Table of Contents
II. Food-Drug Interactions Explained
VI. FAQ: What pain relievers should you avoid while taking Xarelto?
Xarelto (rivaroxaban) can interact with other medications, supplements, and certain foods in ways that may increase your risk of side effects, including serious bleeding. These interactions are one of the most important safety considerations when taking a blood thinner, especially since many common over-the-counter products and everyday dietary choices can play a role.
This article explains how Xarelto food and drug interactions work, what to watch for, and when to check with your doctor or pharmacist before combining Xarelto with other substances.
What is Xarelto?
Xarelto is a prescription anticoagulant used to treat and prevent certain blood clots, including deep vein thrombosis (which can occur in the limbs or pelvic region) and pulmonary embolism (a blood clot in the lungs). [1]
Xarelto is often prescribed to patients after knee or hip replacement surgery when the risk of getting a blood clot is higher due to bed rest. People with certain heart rhythm problems may also be given Xarelto to lower their risk of stroke caused by a blood clot. [1]
Although Xarelto may prevent blood clots in some instances, it also has some side effects. One of the most dangerous side effects of Xarelto is the increased risk of major bleeding events. [1]
Be sure to educate yourself and speak with your doctor about any questions or concerns you may have before starting a Xarelto prescription. That’s where Canada Drug Warehouse comes in. Through our trusted online pharmacy referral service, you can learn more about your blood thinner options and how to save money on your Xarelto prescription. Talk with your doctor about whether the benefits of this medication outweigh the risks for your situation.
Get savings updates for Xarelto
Food-Drug Interactions Explained
A drug interaction occurs when another drug or substance affects the activity of a drug. Due to the drug-drug interaction, the effects of a drug are either increased or decreased, or a new effect (a side effect) is produced. Accidental misuse and a lack of knowledge about the active ingredients in a drug are factors that contribute to interaction risks. [2]
A food-drug interaction is also a possibility. When certain foods and drugs are taken together, they can alter the body’s ability to use components of these foods or drugs, and may also cause negative side effects. Food, beverages, and dietary supplements can all cause drug interactions. Grapefruit is one of the most common foods that contribute to food-drug interactions. [2]
Drug-disease interactions are also important to consider. Certain health conditions can affect how a medication works in the body or increase the risk of side effects. [2] For example, Xarelto is generally not used in people with bleeding disorders because, as a blood thinner, it can further increase the risk of serious bleeding. [3]
Food Interactions
No More Vitamin K Interactions
It is important to know of any dietary restrictions you may need to adopt when taking Xarelto. Some anticoagulant medications would interact negatively with high-vitamin K-rich foods such as leafy greens, kale, broccoli, brussels sprouts, and collards, to name a few. The body uses vitamin K to help blood clot. [4]
Warfarin (an anticoagulant drug), for example, works by blocking the blood clotting step that depends on vitamin K. [5] There are varying recommendations about whether or not to consume vitamin K-rich foods while on certain anticoagulant medications. Some findings suggest consistency matters more than avoidance — don’t avoid vitamin K foods completely, rather, maintain a consistent intake each day to keep the amounts of the vitamin and warfarin in balance. [4]
Xarelto differs from warfarin and other blood-thinning medications in its relationship with vitamin K. Xarelto may not interact with vitamin K like other medications. You can eat vegetables high in vitamin K, and it will not interfere with your medication. [1]
Grapefruit
Grapefruit is a citrus fruit with many health benefits. The downside to grapefruits is that they interact with many common medications. Be cautious when pairing grapefruit or grapefruit juice with any medications you are taking, and always speak with your doctor about any concerns you have.
Grapefruit and some related citrus fruits, such as Seville oranges, tangelos, and Minneolas, contain compounds called furanocoumarins. [7] These compounds can interfere with CYP3A4, an enzyme in the small intestine that helps break down certain medications. When CYP3A4 is blocked, more of the medication may enter the blood and stay in the body longer, which can increase the risk of side effects. This interaction does not affect every medication or every anticoagulant in the same way, so patients should ask their doctor or pharmacist whether grapefruit is safe with their specific prescription. [8]
Drug Interactions
You may have a higher risk of bleeding if you take Xarelto with Aspirin or aspirin-containing products, long-term (chronic) use of non-steroidal anti-inflammatory drugs (NSAIDs), warfarin sodium (Coumadin, Jantoven), any medicine that contains heparin, clopidogrel (Plavix), selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs), and other medicines to prevent or treat blood clots [1]
Below is a more comprehensive list of medications and supplements to avoid, although it’s important to note this may not be a complete list — always consult your doctor for appropriate information.
Medications and supplements to avoid include:
- Aspirin and aspirin-containing products
- NSAIDs such as ibuprofen (Motrin, Advil) or naproxen (Aleve) [3]
Herbals or vitamins with blood-thinning traits to avoid:
- Ginger
- Garlic
- Ginkgo Biloba
- Alfalfa
- Anise
- Bilberry
- St. John’s wort
- Feverfew
- Fish oil
- Vitamin E [3]
Prescription medications that should not be taken with Xarelto:
- Ketoconazole (Nizoral tablets)
- Itraconazole (Sporanox, Onmel)
- Ritonavir (Norvir)
- Clarithromycin (Biaxin)
- Rifampin (Rifadin)
- Phenytoin (Dilantin)
- Carbamazepine (Tegretol)
Tell your doctor if you take an antidepressant, and here are ones to avoid:
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Duloxetine (Cymbalta)
- Venlafaxine (Effexor XR)
Avoid other blood-thinning medications:
- Apixaban (Eliquis)
- Dabigatran (Pradaxa)
- Edoxaban (Savaysa)
- Warfarin (Coumadin, Jantoven)
- Enoxaparin (Lovenox)
- Heparin [3]
Generic Rivaroxaban and Cost
Xarelto is often easier to use than older blood thinners, but the cost can make some people hesitate to fill their prescription. Generic Xarelto, called rivaroxaban, may offer a more affordable option.
Generic versions of Xarelto have received FDA approval and are entering the U.S. market. As availability expands, pricing may continue to vary based on factors such as location, insurance coverage, and pharmacy. [6]
With a valid prescription, U.S. patients can order approved strengths of generic rivaroxaban through Canada Drug Warehouse. Canada Drug Warehouse works with licensed Canadian pharmacies and approved international fulfillment centers, which may help patients access generic rivaroxaban.
For More Information
Always inform your doctor about other medications and supplements you are taking prior to starting a Xarelto prescription. If you have signs of bleeding, a blood clot, a stroke, or an allergic reaction, seek medical treatment immediately.
At Canada Drug Warehouse, you can learn more about how Xarelto works and when a prescription for this medication is suitable. Along with becoming more informed about your treatment plan, you can save up to 90% on prescriptions like generic Xarelto and never have to step foot in a pharmacy ever again!
FAQ: What pain relievers should you avoid while taking Xarelto?
Ask your doctor or pharmacist before taking any pain reliever with Xarelto, especially aspirin or nonsteroidal anti-inflammatory drugs, also called NSAIDs. Common NSAIDs include ibuprofen and naproxen, which are found in products like Advil, Motrin, and Aleve. These medications can raise your risk of bleeding when combined with Xarelto.
Check the label before taking any over-the-counter pain, cold, flu, headache, or arthritis product. Some products contain aspirin, ibuprofen, naproxen, or other NSAIDs, even if they are not marketed mainly as pain relievers. If you are unsure, ask a pharmacist which option is safest based on your prescription and health history.
Before taking an over-the-counter pain reliever while on Xarelto:
- Ask your doctor or pharmacist which pain reliever is safest for you.
- Avoid aspirin unless your doctor specifically tells you to take it.
- Check labels for aspirin, ibuprofen, naproxen, or other NSAIDs.
- Ask before using cold, flu, headache, muscle pain, or arthritis products.
- Get medical help right away if you notice unusual bruising, bleeding that will not stop, black or bloody stools, vomiting blood, or other signs of serious bleeding.
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.