Direct oral anticoagulant (DOAC) — Factor Xa inhibitor Pregnancy: Contraindicated in pregnancy and breast-feeding (§4.3, §4.6); women of child-bearing potential should avoid becoming pregnant during treatment.

Rivaroxaban

Brand names: Xarelto

Used in: Venous Thromboembolism (DVT & PE)

Rivaroxaban is a direct oral factor Xa inhibitor (DOAC) for atrial-fibrillation stroke prevention, VTE treatment/prevention and, at low dose, vascular protection.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: DVT/PE treatment and prevention of recurrent DVT/PE: 15 mg twice daily for the first 3 weeks, then 20 mg once daily

Route: Oral (15 mg and 20 mg doses taken with food)

Frequency: Twice daily (weeks 1–3), then once daily

Elderly (US §8.5): no dose adjustment on the basis of age alone, and efficacy is similar to younger patients, but both thrombotic and bleeding event rates are higher in older patients — use with care. Other eMC indications: VTE prevention after elective hip or knee replacement — 10 mg once daily (first dose 6–10 h after surgery; hip 5 weeks, knee 2 weeks). Extended prevention of recurrent DVT/PE after ≥6 months of treatment — 10 mg once daily (or 20 mg once daily if recurrence risk is high). Prevention of stroke/systemic embolism in non-valvular atrial fibrillation (eMC §4.8 / US label) — 20 mg once daily (15 mg once daily if CrCl ≤50 mL/min per US label); this indication is covered by the 15/20 mg product SPC, not the 10 mg SPC posology provided here. Paediatric VTE (birth to <18 years): body-weight-adjusted dosing (oral suspension available) to achieve exposure similar to adults treated with 20 mg once daily — not a simple per-kg figure in the labelling; not recommended in certain low-weight/pre-term neonates. Verify paediatric dosing against a current children's formulary.

Dose adjustments

Renal

CrCl 15–29 mL/min: use with caution; use not recommended if CrCl <15 mL/min. VTE prevention (surgery): no adjustment for CrCl 30–80 mL/min. DVT/PE treatment: no adjustment for CrCl 50–80 mL/min; for CrCl 15–49 mL/min give 15 mg twice daily for the first 3 weeks, then consider reducing 20 mg once daily to 15 mg once daily if bleeding risk outweighs recurrence risk. Particularly relevant in the elderly, who often have reduced renal function.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Nonvalvular Atrial Fibrillation : 15 or 20 mg, once daily with food ( 2.1 ) Treatment of DVT and/or PE : 15 mg orally twice daily with food for the first 21 days followed by 20 mg orally once daily with food for the remaining treatment ( 2.1 ) Reduction in the Risk of Recurrence of DVT and/or PE in patients at continued risk for DVT and/or PE : 10 mg once daily with or without food, after at least 6 months of standard anticoagulant treatment ( 2.1 ) Prophylaxis of DVT Following Hip or Knee Replacement Surgery : 10 mg orally once daily with or without food ( 2.1 ) Prophylaxis of VTE in Acutely Ill Medical Patients at Risk for Thromboembolic Complications Not at High Risk of Bleeding : 10 mg …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2026-01-16. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to the active substance or any excipient
Active clinically significant bleeding
Lesion or condition at significant risk of major bleeding (e.g. recent/current GI ulceration, malignant neoplasm at high bleeding risk, recent brain/spinal injury or surgery, recent intracranial haemorrhage, known/suspected oesophageal varices, arteriovenous malformations, vascular aneurysms)
Concomitant treatment with other anticoagulants, except when switching therapy or for catheter-patency UFH
Hepatic disease associated with coagulopathy and clinically relevant bleeding risk (including cirrhosis Child-Pugh B and C)
Pregnancy and breast-feeding

Side effects

Bleeding (most common)
Epistaxis
Gastrointestinal tract haemorrhage
Anaemia
Mucosal bleeding (gingival, genitourinary)

Interactions

Not recommended with systemic azole-antimycotics (ketoconazole, itraconazole, voriconazole, posaconazole) or HIV protease inhibitors (e.g. ritonavir) — strong combined CYP3A4 and P-gp inhibitors that raise rivaroxaban levels and bleeding risk
Concomitant anticoagulants are contraindicated (except during switching)
Combined P-gp and strong CYP3A inducers reduce rivaroxaban exposure and may increase thromboembolic risk

Clinical monograph

How it works

It directly inhibits factor Xa.

Prescribing in practice

The higher treatment doses must be taken with food for adequate absorption; most indications are once daily.
Dose-reduce in renal impairment and avoid if severe; avoid in significant hepatic impairment with coagulopathy.
Bleeding is the main risk (andexanet alfa reversal where available).

Monitoring

Monitor renal and hepatic function and the full blood count; watch for bleeding.

Counselling the patient

Take the higher treatment dose with food, at the same time each day.
Report any bleeding.
Tell clinicians you take it before procedures.

Evidence & guidelines

Effective for AF and VTE (ROCKET-AF, EINSTEIN; NICE NG196).

Reference: NICE NG196; EINSTEIN trials; ROCKET-AF trial; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

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