My doctor says I can take Xarelto in the morning. Why do instructions say evening?
Question posted by WF_Mitchell on 6 Aug 2013
Last updated on 7 November 2019 by david_pharmer
5 Answers
As per the manufacturers package insert; for atrial fibrillation not caused by a heart valve problem- "take one time a day with your evening meal."
For blood clots in the veins of the arms or legs-
"take 1 or 2 times a day as directed by your doctor. 10mg dose may be taken with or without food, and the 15mg or 20mg doses should be taken with food."
Xarelto doses should be given the same time each day.
I hope this was helpful.
Pharmacist David
I have been on Xarelto for 5 years. I have always taken it just before I go to bed at 10pm. Most clots are formed when there is no activity. I have had no side effects. I love that I don’t have to get blood work done every month. I go every 6 months. I have had emergency surgery where they have taken me off it and when putting me back on it’s always been in the evening.
The problem is that the 15mg and 20mg doses have reduced bioavailability when not taken with food. If you don't take it with a meal, you're effectively getting a lower dose.
In 2015 there was an article published in the Journal of Thrombosis and Haemostasis about a study of chronotherapy of blood thinners, specifically comparing the impact of morning vs. evening dosing of Xarelto. Apparently there's a bit of a circadian rhythm involved in blood clotting and hypofibrinolysis. The study concluded that rivaroxaban intake in the evening reduced morning F1+2 concentrations better at 8:00 AM than an administration on awakening. In addition, this suppression effect was longer lasting after evening intake and better matches morning hypofibrinolysis. So based on that study the drug is not only more effective when taken at night, it is also safer.
I have been taking 20mg of Xarelto for years at the evening meals and not had any adverse reactions. My Phisician and Nurse Practioner recommend both recommend staying with the manufacturers instructions.
Unfortunately that is not an answer. Just an experience.
Your Phisician [sic] and Nurse Practioner [sic] are probably not knowledgeable of drugs which is not unusual.
They are knowledgeable. Your source obviously is not and neither are you. My experience and knowledge come from extended actual use.
Your evidence is anecdotal based on a sample size of one which is hardly scientific. Your doc and nurse have no clue and they are just following the instructions on the package. They should ask their drug rep while they are gorging themselves on his/her free lunches. He/she would not know either but I'm sure but they could find out maybe (maybe).
You're comments show your misinformation. My Physician and Nurse Practioner have been in the medical group I use and I know their educational background and experience. My Cardiologist also recommends the manufacturers instructions as do my Urologist and a number of others.
Okay what is their educational background and experience? Were they pharmacist before becoming doctors and nurses? Inquiring minds want to know.
Again please refrain from making anecdotal comments.
My doctor says it's also out of safetymesures: the first nine hours you are even more vulnerable to exceeded bleedings if you should have an accident. When you take it before going to bed, the risk is smaller. So I always take it at 10PM.
Do you take it with food at 10PM?
No, just a little water and never had any discomfort.
Think about what you are taking and why you are taking it.
It is a blood thinner to prevent clots and you take it once a day.
If a clot is to for, it usually happens during a period of inactivity or something unusual such as air travel and its condition of poor air quality and low pressures.
Well now lay down and sleep for 8 hours. Best to have taken a clot preventer, should you be at risk at all, before rather than after the sleep period - it will be most effective in reducing the chance of a clot.
If a doctor says take it in the morning or even just "you can take it in the morning" it just shows doctors are unthinking automatons. You should change your doctor and find one who actually thinks. You may actually find a cure or better outcome at least with someone who thinks rather than just prescribes regardless of outcome.
Rivaroxaban doses of 15 and 20 mg should be taken with food to ensure maximum absorption of the dose. The lower 10 mg doses can be taken without regards to food.
Is there any actual research evidence that demonstrates administration of this drug with dinner has decreased incidence of DVT, PE, or Stroke. Theoretic arguments like "you are less active during sleep and this is the time where you need your blood thinners to work more" are not contextually accurate for many of us.
If you are working and spend protracted periods sitting with your lower extremities in a dependent position, your venous return is likely far worse than when sleeping at night. People who experience mild pedal edema during the day frequently find that their feet have far less edema after waking in the morning.
Having increased risk of bleeding for the first 12 hours after administration may be real and if advised by your MD certainly seems prudent.
There is a study that shows that if the 15mg and 20mg doses aren't taken with food, that you don't absorb the whole pill.
The uptake of Xarelto i aided when to take it with food.
The uptake of Xarelto i aided when to take it with food.
Because the manufacturer has found that taking it with the evening meal is the best time to take it.
Actually the manufacturer (J&J) only submitted the drug taken with the evening meal to the FDA for expediency sake. It has nothing to do with the drug's efficacy for other times of day.
Have you noticed that none of the other responders cite any credentials to give credence to their "opinions"? I will stick with my physician's advice every time over some ananomous Web poster. I know what his credentials are.
In 2015 there was an article published in the Journal of Thrombosis and Haemostasis about a study of chronotherapy of blood thinners, specifically comparing the impact of morning vs. evening dosing of Xarelto. Apparently there's a bit of a circadian rhythm involved in blood clotting and hypofibrinolysis. The study concluded that rivaroxaban intake in the evening reduced morning F1+2 concentrations better at 8:00 AM than an administration on awakening. In addition, this suppression effect was longer lasting after evening intake and better matches morning hypofibrinolysis. So based on that study the drug is not only more effective when taken at night, it is also safer.
Related topics
Further information
- Xarelto uses and safety info
- Xarelto prescribing info & package insert (for Health Professionals)
- Side effects of Xarelto (detailed)
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