Table of Contents

I. Common Side Effects of Xarelto

II. Serious Bleeding Symptoms to Watch For

III. Who Should Not Take Xarelto?

IV. What to Tell Your Doctor Before Taking Xarelto

V. Xarelto and Pregnancy

VI. Xarelto and Surgery or Dental Procedures

VII. Xarelto and Alcohol

VIII. Xarelto Black Box Warnings

IX. Xarelto Drug Interactions

X. When to Talk to a Pharmacist or Doctor

XI. Conclusion

XII. FAQ: How can I lower my risk of bleeding while taking Xarelto?

Xarelto (rivaroxaban) is a prescription anticoagulant, also called a blood thinner, used to help prevent and treat blood clots. Because Xarelto affects how your blood clots, its most common side effect is bleeding. This can range from mild bruising to serious bleeding that needs medical attention. [1]

This article explains what to know about Xarelto side effects and contraindications, including common and serious side effects, warning signs of severe bleeding, drug and alcohol interactions, who should not take Xarelto, and why you should not stop taking it without talking to your doctor.

Common Side Effects of Xarelto

The most common side effect of Xarelto in adults is bleeding. This may include bruising more easily, bleeding gums, nosebleeds, or bleeding that takes longer than usual to stop. [1]

In children, the most common side effects of Xarelto include:

• Bleeding
• Cough
• Vomiting
• Gastroenteritis [1]

Even minor cuts, nosebleeds, or gum bleeding may last longer than expected when taking Xarelto. Bleeding should not be ignored if it is unusual, frequent, heavy, or difficult to control.

To learn more about how Xarelto works in the body, read our in-depth article, What Is Xarelto, and How Does It Work? 

Serious Bleeding Symptoms to Watch For

Xarelto can increase the risk of serious bleeding that may need medical attention. Call your doctor or get medical help right away if you notice:

• Severe bleeding
• Bleeding that lasts a long time
• Frequent nosebleeds
• Unusual bleeding from the gums
• Heavier-than-normal menstrual bleeding
• Unexpected vaginal bleeding
• Red, pink, or brown urine
• Bright red or black stools
• Coughing up blood or blood clots
• Vomiting blood
• Vomit that looks like coffee grounds [1]

You should also get medical help if you feel unusually weak, dizzy, or have headaches along with possible bleeding symptoms. Pain, swelling, or new drainage from a wound site may also be a warning sign. [1]

Who Should Not Take Xarelto?

You should not take Xarelto if you currently have certain types of abnormal bleeding or if you are allergic to rivaroxaban or any ingredient in Xarelto. [1]

Xarelto is also not recommended for people with artificial heart valves, including those who have had transcatheter aortic valve replacement. It is also not recommended for people with antiphospholipid syndrome, especially those with positive triple antibody testing. [1]

What to Tell Your Doctor Before Taking Xarelto

Before taking Xarelto, tell your doctor about your full medical history. This is especially important if you have or have ever had:

• Bleeding problems
• Liver problems
• Kidney problems
• Antiphospholipid syndrome [1]

You should also tell your doctor if you are pregnant, planning to become pregnant, breastfeeding, or planning to breastfeed. [1]

Kidney and liver problems matter because they can affect whether Xarelto is appropriate for you or whether closer monitoring is needed. Xarelto should be avoided, or the dose adjusted, in certain patients with renal impairment. [1]

Xarelto should also be avoided in patients with moderate or severe hepatic impairment or liver disease associated with coagulopathy because drug exposure and bleeding risk may be increased. [1]

Xarelto and Pregnancy

Tell your doctor right away if you become pregnant while taking Xarelto. Taking Xarelto during pregnancy may increase the risk of bleeding in the mother or unborn baby. It is not known whether Xarelto will harm an unborn baby. [1]

Xarelto should be used with caution in pregnant women because of the potential for obstetric hemorrhage or emergent delivery. Pregnant patients taking Xarelto should report any bleeding or symptoms of blood loss right away. [1]

Xarelto can pass into breast milk. If you are breastfeeding or planning to breastfeed, talk to your doctor about the best way to feed your baby during treatment. [1]

Xarelto and Surgery or Dental Procedures

Xarelto may need to be stopped for one or more days before surgery or another procedure to lower the risk of bleeding. Your doctor will tell you when to stop taking it and when to start again. [1]

Do not stop Xarelto on your own. Stopping it too early or for too long may increase your risk of blood clots. [1]

Xarelto and Alcohol

You can drink alcohol in moderation while taking Xarelto, but talk to your doctor about what is safe for you. [2]

Heavy drinking, especially binge drinking, can be dangerous while taking Xarelto because alcohol can increase the risk of bleeding. [2]

Xarelto Black Box Warnings

Xarelto has two black box warnings: one for blood clots after stopping treatment too early and one for spinal or epidural blood clots. [1]

Stopping Xarelto too early may increase blood clot risk

Do not stop taking Xarelto without talking to the doctor who prescribed it. Stopping Xarelto too early can increase the risk of blood clots. In people with nonvalvular atrial fibrillation, this may increase the risk of stroke. [1]

Xarelto may increase the risk of spinal or epidural blood clots

Xarelto may increase the risk of spinal or epidural blood clots, also called hematomas. These have occurred in people taking Xarelto who receive spinal or epidural anesthesia or have a spinal puncture. [1]

In serious cases, these blood clots can cause long-term or permanent paralysis. The risk may be higher if you:

• Have an epidural catheter
• Take NSAIDs or other medicines that affect blood clotting
• Have a history of repeated or difficult spinal punctures
• Have a history of spinal problems
• Have had spinal surgery [1]

Tell your doctor right away if you have back pain, tingling, numbness, muscle weakness, especially in the legs or feet, or loss of bowel or bladder control. [1]

Xarelto Drug Interactions

Tell your doctor about all medications you take, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements. Some medications can change how Xarelto works or increase the risk of bleeding. [1]

Let your doctor know if you’re taking any of the following:

• Ketoconazole
• Ritonavir
• Erythromycin
• Carbamazepine
• Phenytoin
• Rifampin
• St. John’s wort
• Aspirin or aspirin-containing products
• Long-term NSAID use
• Warfarin
• Heparin
• Clopidogrel
• SSRIs
• SNRIs
• Other medicines used to prevent or treat blood clots may increase bleeding risk [1]

For a more detailed breakdown of interactions, read our article Xarelto Food and Drug Interactions. 

When to Talk to a Pharmacist or Doctor

Talk to your doctor or pharmacist if you are unsure how to take Xarelto, whether your other medicines interact with it, or what to do if you miss a dose. You should also ask for guidance before taking any new prescription medication, over-the-counter drug, vitamin, or herbal supplement.

Take Xarelto exactly as prescribed, do not stop it on your own, and get medical help right away if you notice signs of serious bleeding or unusual symptoms.

Conclusion

Xarelto can help prevent and treat serious blood clots, but it also increases the risk of bleeding. Some bleeding may be mild, such as bruising or bleeding that takes longer to stop. However, heavy, unusual, frequent, or hard-to-control bleeding should be taken seriously.

To use Xarelto safely, take it exactly as prescribed, do not stop it without talking to your doctor, and tell your healthcare providers about all medications, supplements, medical conditions, and upcoming procedures. Get medical help right away if you notice signs of serious bleeding or any unusual or persistent symptoms. 

FAQ: How can I lower my risk of bleeding while taking Xarelto?

The best way to lower your risk of bleeding while taking Xarelto is to avoid anything that makes bleeding more likely and to act early if bleeding seems unusual. Since Xarelto slows the blood’s ability to clot, even minor injuries can cause you to bleed for longer. The goal is not to avoid normal life, but to reduce preventable cuts, falls, and procedure-related bleeding risks. 

Wear proper safety gear during activities such as cycling or higher-risk sports, use protective gloves when working with sharp tools, and be careful when trimming your hair or nails. Small habits, such as using a soft toothbrush and wearing shoes to avoid cuts on your feet, can also help reduce avoidable bleeding.

To lower your bleeding risk when taking Xarelto:

1. Take Xarelto exactly as prescribed.
2. Tell your doctor or dentist you are taking Xarelto before any procedure.
3. Wear proper safety gear during activities that could cause injury.
4. Use gloves when working with sharp tools.
5. Use a soft toothbrush and be careful when trimming nails or hair.

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.