Xarelto dosage, forms, and strengths

Xarelto is a brand-name prescription anticoagulant that is taken as a tablet once or twice per day. Xarelto contains the active ingredient rivaroxaban, and it is used to treat or prevent blood clots in the blood vessels of the legs, lungs, and other parts of the body. While blood clots are necessary to stop bleeding from an injury, they can sometimes form in the arteries or veins and be transported throughout the bloodstream. Blood clots can get stuck in blood vessels and cause serious or even life-threatening problems like strokes and heart attacks. Anticoagulants can be used to treat blood clots that don’t dissolve on their own or blood clots that can become dangerous if left untreated.

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Xarelto forms and strengths

Xarelto tablets come in a range of different strengths. 

• Tablets: 2.5 milligrams (mg), 10 mg, 15 mg, 20 mg

Xarelto dosage for adults

Xarelto is used to treat venous thromboembolism, which is a disorder that includes blood clots in the legs or pelvis (deep vein thrombosis, or DVT) and blood clots in the lungs (pulmonary embolism, or PE). It is also prescribed to decrease the risk of developing a DVT or PE in people who are hospitalized with an acute illness, people who have had previous blood clots, and others at high risk of blood clotting problems. In addition, Xarelto can be used to prevent blood clots in people with atrial fibrillation, coronary artery disease, or peripheral artery disease to decrease the risk of cardiovascular events, like heart attacks and strokes. 

Source: Epocrates

Xarelto dosage for venous thromboembolism

Venous thromboembolism (VTE) can be divided into two conditions: deep vein thrombosis (DVT) and pulmonary embolism (PE). Deep vein thrombosis is a serious medical condition that occurs when a blood clot forms in a deep vein, usually in the legs, pelvis, or arms. Part of the blood clot could break loose and travel to the lungs, causing a potentially life-threatening condition called a pulmonary embolism (PE). 

Xarelto, also known as rivaroxaban, is an oral anticoagulant that disrupts the blood clotting process to prevent blood clots or keep blood clots from getting bigger. Blood clots are formed through a cascade of reactions involving certain proteins called clotting factors. Anticoagulants typically work by blocking one of the steps in the clotting process. Rivaroxaban is a factor Xa inhibitor that blocks the activity of clotting factor Xa (“10-A”). This anticoagulant is a potent direct factor Xa inhibitor that blocks clotting within a blood clot itself, speeding up the breakdown of the clot.

• Standard dosage for the treatment of DVT and/or PE in adults: 15 mg taken with food twice daily at the same time each day for 21 days followed by 20 mg taken with food once daily at the same time each day

Xarelto dosage for the prophylaxis of venous thromboembolism

Xarelto can be used to reduce the risk of DVT and PE in people at risk for blood clots. Risk factors include a previous DVT or PE, a hip replacement or knee replacement surgery, and hospitalization with an acute illness. 

• Standard dosage to prevent VTE in people with continuing risk factors: 10 mg taken with or without food once daily starting six months after initial anticoagulant therapy

• Standard dosage to prevent VTE after hip replacement surgery: 10 mg taken with or without food once daily for 35 days starting six to 10 hours after surgery

• Standard dosage to prevent VTE after knee replacement surgery: 10 mg taken with or without food once daily for 12 days starting six to 10 hours after surgery

• Standard dosage to prevent VTE due to hospitalization for acute illness: 10 mg taken with or without food once daily for 31 to 39 days

Xarelto prophylaxis dosage for nonvalvular atrial fibrillation, coronary artery disease (CAD), and peripheral artery disease (PAD)

People with nonvalvular atrial fibrillation (an irregular heart rhythm that does not involve the heart valves), coronary artery disease, or peripheral artery disease may be more likely to develop blood clots in their circulatory system. Xarelto is used in people with these conditions to prevent dangerous blood clotting and reduce the risk of cardiovascular events like stroke or heart attack. 

• Standard dosage to prevent stroke in people with nonvalvular atrial fibrillation: 20 mg taken once daily with the evening meal

• Standard dosage to prevent cardiovascular events in people with coronary artery disease: 2.5 mg taken with or without food twice per day, plus a daily 75-100 mg dose of aspirin

• Standard dosage to prevent complications from blood clots in people with peripheral artery disease: 2.5 mg taken with or without food twice per day, plus a daily 75-100 mg dose of aspirin

Xarelto dosage for children

The U.S. Food and Drug Administration has not approved Xarelto for use in anyone younger than 18. Clinical trials have not been performed to determine if Xarelto is safe or effective when given to children.

Xarelto dosage restrictions

The maximum dosage of Xarelto in adults is 30 mg per day.

Xarelto is generally avoided or given at a reduced dosage in people with kidney problems or liver impairment. A dose of Xarelto is processed in the liver and cleared through the kidneys. If there are problems in the liver or kidneys, there is a risk that Xarelto concentrations in the blood will get too high. Higher rivaroxaban concentrations can increase the risk of bleeding and other side effects.

People with severe renal impairment (CrCl <15 milliliters (mL) per minute) may not be recommended Xarelto unless they are being treated for atrial fibrillation, coronary artery disease, or peripheral artery disease. People with mild to moderate renal impairment or normal renal function (CrCl >15 milliliters (mL) per minute), except for those being treated for atrial fibrillation, can take standard Xarelto doses. People with nonvalvular atrial fibrillation will be recommended to take 15 mg instead of 20 mg once daily if their creatinine clearance is lower than 50 mL/min.

Aside from breaking down Xarelto, the liver is responsible for making the proteins responsible for blood clotting. As a result, people with liver disease often have a condition called coagulopathy, or problems forming blood clots. People with moderate to severe hepatic impairment (liver dysfunction) or coagulopathy-associated liver disease should avoid the use of Xarelto because of an increased risk of bleeding. 

Xarelto is not recommended in people with active major bleeding, prosthetic heart valves, or triple positive antiphospholipid syndrome. Xarelto should also be avoided in people with PE who have unstable blood pressure or poor circulation. 

How to take Xarelto

Xarelto is prescribed to prevent serious medical problems, so make sure you understand how and when to take the medicine.

Before you take Xarelto

• Take this medication as directed by the prescribing healthcare provider. Be sure you understand all the recommendations you should follow when taking Xarelto:

• • Dose: As with other prescription drugs, the dose of Xarelto can vary depending on the condition being treated.

  • Schedule: A healthcare professional may instruct you to take Xarelto once or twice per day and may suggest a particular time to take the medicine.

  • Food: The 15 mg and 20 mg tablets of Xarelto must always be taken with food. The 2.5 mg and 10 mg tablets can be taken with or without food.

  • Other drugs: Xarelto may need to be taken with a daily aspirin.

  • Missed dose: The instructions for taking a missed dose will vary depending on the condition being treated.

• This medicine should come with a medication guide. If it doesn’t, it can be found in the prescribing information, or a pharmacist can supply one. Read this medication guide carefully each time you fill a prescription. It will tell you what to watch for and what to do if there’s a problem.

Taking Xarelto

• Swallow the tablet whole with water.

• If swallowing the tablet is too difficult, crush the tablet and mix it with a small amount of applesauce. Consume the applesauce immediately after mixing. at some food after the mixture has been swallowed if a 15 mg or 20 mg tablet was crushed. Eating food is not necessary with the 2.5 mg or 10 mg tablets.

• The tablet can also be crushed and mixed with 50 mL of water for administration through a feeding tube. Follow this up with a feeding if a 15 mg or 20 mg tablet was administered. Enteral feeding is not necessary after administering a 2.5 mg or 10 mg tablet. 

Precautions

• Do not stop taking this medication unless directed by a healthcare provider. Xarelto comes with an FDA boxed warning that if no other anticoagulants are being taken, discontinuation of Xarelto will significantly raise the risk of blood clots, heart attack, and stroke.

• Do not allow the Xarelto prescription to run out. This medicine must be taken every day, so make sure to refill the prescription on time.

• There’s an increased risk of bleeding around the spinal cord (epidural or spinal hematoma) during epidural procedures or a spinal puncture. Make sure to tell your healthcare provider if you are undergoing epidural anesthesia, spinal anesthesia, or any other spinal cord procedure.

• Store Xarelto at room temperature (68°F to 77°F) in a closed container.

Xarelto dosage FAQs

How long does it take Xarelto to work?

Xarelto begins to affect coagulation about an hour after a dose is taken. Maximum effects of Xarelto are reached within two to four hours. Food does not interfere or help with the body’s absorption of 2.5 mg or 10 mg doses. However, the absorption of 15 mg and 20 mg doses may be low unless food is taken with the dose.

What happens if I miss a dose of Xarelto?

Ask a healthcare provider or pharmacist what to do if a dose is missed before taking this medicine. Taking or skipping a missed dose will depend on the condition being treated.

• If you take 10 mg, 15 mg, or 20 mg Xarelto once per day: Take the missed dose as soon as you remember. If it is the next day, skip the missed dose and take the next dose as scheduled. Do not double a dose on the same day to make up for a missed dose. 

• If you take 15 mg Xarelto twice per day: Take the missed dose as soon as you remember to make sure you take a total of 30 mg per day. It is okay to take two 15 mg tablets at the same time. Continue the regular twice-daily schedule the following day.

• If you take 2.5 mg Xarelto twice per day: Skip the missed dose and take a dose at the next scheduled time. 

Can you overdose on Xarelto?

Taking too much Xarelto can cause bleeding problems. If an overdose is suspected, call a poison helpline or get emergency medical treatment.

What interacts with Xarelto?

As with all medications, Xarelto may cause problems when combined with other prescription or over-the-counter drugs. Keep a list of all prescription and over-the-counter drugs you take and share this list with your doctor or pharmacist before taking Xarelto. Make sure you include any dietary or herbal supplements being taken, too. Though they may seem harmless, supplements such as St. John’s wort can also cause problems when combined with Xarelto. Unlike other blood thinners, the effectiveness of Xarelto is not affected by vitamin K found in green vegetables and other foods.

Because the most common and serious side effect of Xarelto is bleeding, the drug interactions patients should be most concerned about involve drugs that also interfere with the body’s ability to form blood clots. These drugs include warfarin, heparin-based drugs such as enoxaparin, clopidogrel, and aspirin or aspirin-containing products. Nonsteroidal anti-inflammatory drugs (NSAIDs), selective serotonin reuptake inhibitors (SSRIs), and serotonin and norepinephrine reuptake inhibitors (SNRIs) can also interfere with blood clotting and should be avoided or used with caution while taking Xarelto.

Other drugs may increase the risk of bleeding and other adverse reactions by interfering with the body’s ability to break down rivaroxaban. These drugs include the antibiotic erythromycin, the antiviral ritonavir, and the antifungal medications ketoconazole and itraconazole. These drugs may need to be avoided while taking Xarelto.

Is it safe to take Xarelto during pregnancy?

Because of the risk of maternal bleeding, emergent delivery, and possible harm to the fetus, Xarelto should be avoided or used with caution during pregnancy. 

It’s unknown if Xarelto is safe to take while breastfeeding. Rivaroxaban is present in human breast milk in small amounts, but the risks of adverse effects in a nursing baby are not completely known. Consult a healthcare provider before taking Xarelto while breastfeeding to determine the best way to take the medication or another method to feed your baby. 

Related resources for Xarelto dosages:

• Factor Xa inhibitors, Bayer

• Rivaroxaban drug summary, Prescriber’s Digital Reference

• Xarelto, Epocrates

• Xarelto prescribing information, U.S. National Library of Medicine

• Xarelto, Janssen