As of early 2025, dozens of alternatives to the popular anticoagulant Xarelto (Bayer) were officially registered in Russia. According to RNC Pharma’s Audit of Pharmaceutical Drug Retail Sales in Russia database, around 1.43 million packages of drugs containing rivaroxaban worth 4.2 billion rubles, including 419,000 packages of alternatives worth 375 million rubles, were sold in January–March 2025.

The generics accounted for 29.3% of the sales in physical terms. In monetary terms, however, the share of the alternatives was only 9% due to the high cost of the original Xarelto. The demand for the generics is steadily growing—only about 6,000 packages were sold in the first week of 2025, while in the last week of March, the sales exceeded 41,000 packages. In March 2025, the alternatives accounted for 35.7% of the sales in packages and 12.4% in rubles. Interestingly, around 20 SKUs of Xarelto were on the market in the analyzed period, while the manufacturers of the generics offered from 2 to 11 SKUs.

Kruoksaban by Ozon Pharm was the best-selling generic in Q1 2025, accounting for over 43% of the sales of alternatives in physical (around 181,000 packages) and 34.6% of the sales in monetary terms (130 million rubles). Zinacoren by Akrikhin ranked second, accounting for nearly 15% of the sales in packages. The unbranded generic by Severnaya Zvezda accounted for 9.5% of the sales in packages. The generics by 21 manufacturers—both Russian and foreign—accounted for the remaining 32.5%. Among the foreign-made alternatives, the most notable examples are Xiltess by Egis and Rivaroxia by KRKA, together accounting for 13.6% of the sales in physical terms.

The daily sales of Xarelto and its alternatives show that the sales of the original drug are falling, while those of the generics are increasing. However, the sales of Xarelto in physical terms in Q1 2025 fell by only 6% from Q1 2024, which is around 68,600 packages, and by less than 5% in monetary, which is only about 184 million rubles. While the alternatives are currently meeting the needs of new consumers, the medium-term outlook suggests that the pressure on the original drug will certainly increase. Furthermore, the numeric distribution of the original drug in Russia fell 19.4 percentage points (56% in January–March 2025 against 76% back in January–March 2024). However, the numeric distribution of another anticoagulant and an indirect alternative to Xarelto, Eliquis by Pfizer (INN-apixaban), is now significantly higher than that of Xarelto—68%, down 16.8 percentage points from January–March 2024.