor Xa inhibitor (DOAC)
- Forms
- Tab: 2.5, 10, 15, 20mg
- Dose
- AF stroke prevention: 20mg once daily with evening meal (15mg if CrCl 15-50)
- MOA
- Direct factor Xa inhibition
Black Box Warning
- Premature discontinuation increases the risk of thrombotic events including stroke
- Spinal/epidural hematoma risk with neuraxial anesthesia or puncture
Indications
- Reduce risk of stroke and systemic embolism in nonvalvular atrial fibrillationFDA-labeled
- Treatment and prevention of DVT/PEFDA-labeled
- Reduce major cardiovascular events in CAD/PAD (2.5mg twice daily with aspirin)FDA-labeled
Mechanism of Action
- Direct factor Xa inhibitor
Full Dosing
Adult / usual
- VTE treatment: 15mg twice daily for 21 days, then 20mg once daily with food
Renal
- AF: 20mg once daily with the evening meal; 15mg once daily if CrCl 15-50mL/min
- Avoid in AF if CrCl below 15mL/min
Contraindications
- Active pathological bleeding
- Severe hypersensitivity to rivaroxaban
Drug Interactions
- Combined strong CYP3A4/P-gp inhibitors or inducers: avoid (includes carbamazepine, phenytoin, rifampin which lower levels)
- NSAIDs, antiplatelets and SSRIs increase bleeding risk
Adverse Effects
- Bleeding (GI, intracranial)
- Anemia
- Pruritus, back pain
Monitoring Parameters
- Renal function and CBC
- Take 15mg and 20mg doses with food for absorption
- Bleeding signs
Pregnancy & Lactation
- Limited data; avoid in pregnancy
- Avoid during breastfeeding