III. Food Interactions
What is Xarelto?
Xarelto is a prescription non-generic anticoagulant drug that is used to treat specific blood clots. These types blood clots are deep vein thrombosis (occur in the limbs, arms, or pelvic region) and pulmonary embolism (a blood clot in the lungs).
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.
Although Xarelto may prevent blood clots in some instances, it also has many negative side effects. One of the most dangerous side effects of Xarelto is the increased risk of major bleeding events. The Xarelto safety information warns that Xarelto can cause bleeding which can be serious and may lead to death. 
Be sure to educate yourself and speak with your doctor about any questions or concerns you may have, before starting a Xarelto prescription. Consider for yourself if the benefits of taking this drug outweigh the potentially harmful side effects.
Food-Drug Interactions Explained
A drug interaction is 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.
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 to contribute to food-drug interactions.
Lastly, drug-disease interactions must be considered. A certain disease someone has can change the effects of a drug, and can also produce unwanted side-effects.  For example, Xarelto is not recommended if you have a bleeding disorder due to the fact that it is an anticoagulant, or blood-thinning, medication and can increase your risk of major bleeding events. 
No More Vitamin K Interactions
Previous to the existence of Xarelto, most anticoagulant medications would interact negatively with high-vitamin K rich foods such as leafy greens, kale, broccoli, brussel sprouts, and collards, to name a few. The body uses vitamin K to help blood to clot.
Warfarin (an anti-coagulant drug), for example, works by blocking the blood clotting step that depends on vitamin K. 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. 
Xarelto differs from warfarin and other blood-thinning medications in its relationship with vitamin K. The explanation on the Xarelto website indicates that Xarelto does not interact with vitamin K. The website states that you can eat vegetables high in vitamin K and it will not interfere with your medication.  Xarelto may not interact with vitamin K like other medications.
Grapefruit is a citrus fruit with many health benefits. The downside to grapefruits is that it interacts 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 a few of its cousins (seville oranges, tangelos, pomelos, and minneolas), contain a chemical called furanocoumarins. Furanocoumarins disrupt the function of a group of proteins called CYPs. CYPs are responsible for breaking down medications, such as anticoagulant drugs, reducing the blood levels of them. The danger of furanocoumarins and its disruption of CYPs is that they have been shown to increase the blood level of medications. Grapefruit can increase the side effects of these drugs. 
If you read through the Xarelto website, it states clearly that there are no known dietary restrictions while taking the drug. Xarelto drug manufacturers, Bayer and Janssen Pharmaceuticals, have not issued any warnings regarding grapefruit juice. However, there are many sources that claim grapefruit does interact with Xarelto. 
The claim that Xarelto has no dietary restrictions may not be entirely accurate. The Canadian Medical Association Journal published an article in 2012 that indicates more than 85 drugs are known to interact with grapefruit. 
Despite Xarelto’s absence of dietary restriction warnings, it may be best to avoid grapefruit (and its close relatives) to decrease adverse drug reaction and side effects risk.
When you search Xarelto, it indicates that over 250 drugs are known to interact with Xarelto; over 100 of those are major drug interactions.  Despite the easy access to online information, it is crucial to speak with your doctor to inform them of all your medications so they can prevent drug interactions.
Xarelto safety information indicates medicines to avoid while taking this drug. 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 
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)
Herbals or vitamins with blood-thinning traits to avoid:
- Ginko Biloba
- St. John’s wort
- Fish oil
- Vitamin E 
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:
- Effexor XR
- Avoid other blood thinning medications:
- Apixaban (Eliquis)
- Dabigatran (Pradaxa)
- Edoxaban (Savaysa)
- Warfarin (Coumadin, Jantoven)
- Enoxaparin (Lovenox)
- Hesparin 
For More Information
Always tell your doctor of other medications and supplements you are taking prior to starting a Xarelto prescription. If you have signs of bleeding, blood clot, stroke, or allergic reaction, seek medical treatment immediately. Learn more about how Xarelto works and when a prescription for this medication is suitable.
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.