Xarelto (rivaroxaban) is a brand-name drug that’s prescribed to treat or lower the risk of blood clots and certain other conditions. As with other drugs, Xarelto can cause side effects, such as fatigue and dizziness.

Xarelto is approved by the Food and Drug Administration (FDA) for use in adults to:

Xarelto is also approved for use in children to:

  • treat venous thromboembolism (VTE) and lower the risk of additional VTEs in children of all ages who have already had at least 5 days of initial blood thinner treatment
  • help prevent blood clots in children ages 2 years and older who have congenital heart disease and have had the Fontan procedure (a type of open-heart surgery)

Xarelto is available in two forms: oral tablet and oral liquid suspension.

Like other drugs, Xarelto can cause side effects. Read on to learn about potential common, mild, and serious side effects. For a general overview of Xarelto, including details about its uses, see this article.

Xarelto can cause certain side effects, some of which are more common than others. These side effects may be temporary, lasting for a few days or weeks. But if the side effects last for longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

These are just a few of the more common side effects reported by people who took Xarelto in clinical trials:

Mild side effects can occur with Xarelto use. This list doesn’t include all possible mild side effects reported with the drug. For more information, you can refer to Xarelto’s prescribing information.

Mild side effects of Xarelto can include:

These side effects may be temporary, lasting for a few days or weeks. But if the side effects last for longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you develop a side effect while taking Xarelto and want to tell the FDA about it, visit MedWatch.

* For more information on this side effect, see “Side effect specifics” below.

Xarelto may cause serious side effects, although these weren’t common in clinical trials. The list below may not include all possible reported serious side effects of the drug. For more information, you can refer to Xarelto’s prescribing information.

If you develop bad or serious side effects while taking Xarelto, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Serious side effects, which are explained in more detail in the “Side effect specifics” section below, include:

* Xarelto has a boxed warning for this side effect. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Side effect specifics” section below.
† This side effect is possible after taking Xarelto. Although it wasn’t reported in clinical trials, the side effect has been reported in people taking Xarelto since the drug was approved.

Some side effects were more common in children in Xarelto’s clinical trials. These side effects include bleeding, which was also a common side effect in adults. And the following side effects were not reported in adults, but were reported in children:

However, it’s possible for any of Xarelto’s side effects in adults to also occur in children.

In clinical trials of Xarelto, researchers specifically looked at whether side effects in older adults were different from those in younger adults.

In these trials, people 65 years and older were more likely to experience bleeding as a side effect of Xarelto. No other age-related differences in side effects were seen.

If you have questions about Xarelto’s side effects given your age, talk with your doctor or pharmacist. And for more information about bleeding as a side effect of Xarelto, see the “Side effect specifics” section below.

Xarelto may cause several side effects. Here are some frequently asked questions about the drug’s side effects and their answers.

Can Xarelto affect the liver?

It’s not likely. Liver-related side effects weren’t seen in people taking Xarelto in clinical trials.

Since the drug was approved, there have been reports of liver-related side effects in people taking Xarelto. These side effects include liver damage and hepatitis (inflammation in your liver). But it’s unclear how often these side effects may occur and if Xarelto may be the cause.

If you have questions about how Xarelto may affect your liver, talk with your doctor.

What are the side effects of the 20-milligram strength of Xarelto?

In clinical trials, people who took the 20-milligram (mg) strength of Xarelto reported side effects such as:

In this trial, people took Xarelto to treat either deep vein thrombosis or pulmonary embolism, which are types of blood clots.

If you’re experiencing side effects from taking Xarelto, including the 20-mg strength, talk with your doctor about treatment options.

Is hair loss a side effect of Xarelto?

No, hair loss wasn’t reported as a side effect in people taking Xarelto in clinical trials.

If you have questions about potential hair loss while taking Xarelto, talk with your doctor.

Can Xarelto cause weight gain?

It’s unlikely. In clinical trials, people taking Xarelto didn’t report weight gain as a side effect.

If you have questions or concerns about weight gain while you’re taking Xarelto, talk with your doctor. They can recommend ways to help you maintain a body weight that’s healthy for you.

Are there any side effects of stopping Xarelto treatment?

Yes, it’s possible to experience side effects from stopping Xarelto. In fact, Xarelto has a boxed warning for the risk of blood clots if you stop taking the drug before the recommended duration of treatment. See the “Side effect specifics” section just below for more information about this.

If you have questions about side effects after you stop taking Xarelto, talk with your doctor or pharmacist.

Learn more about some of the side effects that Xarelto may cause.

Fatigue

Fatigue (lack of energy) is a possible side effect of Xarelto.

This side effect was somewhat common in people taking Xarelto in clinical trials. But no one reported severe fatigue or stopped taking Xarelto due to fatigue.

What you can do

If you have fatigue while taking Xarelto, talk with your doctor. They may suggest ways to treat this side effect. If fatigue is affecting your daily life, your doctor may suggest a drug other than Xarelto for you.

Bleeding

Bleeding was the most common side effect reported in people taking Xarelto in clinical trials.

Xarelto is an anticoagulant (blood thinner), which is a drug that makes it harder for your body to form blood clots. So it’s not unusual that the drug increases your risk of bleeding. But it’s important to be aware that Xarelto can cause bleeding anywhere in your body, including internal bleeding. Internal bleeding can affect your organs, such as your stomach, lungs, brain, and eyes.

Xarelto may cause both mild and severe bleeding. In very rare cases, severe bleeding from Xarelto can be life threatening. Most people who reported bleeding in clinical trials experienced mild bleeding. This may cause you to bleed or bruise more easily than usual. It may also cause bleeding to take longer than usual to stop.

The following symptoms may indicate more severe bleeding:

  • bleeding that lasts for a long time or is heavier than usual
  • unexpected bleeding, such as unusual bleeding from the gums
  • severe bleeding, or bleeding that can’t be managed
  • vomiting blood (which may look similar to coffee grounds, in some cases)
  • stool that’s red or black and tarry
  • brown, red, or pink urine
  • coughing up blood or blood clots
  • unusual vaginal bleeding or heavy periods
  • headache, dizziness, or weakness (which could be symptoms of bleeding in your head or brain)
  • new or worsening symptoms at wound sites after you’ve had surgery, such as pain, swelling, or fluid drainage

If you develop severe bleeding, your doctor may treat it with an injection of a drug called Andexxa. This drug works to reverse the effects of Xarelto (specifically, to stop Xarelto from preventing blood clot formation in your body). It’s used to treat severe, unmanaged, or life threatening bleeding in people taking drugs such as Xarelto.

Note: Xarelto has a boxed warning for bleeding around the brain or spine. A boxed warning is the most serious warning from the FDA. See “Risk of spinal or epidural hematoma” below for details.

What you can do

Talk with your doctor about your risk of bleeding while taking Xarelto. It’s also important to monitor yourself for any unusual bleeding or bruising while taking Xarelto. Make sure that you (and any caregivers) know what symptoms to watch for.

If you experience any of the symptoms of severe bleeding listed above, call 911 (or your local emergency number) immediately. Or, go to your nearest emergency room.

Abdominal pain

Xarelto may cause abdominal pain. This was a somewhat common side effect in people taking Xarelto in clinical trials. But no one reported severe abdominal pain or stopped taking Xarelto due to abdominal pain in these trials.

What you can do

Abdominal pain can be a side effect of Xarelto. But it can also be a symptom of internal bleeding, such as bleeding in your stomach or intestines.*

For this reason, if you have abdominal pain while taking Xarelto, call your doctor. They’ll likely want to examine you to help determine if your pain is a symptom of a more serious side effect. If your abdominal pain is mild and likely not a symptom of bleeding, your doctor may suggest treatments to relieve this side effect.

* For more information on bleeding with Xarelto, see “Bleeding” just above.

Risk of blood clots if you stop taking Xarelto too soon

Xarelto has a boxed warning for the risk of blood clots if you stop taking the drug too soon. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.

If you stop taking Xarelto before the recommended length of treatment, your risk of having a blood clot increases. If you have a condition that affects your arteries or heart, stopping Xarelto also increases your risk of heart attack and stroke. Examples of these conditions include peripheral artery disease and coronary artery disease.

Symptoms of a blood clot vary depending on the location of the clot and may include:

  • pain and swelling, which can affect a specific area of the body, such as the calf
  • trouble breathing
  • nausea
  • lightheadedness

For more information about this warning, see Xarelto’s drug label information. You can also talk with your doctor.

What you can do

You should not stop taking Xarelto unless your doctor instructs you to do so.

Sometimes, you may need to temporarily stop taking Xarelto, with your doctor’s approval. This may be recommended before certain dental, medical, or surgical procedures. Your doctor will give you specific dates for when to stop taking Xarelto and when to start taking it again after your procedure. And, in the time leading up to your procedure, your doctor may prescribe a medication other than Xarelto for your condition.

Risk of spinal or epidural hematoma

Xarelto has a boxed warning for risk of spinal or epidural hematoma. A boxed warning is the most serious warning from the FDA. It alerts doctors and patients about drug effects that may be dangerous.

If you receive certain injections while taking Xarelto, there’s a risk of bleeding around your spine or brain. These injections include spinal and epidural injections, such as lumbar punctures.

It’s possible that this bleeding around your spine or brain could cause a spinal or epidural hematoma. A spinal hematoma is a buildup of blood around your spine. And an epidural hematoma is a buildup of blood around your brain. These hematomas can cause brain damage or paralysis (an inability to move parts of the body), either of which can be long lasting or permanent.

You may be at higher risk for a spinal or epidural hematoma if you:

  • take other medications that affect your body’s ability to form blood clots, including:
  • have a history of repeated or difficult spinal or epidural injections
  • have a history of spinal surgery or problems with your spine

For more information about this warning, see Xarelto’s prescribing information. You can also talk with your doctor.

* Xarelto is also a blood thinner. Blood thinners are also called anticoagulants.

What you can do

If your doctor determines that it’s necessary for you to receive a spinal or epidural injection while you’re taking Xarelto, they’ll monitor you for symptoms of bleeding around your brain or spine. These symptoms may include:

  • loss of ability to regulate your bladder or bowels
  • back pain
  • numbness
  • tingling
  • muscle weakness

Numbness, tingling, and muscle weakness are particularly likely to affect your feet and legs.

If you have any of the above symptoms while taking Xarelto, talk with your doctor immediately.

Allergic reaction

As with most drugs, Xarelto can cause an allergic reaction in some people. This side effect wasn’t reported in clinical trials, but it has been reported since the drug was approved.

Symptoms can be mild or serious and can include:

  • rash
  • itching
  • flushing
  • swelling under your skin, typically in your lips, eyelids, feet, or hands
  • swelling of your mouth, tongue, or throat, which can make it hard to breathe

What you can do

For mild symptoms of an allergic reaction, call your doctor right away. They may recommend ways to ease your symptoms and determine whether you should keep taking Xarelto. But if your symptoms are serious and you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Below are precautions to be aware of before you begin taking Xarelto.

Boxed warnings

This drug has boxed warnings. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

  • Risk of blood clots if you stop taking Xarelto too soon: Stopping treatment with Xarelto increases your risk of having a blood clot.
  • Risk of spinal or epidural hematoma: Getting a spinal or epidural injection while you’re taking Xarelto could cause bleeding around your spine or brain. This could result in either a spinal or epidural hematoma. This refers to a buildup of blood around your spine or brain.

For details, see the “Side effect specifics” section above.

Other precautions

Be sure to talk with your doctor about your health history before you take Xarelto. This drug may not be the right treatment for you if you have certain medical conditions or other factors that affect your health. The conditions and factors to consider include:

  • Bleeding problems: You should not take Xarelto if you have any active unusual bleeding or an increased risk of bleeding. This may apply if you’re having cancer treatment or you have a stomach ulcer. Taking Xarelto increases your risk of bleeding. So if you have a history of bleeding problems, talk with your doctor about whether Xarelto is right for you.
  • An artificial heart valve: You should not take Xarelto if you have an artificial heart valve. In a clinical trial, Xarelto increased the risk of side effects when used in people with a specific type of artificial heart valve. And Xarelto hasn’t been studied with most other types of artificial heart valves. Talk with your doctor about treatments other than Xarelto that may be safer for you.
  • Kidney problems: Xarelto may build up in your body if your kidneys aren’t working well. If you have kidney problems, you may need to take a lower dosage of Xarelto than usual. Or, your doctor may recommend a different medication that’s safer for you. Talk with your doctor about whether Xarelto is safe for you to take if you have kidney problems. Xarelto will not typically be prescribed for use in children who have kidney problems.
  • Liver problems: If you have moderate to severe liver problems, you should not take Xarelto. And you should avoid taking Xarelto if you have a blood clotting condition that’s related to a liver problem. Before taking Xarelto, talk with your doctor about your history of liver problems. Xarelto is typically not prescribed for use in children who have liver problems.
  • Pulmonary embolism (PE) requiring treatment to dissolve the clot: Xarelto shouldn’t be used to treat PE that needs surgery or medication to dissolve the clot. But the drug may be used to treat PE in other cases (see this article for details). If you’re taking Xarelto to treat PE, be sure to talk with your doctor about whether Xarelto is right for your specific type of PE.
  • Triple-positive antiphospholipid syndrome (APS): If you have APS, taking Xarelto increases your risk of developing blood clots. Make sure that your doctor knows about your condition. They can recommend a medication other than Xarelto for you.
  • Allergic reaction: You shouldn’t take Xarelto if you’ve ever had an allergic reaction to the drug or any of its ingredients. Talk with your doctor about which other treatments are better choices for you.

Alcohol with Xarelto

Alcohol isn’t known to interact with Xarelto. However, drinking large amounts of alcohol while taking Xarelto can increase your risk of bleeding, especially in your stomach or digestive tract.

If you drink alcohol, talk with your doctor about how much is safe, if any, for you to drink while you’re taking Xarelto.

Pregnancy and breastfeeding while taking Xarelto

Pregnancy: Taking Xarelto during pregnancy can increase the risk of bleeding in both the pregnant person and the fetus. The drug can also increase the risk of pregnancy-related hemorrhage (excessive bleeding) and complications with labor and delivery.

For these reasons, blood thinners other than Xarelto are typically prescribed for use during pregnancy. But Xarelto may be prescribed during pregnancy if your doctor determines that the drug’s benefits outweigh its risks. Talk with your doctor if you become pregnant or plan to become pregnant while taking Xarelto.

Breastfeeding: Xarelto has been shown to pass into breast milk. But the drug’s potential effects on a child who is breastfed aren’t known. If you’re breastfeeding or planning to do so, be sure to talk with your doctor before you take Xarelto. They can help determine whether this is safe for you and your child.

Xarelto is approved to help prevent and treat certain blood clots. If you’d like to learn more about Xarelto, talk with your doctor or pharmacist. They can help answer any questions you have about side effects from taking the drug.

Besides talking with your doctor, you can do some research on your own. These articles might help:

  • More information about Xarelto: For details about other aspects of Xarelto, refer to this article.
  • Drug comparison: To learn how Xarelto compares with Eliquis, you can see this article.
  • Dosage: For information about the dosage of Xarelto, view this article.
  • Interactions: To find out about Xarelto’s interactions, see this article.
  • Cost: For information about the cost of Xarelto treatment, you can refer to this article.
  • A look at cardiovascular health: For details about the conditions Xarelto is used for, our cardiovascular health hub may be helpful.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.