Table of Contents
III. What Is Xarelto Used For?
IV. What Should You Know Before Taking Xarelto?
V. What Are the Side Effects of Xarelto?
VI. What Medicines Can Interact With Xarelto?
VII. Can You Drink Alcohol While Taking Xarelto?
VIII. What Activities Should You Be Careful With While Taking Xarelto?
IX. Can You Take Xarelto During Pregnancy or Breastfeeding?
X. How Should You Take Xarelto?
XI. FAQ: How do I stop taking Xarelto safely?
Xarelto is a prescription blood thinner that helps treat and prevent certain blood clots in people who are at risk because of heart rhythm problems, recent surgery, reduced mobility, or certain blood vessel conditions. It is the brand name for rivaroxaban and belongs to a group of medications called direct oral anticoagulants, or DOACs. [1]
This article explains what Xarelto is, how it works in the body, why doctors prescribe it, and what safety information patients should know before taking it. It also covers possible side effects, bleeding risks, drug interactions, and precautions to discuss with your doctor or pharmacist.
How Does Xarelto Work?
Xarelto is an anticoagulant, which means it reduces the blood’s ability to form clots. [2]
Blood clotting is a normal process that helps stop bleeding after an injury. It involves platelets, which are small blood cells that gather at the site of bleeding, and clotting factors, which are proteins made by the liver that help build and strengthen the clot. [2]
Xarelto is considered a direct oral anticoagulant, also called a DOAC. DOACs work differently from older blood thinners because they target fewer parts of the clotting process. Xarelto specifically targets Factor Xa, one of the clotting factors involved in this process. As a result, the blood takes longer to clot, which can help treat or prevent harmful blood clots. [1]
What Is a Blood Clot?
A blood clot is a clump of blood that has changed from a liquid into a gel-like or semi-solid form. Clotting is a normal and necessary process that helps stop bleeding after a cut or injury. The problem is that clots can become dangerous when they block blood flow or travel to another part of the body. [3]
A clot in a deep vein, often in the leg, is called deep vein thrombosis (DVT). If part of that clot breaks loose and travels to the lungs, it can cause a pulmonary embolism (PE). Blood clots can also travel to the brain and cause a stroke, especially in people with certain heart rhythm problems such as nonvalvular atrial fibrillation. [3]
Blood clots can become a medical emergency. Symptoms such as sudden chest pain, trouble breathing, one-sided weakness, severe leg swelling, coughing up blood, or sudden confusion should be treated urgently. [3]
What Is Xarelto Used For?
Xarelto is used to treat or help prevent blood clots in several adult conditions. The exact reason for taking Xarelto depends on the person’s diagnosis, clotting risk, bleeding risk, and treatment plan.
Xarelto for Nonvalvular Atrial Fibrillation
Xarelto may be prescribed to adults with nonvalvular atrial fibrillation, a type of irregular heartbeat that is not caused by a heart valve problem. In atrial fibrillation, part of the heart does not beat normally, which can allow blood clots to form. These clots may travel to the brain and cause a stroke. For this use, Xarelto helps reduce the risk of stroke and blood clots. [1]
Xarelto for DVT and Pulmonary Embolism
Xarelto may be used to treat blood clots in the deep veins of the legs, known as DVT, or blood clots in the lungs, known as pulmonary embolism. It may also be used to reduce the risk of these clots happening again in adults who remain at risk after receiving treatment for at least 6 months. [1]
Xarelto After Hip or Knee Replacement Surgery
Xarelto may be prescribed after hip or knee replacement surgery to help prevent blood clots in the legs and lungs. Reduced mobility is common after surgery and can increase the risk of clot formation. [1]
Xarelto for Coronary Artery Disease and Peripheral Artery Disease
Xarelto may be used with low-dose aspirin in adults with coronary artery disease or peripheral artery disease. Coronary artery disease involves reduced or blocked blood supply to the heart. Peripheral artery disease involves reduced blood flow to the legs. [1]
When used with low-dose aspirin, Xarelto may help reduce the risk of serious heart problems, heart attack, stroke, sudden reduced blood flow to the legs, and major amputation in certain adults with these conditions. [1]
Xarelto for Certain Hospitalized Adults
Xarelto may also be used to help prevent blood clots in certain adults who are hospitalized for an acute illness and after discharge. This use applies to adults who are at risk of clots because of reduced mobility and other risk factors, but who do not have a high risk of bleeding. [1]
What Should You Know Before Taking Xarelto?
Before taking Xarelto, tell your doctor about your full medical history, including any bleeding problems, liver problems, kidney problems, antiphospholipid syndrome, pregnancy, plans to become pregnant, or breastfeeding. Xarelto is not for use in people with artificial heart valves and is not for use in people with antiphospholipid syndrome, especially those with positive triple antibody testing. [1]
Xarelto has black box warnings, which are the strongest safety warnings required for prescription medications:
- Prematurely stopping Xarelto can increase the risk of blood clots, including stroke. If Xarelto needs to be stopped for a reason other than serious bleeding or completing treatment, your doctor may consider another anticoagulant to help reduce clot risk.
- Xarelto also has a black box warning about spinal or epidural hematomas. These are serious blood clots that can form around the spine in people who receive spinal or epidural anesthesia or have a spinal puncture while taking Xarelto. In rare cases, they may cause long-term or permanent paralysis. Get medical help right away if you develop back pain, tingling, numbness, muscle weakness, or loss of bladder or bowel control. [1]
You should not take Xarelto if you currently have certain types of abnormal bleeding or if you are allergic to rivaroxaban or any of the ingredients in Xarelto. [1] Xarelto also contains non-medicinal ingredients, which may matter if you have allergies or sensitivities to certain inactive ingredients. These ingredients may include:
- cellulose microcrystalline
- croscarmellose sodium
- ferric oxide red
- ferric oxide yellow
- hypromellose
- lactose monohydrate
- magnesium stearate
- polyethylene glycol
- sodium lauryl sulfate
- titanium dioxide [4]
What Are the Side Effects of Xarelto?
The most common side effect of Xarelto in adults is bleeding. Because Xarelto lowers the blood’s ability to clot, you may bruise more easily, and bleeding may take longer to stop. [1]
Call your doctor or get medical help right away if you notice signs of serious bleeding, including:
- Bleeding that is severe or will not stop
- Nosebleeds that happen often
- Unusual bleeding from the gums
- Menstrual bleeding that is heavier than normal
- Red, pink, or brown urine
- Bright red or black stools that look like tar
- Coughing up blood or blood clots
- Vomiting blood or vomit that looks like coffee grounds
- Headaches, dizziness, or weakness
- Pain, swelling, or new drainage at a wound site [1]
Xarelto may also increase the risk of spinal or epidural blood clots in people who receive spinal anesthesia, have an epidural catheter, or have a spinal puncture. Symptoms can include back pain, tingling, numbness, muscle weakness, especially in the legs or feet, or loss of bowel or bladder control. These symptoms need urgent medical attention. [1]
What Medicines Can Interact With Xarelto?
Some medicines can increase the risk of bleeding when taken with Xarelto. Tell your doctor about all prescription medications, over-the-counter drugs, vitamins, and herbal supplements you take.
Medicines that may increase bleeding risk include:
- Aspirin or aspirin-containing products
- Long-term use of nonsteroidal anti-inflammatory drugs, also called NSAIDs
- Warfarin
- Medicines that contain heparin
- Clopidogrel
- Selective serotonin reuptake inhibitors, also called SSRIs
- Serotonin norepinephrine reuptake inhibitors, also called SNRIs
- Other medicines used to prevent or treat blood clots [1]
Ask your doctor or pharmacist before starting any new medication while taking Xarelto, including common pain relievers. Even non-prescription products can matter when a blood thinner is involved.
For a more detailed breakdown of possible food and medication interactions, read our article Xarelto Food and Drug Interactions.
Can You Drink Alcohol While Taking Xarelto?
You may be able to drink alcohol in moderation while taking Xarelto, but you should ask your doctor what is safe for you. [2]
Heavy drinking or binge drinking is risky while taking Xarelto because alcohol can increase your chance of bleeding. This is especially important if you take other medicines that can also raise bleeding risk. [2]
What Activities Should You Be Careful With While Taking Xarelto?
Because Xarelto can make bleeding harder to stop, it is important to reduce the risk of cuts, bruises, and injuries. Use caution with sharp objects such as razors, scissors, kitchen knives, and nail clippers. A soft toothbrush may help reduce gum bleeding.
Avoid activities that carry a high risk of injury unless your doctor says otherwise. If you fall, hit your head, or have a serious injury while taking Xarelto, contact a doctor right away, even if you feel fine. Internal bleeding is not always obvious at first.
Can You Take Xarelto During Pregnancy or Breastfeeding?
Tell your doctor if you are pregnant, planning to become pregnant, breastfeeding, or planning to breastfeed. It is not known if Xarelto will harm an unborn baby, but taking Xarelto during pregnancy may increase the risk of bleeding in the pregnant person or unborn baby. Xarelto may also pass into breast milk, so your doctor can help decide the safest feeding plan during treatment. [1]
If you become pregnant while taking Xarelto, tell your doctor right away. Also, seek medical help if you notice signs of bleeding or blood loss during pregnancy.
How Should You Take Xarelto?
Take Xarelto exactly as prescribed. Do not change your dose, stop taking it, or skip doses unless your doctor tells you to. The length of treatment depends on why Xarelto was prescribed and your ongoing risk of blood clots or bleeding. [1]
General dosing instructions may vary by condition:
- For nonvalvular atrial fibrillation, Xarelto is usually taken once daily with the evening meal.
- For DVT or PE, Xarelto may be taken once or twice daily, depending on the dose and treatment plan.
- For 15 mg and 20 mg doses, Xarelto should be taken with food.
- For 10 mg doses, Xarelto may be taken with or without food.
- For CAD or PAD, Xarelto may be prescribed as 2.5 mg twice daily with low-dose aspirin, if directed by a doctor. [1]
If you miss a dose, follow the instructions provided by your doctor or pharmacist. The right steps can depend on your dose and how often you take it. If you are unsure, ask a healthcare professional instead of guessing.
FAQ: How do I stop taking Xarelto safely?
Do not stop taking Xarelto on your own. Stopping Xarelto can increase your risk of blood clots, including stroke in people taking it for nonvalvular atrial fibrillation. If Xarelto needs to be stopped because of surgery, dental work, bleeding risk, side effects, or another reason, the doctor who prescribed it should tell you when to stop and when to restart. In some cases, they may prescribe another blood thinner to lower the risk of a clot forming. [1]
If you want to stop taking Xarelto, contact your prescriber first and explain why. This helps them decide whether you need a different medication, a dose change, or a plan around an upcoming procedure.
To stop Xarelto safely:
- Speak to the doctor who prescribed it before making any changes.
- Ask when to stop and restart Xarelto if you have surgery, dental work, or a medical procedure coming up.
- Confirm whether another blood thinner is needed while Xarelto is paused.
- Get medical help right away if you experience any worrisome or persistent symptoms after stopping Xarelto.
The content in this article is intended for informational purposes only. This website does not provide medical advice. In all circumstances, you should always seek the advice of your physician and/or other qualified health professionals(s) for drug, medical condition, or treatment advice. The content provided on this website is not a substitute for professional medical advice, diagnosis or treatment.