Xarelto® (rivaroxaban) Uses, Dosage, Side Effects, and Cost

What Rivaroxaban Is and How It Works

Rivaroxaban is an oral anticoagulant in the direct Factor Xa inhibitor class. It helps prevent and treat blood clots by blocking Factor Xa in the coagulation cascade. This reduces the formation of fibrin and lowers clot growth. Many patients compare the rivaroxaban price and value when considering therapy without insurance.

Rivaroxaban is used for nonvalvular Atrial Fibrillation to reduce the risk of stroke and systemic embolism. It treats deep vein thrombosis and pulmonary embolism and reduces recurrence. It also prevents clots after hip or knee replacement surgery. The 2.5 mg dose with low-dose aspirin may be used in coronary artery disease and peripheral artery disease.

Common tablet strengths include 2.5 mg, 10 mg, 15 mg, and 20 mg. The 10 mg strength is often used after orthopedic surgery. The 15 mg and 20 mg doses are usually taken with food. Rivaroxaban belongs to the rivaroxaban drug class known as direct oral anticoagulants (DOACs).

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Rivaroxaban is the generic name; the rivaroxaban brand most people know is Xarelto. If comparing the brand name for rivaroxaban vs generic, both contain the same active ingredient. Always follow the prescriber’s directions and the rivaroxaban package insert.

Dosage and Usage

• Nonvalvular atrial fibrillation: commonly 20 mg once daily with the evening meal; some patients with reduced kidney function may use 15 mg once daily with food per prescriber direction.
• Treatment of DVT/PE: often 15 mg twice daily with food for 21 days, then 20 mg once daily with food.
• Reduction in risk of recurrence: some may continue 10 mg once daily; follow the prescriber’s plan.
• Post-hip or knee replacement: rivaroxaban 10 mg once daily; food not required.
• CAD/PAD regimen: 2.5 mg twice daily with low-dose aspirin as directed to reduce cardiovascular risk.
• Missed dose—15 mg twice daily phase: take the missed 15 mg as soon as remembered to ensure 30 mg total that day.
• Missed dose—once daily dosing: take as soon as remembered on the same day, then resume the next day. Do not take two doses on the following day.
• Swallow tablets whole with liquid. Tablets may be crushed and mixed in applesauce if needed; the 15 mg and 20 mg doses should be followed by food.

• Storage: keep tablets at 20–25 °C (68–77 °F). Brief excursions 15–30 °C (59–86 °F) are acceptable.
• Protect from moisture. Store in the original bottle or blister until use. Close the cap tightly after each use.
• Do not freeze. Keep away from excessive heat, direct sunlight, and humidity (e.g., bathrooms).
• Travel: keep medicine in carry-on baggage. Pack an extra supply in a separate bag. Bring a copy of the prescription.
• Use a daily pill organizer for trips, and keep tablets out of reach of children and pets.

Benefits and Savings

Rivaroxaban offers predictable anticoagulation and does not require routine INR monitoring. There are fewer dietary restrictions than with warfarin. Many regimens are once daily, which supports adherence. The uses of rivaroxaban cover atrial fibrillation, venous thromboembolism treatment, and surgical prophylaxis, which makes therapy versatile.

Ordering the generic can cut the rivaroxaban cost significantly. Savings of 60–80% vs typical US prices are common at Canadian pharmacies. Multi-month supplies can lower the per-month cost. Patients comparing the price of rivaroxaban without insurance may find the generic more affordable than the brand.

Looking for extra savings? See our rivaroxaban coupon page for current offers and promotions.

Side Effects and Safety

• Common effects: easy bruising, nosebleeds, gum bleeding, heavier menstrual bleeding.
• Gastrointestinal: upset stomach, nausea, abdominal pain, constipation, or diarrhea.
• General: dizziness, headache, fatigue.
• Hematologic: anemia may occur in some patients.
• Skin: rash or irritation, usually mild.

Serious bleeding can occur and may be life-threatening. Seek urgent care for signs of major bleeding. Premature discontinuation increases the risk of thrombotic events. Spinal/epidural hematoma risk exists in patients receiving neuraxial anesthesia or spinal puncture. Avoid use in patients with mechanical heart valves. Significant liver disease, active pathological bleeding, and certain drug interactions are contraindications. Strong dual CYP3A4/P-gp inhibitors or inducers can alter exposure. Risk of hypoglycemia is not relevant unless combined with diabetes agents; monitor overall regimen if multiple drugs are used.

Onset Time

Rivaroxaban is absorbed rapidly. Anticoagulant effect begins within hours of the first dose. For DVT or PE, symptom improvement may take days, while clot protection continues with ongoing dosing. After surgery, prophylactic protection with rivaroxaban 10 mg starts on the day therapy is initiated. Stroke risk reduction in atrial fibrillation depends on consistent daily use.

Compare With Alternatives

Apixaban is another Factor Xa inhibitor. It is dosed twice daily for most uses and has a broad evidence base in atrial fibrillation and venous thromboembolism. Food is not required. Some patients prefer once-daily rivaroxaban for convenience; others may prefer apixaban’s dosing profile.

Xarelto® 20 Mg is the brand version of rivaroxaban. Brand and generic share the same active ingredient and mechanisms. Patients who prefer brand packaging or have specific brand preferences may consider Xarelto, though the generic usually offers lower cost.

Pradaxa® 150 Mg (dabigatran) is a direct thrombin inhibitor. It is taken twice daily and may have a different bleeding profile. Dabigatran capsules must stay in the original packaging to protect from moisture. Some patients switch between these agents based on tolerability, renal function, and prescriber guidance.

Combination Therapy

• Low-dose aspirin may be combined in CAD/PAD regimens; bleeding risk increases, so clinicians select candidates carefully.
• Concurrent NSAIDs or other antiplatelets (e.g., clopidogrel) raise bleeding risk; combinations are used only when benefits outweigh risks.
• Avoid combining with other anticoagulants unless directed during specific transitions or procedures.
• Strong CYP3A4/P-gp inhibitors or inducers may require an alternative therapy due to interaction risk.

Patient Suitability and Cost-Saving Tips

Good candidates include adults with nonvalvular atrial fibrillation who need stroke prevention, and those treating or preventing DVT and PE. Postoperative patients after knee or hip replacement often use rivaroxaban 10 mg for a defined course. The benefits of rivaroxaban include fixed dosing and no routine INR monitoring.

Not all patients should use rivaroxaban. It is not recommended for mechanical heart valves or moderate-to-severe liver disease associated with coagulopathy. Patients with significant bleeding risk, severe renal impairment depending on indication, or antiphospholipid syndrome (triple-positive) may need alternatives. Review the drug class of rivaroxaban and interactions with the prescriber.

To manage the rivaroxaban price, consider a multi-month supply when appropriate. Reorder reminders can help avoid gaps. Some patients evaluate the cash price rivaroxaban and choose generic to reduce costs. This can be helpful for those paying without insurance.

Authoritative Sources

Xarelto Prescribing Information and Medication Guide (Janssen)

Health Canada Drug Product Database: Rivaroxaban

FDA Rivaroxaban Label and Safety Information

Order Xarelto® from Youdrugstore: add to cart, upload your prescription, and we ship with prompt, express, cold-chain handling.

This page is educational and does not replace advice from your healthcare professional. Always follow your prescriber’s directions and the patient information leaflet.