Xarelto 20
Xarelto 20 is Bayer’s rivaroxaban 20 mg tablets — the first oral direct factor Xa inhibitor. ROCKET-AF (2011) non-inferior to warfarin in non-valvular AF; EINSTEIN-DVT/PE (2010) established single-drug treatment for VTE. COMPASS (2017) showed 2.5 mg twice daily + aspirin reduced CV events in stable CAD/PAD. No routine blood monitoring needed (vs warfarin INR). Contraindicated in mechanical valves, pregnancy, severe CKD. Andexanet alfa reverses in emergencies.
✓ Medically reviewed by Morgan Ellis — Pharmacy Researcher · 8 years experience · Last reviewed: May 2026
⚡ Quick Answer — What is Xarelto 20?
Xarelto 20 is 20 mg rivaroxaban tablets from Bayer — direct oral anticoagulant (DOAC) — direct factor Xa inhibitor. Rivaroxaban was introduced by Bayer in 2008 as Xarelto — the first oral direct factor Xa inhibitor. ROCKET-AF (2011) and EINSTEIN-DVT/PE (2010) established non-inferiority to warfarin in AF and VTE. directly inhibits factor Xa, the central convergence point of intrinsic and extrinsic coagulation cascades, reducing thrombin generation. 5-13 hour half-life; renally and hepatically cleared. Dosing: Non-valvular AF: 20 mg once daily with food (15 mg if CrCl 15-50 mL/min). DVT/PE treatment: 15 mg twice daily for 3 weeks then 20 mg once daily. COMPASS vascular prophylaxis: 2.5 mg twice daily with aspirin 75-100 mg daily. Major bleeding ~3-5%/year in AF; GI bleeding somewhat higher than warfarin. No routine monitoring unlike warfarin — a major practical advantage. Reversal with andexanet alfa (specific antidote) where available, or 4-factor prothrombin complex concentrate. Anticoagulant and antiplatelet selection is individualised to diagnosis, bleeding risk, renal function, and drug interactions. Specialist or family-physician supervision is standard.
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What Is Xarelto 20?
Xarelto 20 is 20 mg rivaroxaban tablets from Bayer, supplied in 14-112 tablets. Rivaroxaban was introduced by Bayer in 2008 as Xarelto — the first oral direct factor Xa inhibitor. ROCKET-AF (2011) and EINSTEIN-DVT/PE (2010) established non-inferiority to warfarin in AF and VTE.
How Rivaroxaban Works
Rivaroxaban directly inhibits factor Xa, the central convergence point of intrinsic and extrinsic coagulation cascades, reducing thrombin generation. 5-13 hour half-life; renally and hepatically cleared.
Approved Uses
- Non-valvular atrial fibrillation — stroke prevention (ROCKET-AF)
- Deep vein thrombosis and pulmonary embolism — treatment (EINSTEIN trials) and extended prophylaxis
- VTE prophylaxis after major orthopaedic surgery
- Stable coronary or peripheral arterial disease — 2.5 mg twice daily + aspirin (COMPASS 2017) for atherothrombotic prevention in high-risk patients
Dosage
Non-valvular AF: 20 mg once daily with food (15 mg if CrCl 15-50 mL/min). DVT/PE treatment: 15 mg twice daily for 3 weeks then 20 mg once daily. COMPASS vascular prophylaxis: 2.5 mg twice daily with aspirin 75-100 mg daily.
Bleeding Risk and Monitoring
Major bleeding ~3-5%/year in AF; GI bleeding somewhat higher than warfarin. No routine monitoring unlike warfarin — a major practical advantage. Reversal with andexanet alfa (specific antidote) where available, or 4-factor prothrombin complex concentrate.
No routine blood monitoring required — a major practical advantage over warfarin. Check renal function at baseline, 3 months, then annually (or sooner in acute illness or 75+ years). No dietary restrictions. Missed doses: take if within 6 hours of scheduled dose; otherwise skip — do not double up.
Side Effects
- Major bleeding (~3-5%/year in AF)
- GI bleeding (higher than apixaban, slightly higher than warfarin)
- Anaemia
- Minor bleeding (epistaxis, bruising)
- Hepatotoxicity (rare)
Contraindications
- Active pathological bleeding
- Severe renal impairment (CrCl <15 mL/min)
- Severe hepatic impairment (Child-Pugh B or C)
- Mechanical heart valve (use warfarin)
- Moderate-to-severe mitral stenosis
- Pregnancy (crosses placenta; use heparin / warfarin)
- Concurrent strong dual inhibitors of CYP3A4 + P-gp (azole antifungals, HIV protease inhibitors)
Drug Interactions
- Strong CYP3A4 + P-gp dual inhibitors — CRITICAL. Azole antifungals (ketoconazole, itraconazole), HIV protease inhibitors, clarithromycin — substantially raise rivaroxaban levels; contraindicated.
- Strong CYP3A4 + P-gp inducers (rifampicin, phenytoin, carbamazepine, St John’s Wort) — lower levels; avoid or monitor closely.
- Other anticoagulants, heparins — do not combine except in specific bridging situations under specialist supervision.
- NSAIDs, antiplatelets — additive bleeding risk.
Storage
Store Xarelto 20 below 25°C. Keep out of reach of children.
Frequently Asked Questions
Do I need blood tests on Xarelto 20?
No routine blood tests for efficacy. Check renal function annually.
What should I do if I cut myself while on Xarelto 20?
Apply firm direct pressure for 15-20 minutes without checking. Most minor cuts stop normally; bleeding that continues >20 minutes or bleeds through multiple dressings warrants urgent medical review. Report any black or bloody stools, bright red rectal bleeding, haematuria, unexplained bruising, nosebleeds >15 minutes, or menstrual bleeding much heavier than usual.
Can I take Xarelto 20 in pregnancy?
No — crosses placenta; DOACs are contraindicated in pregnancy. Use LMWH.
What if I need surgery?
Inform the surgical team well in advance. Rivaroxaban stopped 24-48 hours before surgery depending on bleeding risk and renal function.
Where can I buy Xarelto 20 online?
You can buy Xarelto 20 (rivaroxaban 20 mg, 14-112 tablets) from MedsBase with discreet packaging and worldwide shipping.
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| Strength | 20 mg |
|---|---|
| Quantity | 14 Tablet/s, 28 Tablet/s, 42 Tablet/s, 56 Tablet/s, 112 Tablet/s |
Xarelto 20
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Xarelto 20
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