Oral anticoagulants are essential for preventing stroke and pulmonary embolism in patients with atrial fibrillation. Rivaroxaban, a widely prescribed direct factor Xa inhibitor, has been associated with various dermatologic side effects, including pruritus, although rarely. While cutaneous side effects are relatively uncommon with Rivaroxaban, it is crucial to recognize such potential adverse effects to manage them effectively and maintain patient adherence to anticoagulation therapy. The patient’s response to medication change highlights the need for awareness of drug-induced pruritus and the importance of appropriate management strategies.