Educational use only. Drug cards are AI-assisted study material for NCLEX preparation.
Mechanism of action
Directly and reversibly inhibits factor Xa, blocking thrombin generation. Once-daily dosing for many indications (twice-daily for the first 21 days of acute VTE treatment). Used for stroke prevention in non-valvular atrial fibrillation, VTE treatment and prevention, and post-ACS / peripheral artery disease.
Adverse effects
Life-threatening / NCLEX-tested
- Major bleeding — GI bleeding is the most common serious event
- Intracranial hemorrhage (rate lower than warfarin)
- Spinal/epidural hematoma if given near neuraxial procedure
- Hepatotoxicity (rare)
- Hypersensitivity reactions (rare)
Side effects
Common — what to teach
- Easy bruising
- Minor bleeding (gums, nosebleeds, heavier menses)
- Anemia from chronic occult bleeding
- Back pain
Food & drug interactions
Strong CYP3A4 + P-gp inhibitors (ketoconazole, ritonavir) raise levels and bleeding risk — avoid. Strong CYP3A4 + P-gp inducers (rifampin, carbamazepine, phenytoin, St. John's wort) lower levels — also avoid. NSAIDs, aspirin, clopidogrel, and SSRIs add bleeding risk. The 15 mg and 20 mg doses must be taken WITH FOOD for adequate absorption — a critical teaching point.
Nursing implications
Assessment, monitoring, patient teaching
- Teach: 15 mg and 20 mg doses MUST be taken with the largest meal of the day — empty-stomach absorption is poor and stroke/VTE risk rises
- 10 mg and 2.5 mg doses can be taken without regard to food
- Reversal agent: andexanet alfa (Andexxa) for life-threatening bleeding; PCC if andexanet unavailable
- Hold per protocol around invasive procedures based on bleed risk and renal function
- Renal dose adjustment for CrCl 15–50 mL/min; avoid if CrCl < 15
- Reinforce adherence — there is no INR safety net to catch missed doses
- Counsel to report black/tarry stools, blood in urine, severe headache, unusual bruising
When to hold / contraindications
- Active major bleeding
- CrCl < 15 mL/min
- Moderate-severe hepatic impairment with coagulopathy
- Pre-procedure per institutional bleeding-risk protocol
- Co-administration of strong dual CYP3A4 + P-gp inhibitors or inducers
Memory anchor
"Rivaro requires a real meal" — 15/20 mg doses with the biggest meal. Once daily, no INR, andexanet for bleeds. Adherence is the safety net.
Practice Rivaroxaban questions
Test your recall on real NCLEX-style pharmacology questions — with full rationales and an AI Coach for the parts you miss.