Xarelto 20 mg: Uses, cost, and side effects vs. other strengths

In this article:

• What is Xarelto 20 mg used for?
• Xarelto dosage chart
• Xarelto 20 mg vs. 10 mg
• Xarelto 20 mg vs. 15 mg
• How to take Xarelto 20 mg
• When is the best time to take Xarelto 20 mg?
• Xarelto 20 mg side effects
• What’s the cheapest price for Xarelto 20 mg?
• Cost comparison by dose
• Who shouldn’t take Xarelto 20 mg?

In this article

• What is Xarelto 20 mg used for?
• Xarelto dosage chart
• Xarelto 20 mg vs. 10 mg
• Xarelto 20 mg vs. 15 mg
• How to take Xarelto 20 mg
• When is the best time to take Xarelto 20 mg?
• Xarelto 20 mg side effects
• What’s the cheapest price for Xarelto 20 mg?
• Cost comparison by dose
• Who shouldn’t take Xarelto 20 mg?

Xarelto (rivaroxaban) is a prescription blood thinner used to prevent life-threatening blood clots. It is a direct oral anticoagulant (DOAC) that’s FDA approved to prevent blood clots in people at high risk and reduce the risk of stroke, deep vein thrombosis (DVT, a clot in a deep vein) and pulmonary embolism (PE, a clot in the lungs) in certain patients. Healthcare providers prescribe it at different doses depending on the condition being treated and the patient’s medical history.

What is Xarelto 20 mg used for?

Healthcare providers may prescribe 20 mg of Xarelto once daily to prevent strokes in adults with nonvalvular atrial fibrillation. “The 20 mg dose is commonly used daily as a long-term maintenance dose for stroke prevention in this population,” explains Tonie Reincke, MD, medical director at Reincke Vein Center in Sugar Land, Texas. For people with nonvalvular atrial fibrillation and reduced kidney function (creatinine clearance, a measure of how well the kidneys filter waste, of less than 50 mL/min), a lower dose of 15 mg daily is prescribed instead.

For adults with DVT or PE, 20 mg Xarelto is the recommended maintenance dose after the first three weeks of treatment. People with significantly reduced kidney function (creatinine clearance of less than 15 mL/min) are not recommended to take Xarelto for DVT or PE treatment.

Xarelto 20 mg may also be prescribed to prevent recurrent venous thromboembolism (VTE), or blood clots in the veins, in patients younger than 18 years old who weigh more than 50 kg.

For people preventing DVT after hip or knee replacement surgery and those on long-term clot prevention beyond six months, lower doses are typically used.

Xarelto dosage chart
Indication	10 mg	15 mg	20 mg
Prevent stroke in people with nonvalvular atrial fibrillation	N/A	15 mg (renal impairment)	20 mg once daily
Initial DVT/PE treatment	N/A	15 mg twice daily (first 21 days)	N/A
Ongoing DVT/PE treatment	N/A	N/A	20 mg once daily
Extended prevention of DVT	10 mg once daily	N/A	20 mg occasionally

RELATED: Xarelto dosage guide

Xarelto 20 mg vs. 10 mg

“Healthcare providers may adjust the dosage of rivaroxaban based on several factors, including kidney function, bleeding risk, age, body weight, or interactions with other medications,” says Tavi Schlueter, CPNP, PMHS, nurse practitioner and Director of Growth Initiatives at Collaborating Docs. 

Xarelto dosage varies by indication:

• To reduce the risk of recurrent clots and prevent blood clots after hip or knee replacement surgery: Xarelto 10 mg
• For DVT or PE treatment and stroke prevention in people with nonvalvular atrial fibrillation: Xarelto 20 mg 
• For long-term prevention of recurrent VTEs: 15 mg twice a day for three weeks, then 20 mg daily (If treatment extends beyond six months, the dose may be reduced to 10 mg daily.) 

“Dosage adjustments may also occur if a patient develops side effects or if their underlying health status changes,” Schlueter says. Higher doses of Xarelto carry a greater risk of bleeding, the most common side effect of the drug. People with liver or kidney issues taking 20 mg Xarelto may have their dose reduced based on their medical history.

Xarelto 20 mg vs. 15 mg

People starting Xarelto may transition from 15 mg to 20 mg depending on the indication and medical history. “In some cases, patients start on a higher or more frequent dose during the early treatment phase of a clot and transition to a maintenance dose later,” says Schlueter. For DVT or PE treatment, the starting dose is typically 15 mg twice daily (30 mg total daily dose) for the first three weeks, then stepped down to 20 mg once daily.

Since surgery carries an increased risk of bleeding, the dose of Xarelto for recurring VTE prevention after surgery is 10 mg a day.

Higher doses of Xarelto carry a greater risk of bleeding. Major bleeds can involve the brain, gastrointestinal tract, or retina. People with liver or kidney issues process Xarelto differently and may need their dose reduced. This is why people with nonvalvular atrial fibrillation are typically prescribed 20 mg daily for stroke prevention, while those with kidney issues may be recommended 15 mg daily instead.

How to take Xarelto 20 mg

Xarelto 20 mg is taken once daily at the same time each day to avoid fluctuations in drug levels. If you miss a dose, take it as soon as you remember, as long as you remember on the same day of your missed dose. If it’s almost time for your next dose, skip the missed dose and resume your regular schedule. Do not take two doses at the same time.

Do not stop taking Xarelto 20 mg abruptly without medical guidance. Stopping suddenly can increase the risk of blood clots.

Xarelto 20 mg tablets should be taken with food. For people who have trouble swallowing whole tablets, the tablet can be crushed and mixed into applesauce. The mixture should be consumed within four hours.

Always follow your healthcare provider’s instructions and discuss any questions with your care team.

When is the best time to take Xarelto 20 mg?

Xarelto 20 mg should be taken at the same time each day. The timing is flexible as long as it’s taken with a meal at a consistent time each day. You can take 2.5 mg and 10 mg tablets without food, but take 15 mg and 20 mg tablets with food.

Xarelto 20 mg side effects

Patients taking Xarelto have reported side effects ranging from common to rare, and some are serious. 

Common Xarelto side effects

According to Dr. Reincke, the most common side effect of Xarelto is bleeding, since the medication reduces the blood’s ability to clot. About 5% to 28% of patients may experience bleeding as a side effect. Signs of bleeding can include nosebleeds, blood in stool, vomit that looks bright red or like coffee grounds, abdominal cramps, and fatigue. Bleeding risk is higher in people with certain infections, congenital bleeding disorders, retinal or platelet issues, recent procedures, uncontrolled high blood pressure, or older age.

Other common side effects of Xarelto include:

• Dizziness
• Insomnia
• Headache
• Tiredness
• Depression or anxiety
• Abdominal pain
• Back pain
• Limb pain
• Muscle spasm

Xarelto can also cause increased liver enzyme levels, which is why it is not recommended for people with moderate to severe liver problems.

Serious Xarelto side effects 

Serious side effects of Xarelto involve major bleeding, which can be fatal in some cases. Major bleeds occur in fewer than 4% of patients and can include:

• Intracranial hemorrhage (ICH), bleeding that occurs within the skull or brain
• Hemorrhagic stroke, bleeding in the brain that cuts off circulation to brain cells
• Gastrointestinal bleeding, including bleeding in the stomach, intestinal tract, and rectum
• Fatal bleeding

People taking Xarelto who receive spinal anesthesia (medication delivered through a needle in the spine) during a surgical procedure are also at risk of a spinal or epidural hematoma, a dangerous blood clot that forms around the spinal cord. Always inform your healthcare team about all medications you are taking before any surgery or procedure.

What are the side effects of Xarelto 20 mg vs. other doses?

There are no specific studies that suggest the side effects of 20 mg of Xarelto are different from other doses. However, it’s important to note that too high doses (overdoses) of Xarelto can result in bleeding, which can look like nose bleeds, blood in vomit, blood in stool, and abdominal cramps. “Patients should seek medical advice if they notice symptoms such as unusual bruising, prolonged bleeding, dark or bloody stools, severe headache, or dizziness. As with any anticoagulant, balancing clot prevention with bleeding risk is an important part of ongoing medical care,” says Schlueter.

What’s the cheapest price for Xarelto 20 mg?

The average retail price of Xarelto is $805 for 60, 2.5 mg tablets without insurance. With a free SingleCare coupon, 30 tablets of 20 mg brand-name Xarelto can cost $406, roughly half the retail price of 60, 2.5 mg tablets without insurance. Prices vary by location, pharmacy, dose, and quantity.

Generic rivaroxaban was authorized by the FDA in 2025 in all strengths, including 2.5 mg, 10 mg, 15 mg, and 20 mg. However, widespread availability has been primarily limited to the 2.5 mg. Check with your pharmacist for the most current availability in your prescribed strength.

Search for your prescription on singlecare.com or the SingleCare app to find the best Xarelto price near you.

RELATED: How to save on Xarelto

Xarelto cost comparison by dose
Dosage	2.5 mg (60 tablets)	10 mg (30 tablets)	15 mg (30 tablets)	20 mg (30 tablets)
Average retail price	$616	$756	$696	$749
SingleCare price	$48 for generic rivaroxaban at CVS	$408 for brand-name Xarelto at Kroger	$408 for brand-name Xarelto at Kroger	$406 for brand-name Xarelto at Walgreens
How to save	Get coupon

Who shouldn’t take Xarelto 20 mg?

“Generally, patients with active bleeding, certain liver conditions, and kidney disease may not be good candidates for rivaroxaban,” says Dr. Reincke. People who should not take Xarelto 20 mg include:

• People with a known allergy to Xarelto
• People with active bleeding
• People with kidney disease: those with a creatinine clearance (a measure of kidney filtering function) of less than 15 mL/min may need to switch to an alternative treatment
• People at high risk for bleeding, including those who are seriously ill, have cancer, or have bleeding disorders
• People with moderate to severe liver disease
• People with prosthetic heart valves

There is not enough research on the safety of Xarelto 20 mg in pregnant or breastfeeding people. Older adults may process Xarelto more slowly than younger adults, leading to higher drug levels in the body. In these cases, healthcare providers will weigh the risks and benefits carefully before prescribing.

“Because rivaroxaban interacts with some medications, providers also review a patient’s full medication list before prescribing it,” says Schlueter. Drug interactions include medications that affect liver enzymes, such as ketoconazole and carbamazepine, as well as other blood thinners such as warfarin and aspirin.

RELATED: Xarelto interactions with supplements

Bottom line

Xarelto 20 mg is commonly prescribed to reduce the risk of stroke in people with nonvalvular atrial fibrillation and as a maintenance dose for DVT and PE treatment. For long-term prevention beyond six months, lower doses are typically used.

People with liver or kidney issues, active bleeding, or older adults may be at higher risk of side effects at higher doses. Always follow your healthcare provider’s dosing instructions and contact them if you notice any signs of bleeding or other side effects.

A free SingleCare coupon can help lower the cost of your Xarelto 20 mg prescription.