Rivaoxaban with 'food'

At patients day they reinforced the need to take NOACs with food and I was feeling smug because i already knew I must otherwise up to 70% of the drug is lost. But as I queued to speak to the pharmacist who had spoken, about how I could cope with a knee problem in the light of warnings against NSAIDs, i was shocked to hear her say that a piece of fruit was not good enough - apparently the food doesn't need to be a lot but must contain fat for the drug to be absorbed so biscuits, toast and butter or nuts are fine but my customary banana is useless! So glad I heard this as I have been putting myself at risk without knowing - a shame the leaflet with the drug doesn't spell this out and GPs don't mention it.

47 Replies

  • Thank you for posting - I knew it had to be taken with food but didn’t know about the fat content. Should be made clear on the drug instructions

  • When I was in the hospital they gave me the rivaroxaban 20mg just with water, I read that it had to be taken with food.

  • I have never ever been told to take it with food ,let alone fatty food.. That came as a surprise.

    Since being on Ribaraxaban I have developed widespread joint pain . It could just be a coincidence but the onset has been sudden.

    My cardiologist was not interested when I asked him if there was a connection. Other physios have just said it was my age, or my posture ( I was a dancer) that really annoys me .. Only a very well qualified Chinese acupuncturist was plausible , he refused to take my money . He said there was something going on with my joints that he could not diagnose.

    I know we all react differently to medication.

  • I got widespread joint pain when taking apixaban and my EP said that I could swap to any of the other NOACs and wrote to GP detailing them all for me to decide - gotta like that man

  • Hi I'm on apixiban have been for 16 months and I'm getting worse struggle with walking and pains in joints bad fatigue was it difficult changing to another noacs? Need advice please x

  • I changed from Rivaroxaban to Pradaxa - smooth and easy. My cardio advised stopping the Rivaroxaban for 48hrs to see whether the side effects disappeared - and they did. Then I started on Pradaxa. But the drug info says you can change NOAC without any pause between. Your GP or cardio will advise and prescribe.

  • Thanks 🤗

  • Many of the rivaroxaban family increase joint pain significantly. I have ceased those tablets. Replacement is 400mg Co-enzyme Q10, 1 gm L-Carnitine and 10 ml Olive Oil. Have a look at the Cochrane studies.

  • Hi, I'm interested to hear that you've stopped taking rivaroxaban and replaced it with supplements. I went to the Cochrane website but could only find one study about NOACs and AF, done in 2013, which said that NOACs are safer than warfarin. Could you direct me to which studies you mean? Thanks.

  • What I forgot to mention is that a good book explaining most of what we all need is 'Health Defence' by drpaulclayton.co.uk - got me started on bypassing the unknown drugs pushed by the pharma crowd.

  • Thanks - I have now ordered it from Amazon - looks interesting

  • O my goodness, I am SO glad others get joint pain too!!

    When I asked my cardiologist if the sudden onset of joint pain, which makes me really miserable!! Could be due to one of the pills he put me on , he rolled his eyes to heaven and said" am I an expert ?" . I was treated as if I was a halfwit. Two slightly younger doctors in the room with me looked quite embarassed and Kindly said that they thought I SHOULD see a rheumatologist.. That was brave of them. I had to do the referral request though.

    4 different private physios had given me completely conflicting reasons for the joint pain. Only an acupuncturist was honest and told me that he was not going to charge me as he did not know what was going on with my bones.

    It seems that cardiology terrifies other medical departments.

  • One approach is to buy 'Health Defence' by drpaulclayton.co.uk - check the website. The book does not deal specifically with your difficulty, but explains much and has references you can look up.

  • Hi Luludean I had exactly the same problem and eventually came off the drug and returned to Warfarin . Reported it to the Supplier and GP but got the impression It was me with the problem !!. Muscle and joint pains ceased when I stopped taking the drug. Best Wishes HiLil

  • Thanks for this nugget of info, Songbird! Xarelto (Rivaroxaban) was prescribed by my cardiologist who didn't mention anything about when or how to take it, but the patient guidelines that came with the pills stated "Take with evening meal". I've seen these same instructions elsewhere since then and have wondered why it's always "evening meal." Sometimes I don't feel like eating a real meal, so have taken with a piece of fruit, or rice cake. So thanks for the heads-up about making sure that there's some fat in there too. But I wonder how much fat? If you ever find out, please let us know. All the best to you!

  • I don't think it needs to be a lot - she said a couple of biscuits or a piece of toast with some butter.

  • Wow, fast response! Very helpful. Thanks very much, Songbird!

  • I take the NOAC Pradaxa which says can be taken with or without food but with a glass of water

  • Apixaban says with or without food too

  • I too am on Predaxa however I have trouble swallowing the hard capsule and my heart drugs so always have to eat a dry biscuit afterwards to push it down, I take it at 8.0 a.m. with breakfast and again at 8.0 pm in the evening having been told it has to be the same times each day

  • I was advised to take it with my evening meal and I get frantic trying to ensure I eat within a 2 hour window each evening. Is there much leeway regarding timescales given the relatively short half life?

  • I take two a day

  • Rivaroxaban?

  • No as above pradaxa

  • Sorry saw that and still asked. A Homer Simpson "doh" moment.

  • I did not know this either, have been taking mine last thing at night, just after the teeth cleaning ritual. (Has to be after, my teeth bleed profusely if I take Rivaroxaban before teeth cleaning)

    I am fairly sure that I haven’t been told this before, and if I had read it, I’ve forgotten it!

  • It's not just me then...

    I take mine early evening and my teeth bleed through the night as well, leaving me with a horrible mouth in the morning.

  • I have to keep throwing my pillows away, as I can’t cope with the dried blood stains on them!

  • I have always taken mine with my evening meal - it states on the information sheet with tabs to take with a meal. I think my GP also told me to take with food.

  • Thank you Songbird, that's very interesting. I'd read on the info leaflet to eat Rivaroxaban with a meal. And I've seen on here some very helpful advice that it's best to take it during a meal (not before or after, but with it). My own GP completely denied the need to take it with any food- but clearly isn't right there!

    Can I check the pharmacist was talking specifically about Rivaroxaban? My understanding is you don't need to eat at all with other NOACs?

    And also can I ask when they were talking about a couple of biscuits etc being enough, they were only talking about absorption? ie not about the issue of protecting the stomach? (For ages I've been trying to understand which anticoagulant is best for me, having had a duodenal ulcer in the past. My GP and cardiologist both deny that apixaban is gentler!)

    Thanks anyway for the info. And no problem if you can't answer my added queries :) x

  • The pharmacist was talking specifically about rivaoxaban

    I thought the gp who said take food was saying all Noacs but as I was only interested in mine I might be wrong there

  • Thank you, songbird :) I'll keep trying to find out more about the other NOACs then. I think I'd prefer to swap to apixaban, but not if it's safer to have it with food. (Not sure I could eat a meal at both ends of 12 hours!) x

  • Hi JaneFinn. I too have had a duodenal ulcer (which perforated) and now have a gastric ulcer. My stroke consultant put me on Pradaxa (Dabigatran) because of this, as there is a reversal agent available for this but not for the other NOACs.

    I take my Pradaxa with food, as I feel ill if I don't eat after taking the tablet. In the morning I have a slice of buttered toast, and at nighttime I have a chocolate biscuit.

  • Oh thank you for this info, Lizzo- that's very interesting to hear about Pradaxa. It wasn't even suggested as an option to me. I'll investigate more.

    I'm so sorry to hear about your gastric stuff - ugh I sympathise. Great to hear there's a NOAC out there that we can use even with an ulcer...

    Thanks again :)

  • I meant to post this earlier. I've been taken of rivaoxoban and put on abixapan by my cardiologist. He says rivaoxoban needs to be taken with at least 600 calories to work properly, though I can't find that anywhere

  • Thanks for this - typical muddle but if we try to take with a balanced meal should be fine?

  • I was taking mine with breakfast, not always 600 calories, and had another TIA

  • The Pharmacokinetic Properties section of this American publication from 2013 seems to suggest that it doesn't matter whether you take 10mg of Rivaroxaban with or without food. However for 20mg, taking it with food increases the absorbtion - but it doesn't matter whether or not the food is high in fat or carbs.



  • Thanks for this - a really interesting article - and of course contradictory!! Still, I think I will hedge my bets and sneak in a bit of fat!

  • I don't always take apixaban with food. Will have to check.

  • Wow...25 replies and as much confusion as ever! All I can add is that I've taken Rivaroxaban for over a year now - always halfway through an evening meal and the only time I had a problem was when I took the tablet without food which caused a stomach bleed. Not a bad bleed...just a warning not to do that again! Be cheery everyone...we'll show them we are survivors despite some medical confusion! 😊👍

  • Yes, it’s news to me too! So thankful I saw a few posts regarding this subject today. Every day I seem to learn something new about Afib and the drugs prescribed to control it.

  • I take mine in the morning , normally with fruit. Thanks on two parts firstly, for the heads up and secondly, this should justify a full English breakfast on health grounds ! Thanks

  • I have been taking Riveroxaban (Xarelto) now for two years and quite frankly this drug has saved my life. I was given it after an emergency stay in hospital for multiple pulmonary embolisms. I had 12 blood clots go through my heart into both lungs. I was told I was very lucky to have survived and I have been given a second chance that many don't have. I also have severe arthritis and fibromyalgia which has been on going for over 20 years, any additional pain from these drug cannot really be noticed, if there is any, because my pain is high all the time. They have literally been a life saver and recently I had to undergo another operation, in which, the drug had a controlled stop. This was somewhat frightening but I was given a high dependency bed and very good care. I knew how dangerous it was to stop these drugs and I did end up having a small TIA but the operation was necessary and it was successful however I was glad to return to the drugs under controlled conditions. As far as food with the drug goes I was told in hospital to have it with food especially if you are on the higher doses of 15mg or 20mg upwards. Get good advice from your GP or consultant, don't read the 'mish mash' of ideas on the internet you can frighten yourself to death with that. Look for answers that have been properly researched, if you feel you must look, but ask those who care for you and if you don't get an answer you want then push a little harder. It is your life and your body. I am very grateful to this drug. It was a relatively new drug when I first took it, as it was only in about 2011 that it became used for DVT's, although it had been around since 2007. Without it I would not be here so that speaks volumes. Lots of drugs have side effects but it is a balance between what is viable when your life is otherwise in danger. I have my Riveroxaban with morning cereal and milk and I know it works well, and my oxygen saturation levels have gone up which is brilliant. I was told, by my consultant, not to have too much food that contains Vitamin K as that is a clotting agent, like Broccoli, Spring onions, Cabbage & Cucumber. It doesn't mean you can't have any, I have them all but in moderation. I don't get hung up on any of the food things I prefer to get on with my life and just make minor food adjustments that are advised by my consultant or doctor. As Dadog says lets show them we are survivors and if your concerned then push for answers with those who medically treat you. My best wishes to everyone.

  • Apixaban can be taken with or without food. I have taken it for six years. I take at 8.45am before breakfast and the same time at night after dinner with no problems.

  • Me too.

You may also like...