Xarelto is a brand-name prescription drug. It’s called an anticoagulant or blood thinner. Xarelto is prescribed to treat and prevent dangerous blood clots in your body.

Specifically, Xarelto is approved for use in adults to:

  • Treat deep vein thrombosis (DVT). A DVT is a blood clot that forms in a vein deep inside your body. DVTs usually form in a vein in your leg, but they can also form in your arm.
  • Treat pulmonary embolism (PE). A PE is a blood clot that blocks blood flow to your lungs. PEs develop when a DVT gets dislodged from a vein and travels through your bloodstream toward your lungs.
  • Reduce the risk for getting another DVT or PE. Xarelto can be used for this purpose if you’re still at risk of having blood clots after at least 6 months of treatment for a past DVT or PE.
  • Prevent DVT and PE following hip or knee replacement surgery. Xarelto is used for this purpose because these types of surgeries increase your risk of developing blood clots.
  • Prevent blood clots in people admitted to a hospital with an acute medical illness who are at risk of blood clots. Xarelto is used for this purpose because you have a higher risk of blood clots if you’re on bedrest or you can’t move around much. For this use, your doctor may prescribe Xarelto during your hospital stay and for a period of time after you’re discharged from the hospital.
  • Prevent blood clots and stroke in people with atrial fibrillation (A-fib) that’s not caused by a heart valve problem. A-fib is a type of irregular heartbeat that can disrupt blood flow around your body. This condition increases your risk of having blood clots that can travel to other parts of your body, such as your brain. (Blood clots that travel to your brain can lead to stroke.)
  • Prevent blood clots that can cause a heart attack, stroke, or death in people with chronic (long-lasting) coronary artery disease (CAD) or peripheral artery disease (PAD). With CAD, you have narrowed arteries in your heart. With PAD, you have narrowed arteries in your legs. Both of these conditions increase your risk of developing blood clots in your arteries, which can lead to heart attack, stroke, or death. For this purpose, Xarelto is prescribed for use with low-dose aspirin to help prevent blood clots.

Xarelto contains the drug rivaroxaban. It comes as tablets that are taken by mouth. Xarelto is available in four strengths: 2.5 mg, 10 mg, 15 mg, and 20 mg.

Effectiveness

Xarelto has been found effective in several clinical studies that compared it with other commonly used anticoagulant (blood thinning) medications. These medications included aspirin, warfarin (Coumadin, Jantoven), and enoxaparin (Lovenox).

In the studies, Xarelto was as effective as:

  • warfarin in preventing stroke and blood clots in people with A-fib. For example, 3.8% of people taking Xarelto had a stroke or blood clot. In comparison, 4.3% of people taking warfarin had the same outcome.
  • enoxaparin plus warfarin in treating DVT and PE. For example, 2.1% of people taking Xarelto had a DVT or PE during treatment. In comparison, 3.0% of people taking both enoxaparin and another blood thinner drug, such as warfarin, had the same outcome.

However, Xarelto was more effective than:

  • aspirin in preventing DVT or PE. For example, 1.2% of people taking Xarelto had a DVT or PE, compared with 4.4% of people taking aspirin.
  • enoxaparin in preventing blood clots following hip or knee replacement surgery. For example, between 1.1% and 9.7% of people taking Xarelto for hip or knee replacement surgery had a DVT. In comparison, 3.9% to 18.8% of people taking enoxaparin for hip or knee replacement surgery had the same outcome.
  • enoxaparin in preventing blood clots in people with a high risk of blood clots during and after a hospital stay. For example, after 35 days of treatment, 4.4% of people taking Xarelto had a blood clot compared with 5.7% of people taking enoxaparin.

And in people with either CAD or PAD, Xarelto plus aspirin was more effective than aspirin alone in reducing their risk of heart attack and stroke.

For more information on Xarelto’s effectiveness, see the “Xarelto uses” section below.

Xarelto is available only as a brand-name medication. It’s not currently available in generic form.

A generic drug is an exact copy of the active drug in a brand-name medication. Generics usually cost less than brand-name drugs.

Xarelto contains the active drug rivaroxaban.

Xarelto can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Xarelto. These lists don’t include all possible side effects.

For more information on the possible side effects of Xarelto, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to report to the FDA a side effect you’ve had with Xarelto, you can do so through MedWatch.

Mild side effects

The mild side effects of Xarelto that are more common* can include:

  • fatigue (lack of energy)
  • belly pain
  • back pain
  • muscle spasm
  • dizziness
  • fainting
  • anxiety
  • depression
  • trouble sleeping
  • itching

* These side effects occurred in more than 1% of people in clinical studies.

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Xarelto can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

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

  • increased risk of bleeding
  • severe allergic reaction
  • increased risk of blood clots if you stop taking Xarelto*
  • risk of spinal or epidural blood clots if you have a spinal injection while you’re taking Xarelto*

* Xarelto has a boxed warning from the FDA regarding the risk of blood clots if you stop using the drug. It also has a boxed warning regarding the risk of spinal or epidural blood clots if you have a spinal injection while you’re using the drug. A boxed warning is the strongest warning the FDA requires. It alerts doctors and patients about drug effects that may be dangerous.

Side effect details

You may wonder how often certain side effects occur with this drug, or whether certain side effects pertain to it. Here’s some detail on several of the side effects this drug may or may not cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Xarelto. But it’s not known how often this occurs in people taking this drug.

Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (warmth and redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

Call your doctor right away if you have a severe allergic reaction to Xarelto. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency.

Bleeding

Xarelto increases your risk of bleeding. This is because the drug makes it harder for your blood to form clots. While you’re taking Xarelto, you may notice that you bruise more easily than usual. You may also find that it takes longer than usual for you to stop bleeding.

Sometimes, bleeding from a damaged blood vessel can cause blood to build up and clot in the tissues surrounding the blood vessel. This formation is called a hematoma. If the hematoma is under your skin or inside a muscle, it could cause a painful lump or swelling.

But keep in mind that bleeding can occur anywhere in your body. This includes internal bleeding, such as in your stomach, intestines, abdomen (belly), lungs, kidneys, liver, brain, joints, and eyes. In some cases, the bleeding can be serious and may lead to death.

If you have severe bleeding while you’re taking Xarelto, you may need a blood transfusion. You may also need medication to reverse the effect of Xarelto in your body. For more information about this, see the “Reversal of Xarelto” section below.

How common is it to bleed while using Xarelto?

In clinical studies, major bleeding occurred in 0.3% to 3.6% of people taking Xarelto. In comparison, major bleeding occurred in:

  • 3.5% of people who took warfarin (Coumadin, Jantoven)*
  • 0.1% to 1.7% of people who took enoxaparin (Lovenox)*
  • 0.3% to 0.9% of people who took aspirin

The rates of bleeding varied depending on the dosage of each drug that was given and any other drugs it was used with. The rates also varied depending on the condition being treated.

* Warfarin (Coumadin, Jantoven) and enoxaparin (Lovenox) are other commonly used anticoagulant (blood thinning) medications.

What are possible symptoms of bleeding while using Xarelto?

Symptoms of potentially serious bleeding can vary, but they may include:

  • any bleeding that’s severe, lasts a long time, or won’t stop
  • frequent nosebleeds
  • unusual bleeding from your gums
  • unexpected vaginal bleeding or menstrual bleeding that’s heavier than usual
  • blood in your urine, which may be red, pink, or brown in color
  • blood in your stool, which may be red or black in color, or look like tar
  • vomiting blood, which may be red or pink in color, or look like coffee grounds
  • coughing up blood that looks like coffee grounds
  • severe headache
  • dizziness, which could be a sign of low blood pressure that’s caused by internal bleeding
  • joint pain
  • pain, swelling, or bleeding at any wounds

If you have any symptoms of serious bleeding, call your doctor right away. If your symptoms feel life threatening, call 911.

Side effects in older people

Based on clinical studies, older people using Xarelto are more likely to have problems with bleeding than younger people are.

One clinical study looked at people with atrial fibrillation (A-fib) who were taking Xarelto to prevent blood clots and stroke. In the study, major bleeding occurred in 4.9% of people ages 75 years and older who were taking Xarelto. This is compared with major bleeding occurring in 4.4% of people ages 75 and older who were taking warfarin.

In comparison, major bleeding occurred in 2.2% of people less than 65 years of age who were taking either Xarelto or warfarin.

Another clinical study looked at people with either coronary artery disease (CAD) or peripheral artery disease (PAD) who were taking Xarelto and aspirin to prevent heart attack and stroke. In this study, major bleeding occurred in 2.4% of people ages 75 years and older who were taking Xarelto and aspirin. This is compared with 1.2% of people ages 75 years and older who were taking aspirin alone.

In comparison, major bleeding occurred in 0.8% of people under 65 years of age taking Xarelto and aspirin. And major bleeding occurred in 0.6% of people under 65 years of age taking aspirin alone.

If you’re concerned about the risks of Xarelto treatment given your age, talk with your doctor. They can discuss with you the risks and benefits of using this drug.

Fatigue

Xarelto may make you feel tired or fatigued (lacking energy).

In a clinical study of people taking Xarelto to treat a deep vein thrombosis (DVT), 1.4% of people had fatigue. In comparison, fatigue occurred in 0.9% of people with a DVT who took both enoxaparin (Lovenox) and another blood thinner drug, such as warfarin (Coumadin, Jantoven). (Enoxaparin and warfarin are other anticoagulant medications.)

If you feel tired or fatigued while you’re taking Xarelto, talk with your doctor. They can recommend ways to help improve your energy level.

Blood clots

Even though Xarelto lowers your risk of having blood clots, it’s still possible to have a blood clot while you’re taking the drug.

In fact, Xarelto has boxed warnings for blood clots. 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. The boxed warnings for Xarelto are described below.

Risk of blood clots if you stop taking Xarelto

Stopping Xarelto treatment increases your risk of having a blood clot. And if you have heart disease or disease that affects your arteries, stopping Xarelto increases your risk of heart attack and stroke. Don’t stop taking Xarelto unless your doctor recommends that you do.

Sometimes Xarelto needs to be stopped temporarily. For example, this may be recommended before you have a surgical, medical, or dental procedure. In this case, your doctor will tell you when to stop Xarelto and when to start taking it again. In the meantime, your doctor may prescribe another drug for you to take to help prevent blood clots while you’re not taking Xarelto.

Risk of spinal or epidural hematoma

If you have a spinal or epidural injection* while you’re taking Xarelto, there’s a risk that the injection could cause bleeding around your spine or brain. This could lead to either a spinal or epidural hematoma. (With a spinal hematoma, you have a buildup of blood around your spine. With an epidural hematoma, you have a buildup of blood around your brain.) Developing a hematoma in your spine or brain could cause long-lasting or even permanent paralysis.

Having a lumbar puncture (spinal tap) also increases the risk of spinal or epidural hematoma. The risk is higher as well if you take drugs that affect your ability to form blood clots. (These medications include nonsteroidal anti-inflammatory drugs [NSAIDs] and blood thinners.) In addition, the risk is higher if you have had difficult or repeated epidural or spinal punctures in the past, have a history of problems with your spine, or have had surgery on your spine.

If you need a spinal or epidural injection while you’re using Xarelto, your doctor will monitor you for spinal blood clots. Tell your doctor right away if you have any back pain, tingling, numbness, or muscle weakness, especially in your legs and feet, while you’re taking Xarelto. Also tell your doctor right away if you lose control of your bladder or bowels.

* Spinal and epidural injections are used to give certain medications, such as anesthetics or pain relievers. With either injection, a needle is inserted in your back, into the area around your spine. The risk of spinal or epidural hematoma is higher if you have a thin tube (called a catheter) placed into your spine to deliver medication.

Itching

Some people have itching while they’re taking Xarelto. For example, in a clinical study of people taking Xarelto to treat blood clots in their lungs, 2.2% had itching. This side effect was reported in 1.1% of people taking both enoxaparin (Lovenox) and another blood thinner drug, such as warfarin (Coumadin, Jantoven). (Enoxaparin and warfarin are other anticoagulant drugs.)

Other clinical studies looked at people taking Xarelto to prevent blood clots after they’d had hip or knee replacement surgery. In these people, 2.1% of those taking Xarelto had itching. In comparison, 1.8% of people who took enoxaparin had itching.

Keep in mind that sometimes itchy skin or a rash can be a sign of an allergic reaction to the drug. For more information about this, see the “Allergic reaction” section above.

If you have itching or a rash while you’re taking Xarelto, call your doctor. Your doctor can check to see what’s causing your symptoms. And they’ll recommend whether you need any medical treatment.

Dizziness

Xarelto may cause dizziness in some people taking the drug. And in some cases, Xarelto may make you feel faint.

In one clinical study of people taking Xarelto to treat a deep vein thrombosis (DVT), 2.2% of people had dizziness. In comparison, 1.3% of people taking both enoxaparin (Lovenox) and another blood thinner drug, such as warfarin (Coumadin, Jantoven), had dizziness. (Enoxaparin and warfarin are other anticoagulant drugs.)

Other clinical studies looked at people taking Xarelto to prevent blood clots after they’d had hip or knee replacement surgery. In these people, 1.2% of people who took Xarelto had fainting. In comparison, 0.7% of people who took enoxaparin had fainting.

If you feel dizzy, lightheaded, or faint while you’re taking Xarelto, call your doctor right away. These symptoms can sometimes be a sign of internal bleeding. If your symptoms feel life threatening, call 911.

Stomach pain

You may get abdominal (belly) or stomach pain while you’re taking Xarelto.

In a clinical study of people taking Xarelto to treat deep vein thrombosis (DVT), 2.7% had abdominal pain. In comparison, 1.5% of people taking both enoxaparin (Lovenox) and another blood thinner drug, such as warfarin (Coumadin, Jantoven), had abdominal pain. (Enoxaparin and warfarin are other anticoagulant drugs.)

If you have unexplained belly pain while you’re taking Xarelto, call your doctor. Sometimes this symptom can be a sign of internal bleeding. If your symptoms feel life threatening, call 911.

Muscle pain

Some people have muscle pain or spasms while they’re taking Xarelto. Back pain and extremity pain has also been reported in people taking this drug.

In a clinical study of people using Xarelto to treat a deep vein thrombosis (DVT), 2.9% had back pain. In comparison, 1.8% of people taking both enoxaparin (Lovenox) and another blood thinner drug, such as warfarin (Coumadin, Jantoven), had back pain. (Enoxaparin and warfarin are other anticoagulant drugs.)

In the same study, 1.3% of people taking Xarelto had muscle spasms. In comparison, 0.8% of people taking both enoxaparin and another blood thinner drug, such as warfarin, had muscle spasms.

Clinical studies also looked at people taking Xarelto to help prevent blood clots after hip or knee replacement. In these people, 1.2% had muscle spasms. In comparison, muscle spasms occurred in 0.7% of people who took enoxaparin.In the same studies, 1.7% of people taking Xarelto had pain in their extremities. This side effect was also reported in 1.2% of people who took enoxaparin.

If you have pain in your muscles or any other areas of your body while you’re taking Xarelto, talk with your doctor. They can recommend ways to help improve your symptoms.

Insomnia

It’s possible to have insomnia (trouble sleeping) while you’re taking Xarelto.

In a clinical study of people taking Xarelto to treat a deep vein thrombosis (DVT), 1.6% of people had insomnia. In comparison, insomnia occurred in 1.1% of people taking both enoxaparin (Lovenox) and another blood thinner drug, such as warfarin (Coumadin, Jantoven). (Enoxaparin and warfarin are other anticoagulant drugs.)

If you have trouble sleeping while you’re taking Xarelto, talk with your doctor or pharmacist. They can suggest ways to help improve your quality of sleep.

Thrombocytopenia

Some people taking Xarelto have had thrombocytopenia (low platelet level). Platelets are blood cells that help your body to form clots. Having thrombocytopenia increases your risk of bleeding or bruising more often than usual.

Xarelto doesn’t work by lowering your platelets, and low platelet levels weren’t reported in people who took Xarelto during clinical studies. However, this side effect was reported in some people who took Xarelto after it was released onto the market.

If you’re concerned about having a low platelet level while you’re using Xarelto, talk with your doctor.

Hair loss

Hair loss wasn’t reported during clinical studies of Xarelto. However, after the drug’s release onto the market, some cases of hair loss have been reported in people taking Xarelto.

It’s not certain whether these cases of hair loss were definitely caused by Xarelto or not. But other anticoagulant (blood thinning) drugs, such as warfarin (Coumadin, Jantoven) and heparin, are known to cause hair loss. So it’s possible that hair loss may be associated with Xarelto as well.

If you’re concerned about hair loss while you’re taking Xarelto, talk with your doctor.

Weight gain (not a side effect)

Weight gain wasn’t reported as a side effect during clinical studies of Xarelto.

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

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms

Xarelto comes as tablets that are taken by mouth.

Drug strengths: 2.5 mg, 10 mg, 15 mg, and 20 mg

Xarelto tablets come in four strengths: 2.5 mg, 10 mg, 15 mg, and 20 mg.

Dosage for reducing the risk of stroke and blood clots in people with A-fib

The usual dosage of Xarelto to reduce the risk of stroke and blood clots in people with atrial fibrillation (A-fib) is 20 mg taken once every evening. (This dose should be taken with a meal.)

Dosage for treating DVT and PE

The usual dosage of Xarelto to treat deep vein thrombosis (DVT) or pulmonary embolism (PE) is as follows:

  • For your starting dose (sometimes called a loading dose), you’ll take 15 mg twice each day for 21 days.
  • After this, you’ll take 20 mg once a day for as long as your doctor recommends. (This is called your maintenance dose.)

Dosage for reducing the risk of recurrent DVT or PE

Xarelto is used to reduce your risk of having another DVT or PE if:

  • you’ve had at least 6 months of treatment for a DVT or PE with another anticoagulant drug, and
  • you’re still at risk of getting another blood clot

The usual dosage of Xarelto for reducing the risk of another DVT or PE is 10 mg taken once a day.

Dosage for preventing DVT and PE after hip or knee replacement

Xarelto is used as prophylaxis to prevent a DVT or PE following surgery done to replace your knee or hip.

For this use, you’ll start taking Xarelto between 6 and 10 hours after your surgery. Your healthcare provider will check to make sure that the bleeding from your surgery has stopped before you take your first dose of the drug.

Your dosage of Xarelto depends on whether you’ve had your hip or knee replaced. Typical dosages to prevent blood clots after these surgeries are as follows:

  • if you’ve had a hip replacement, the usual dosage is 10 mg taken once a day for 35 days
  • if you’ve had a knee replacement, the usual dosage is 10 mg taken once a day for 12 days

Dosage for preventing VTE in people who are ill

Xarelto is used to prevent venous thromboembolism (VTE) in people who are or were hospitalized for an acute illness. (VTE is a type of blood clot.) Xarelto is prescribed for this use in people who aren’t at risk of bleeding. (Xarelto can raise your risk of bleeding.)

The typical dosage of Xarelto to reduce your risk of blood clots both while you’re in hospital, and after you’re discharged, is 10 mg taken once a day. For this purpose, you’ll take Xarelto for 31 to 39 days, depending on your doctor’s recommendation.

Dosage for reducing the risk of cardiovascular events in people with CAD or PAD

If you have coronary artery disease (CAD) or peripheral artery disease (PAD), Xarelto can be used to lower your risk of having cardiovascular events. Cardiovascular events include heart attacks or strokes caused by blood clots.

For this use, the usual dosage of Xarelto is 2.5 mg taken by mouth twice a day. (This gives a total daily dose of 5 mg.)

Dosage for people with kidney problems

Before prescribing Xarelto for you, your doctor will check to see how well your kidneys are working. This allows your doctor to know whether you’ll need “renal dosing” of Xarelto. Renal dosing is a reduced dose of the drug that’s typically determined by calculating your creatinine clearance.

Creatinine is a waste product that’s produced by your body. Your kidneys filter creatinine out of your blood, and it exits your body through your urine. Measuring the amount of creatinine in your urine (called your creatinine clearance) allows doctors to see how well your kidneys are working.

Usually, your doctor won’t prescribe Xarelto for you to treat or prevent a DVT or PE if your creatinine clearance is lower than 15 mL/min. (Normal creatinine clearance is generally 110 to 150 mL/min in men and 100 to 130 mL/min in women.)

However, Xarelto can be used to reduce the risk of heart attack and stroke if you have kidney problems, no matter how low your creatinine clearance is.

If you have A-fib and your creatinine clearance is 50 mL/min or less, you’ll need a dose reduction of the drug. In this case, the recommended dosage of Xarelto is 15 mg taken once every evening.

Dosage before surgery

Because Xarelto can increase your risk of bleeding, you may need to stop taking it for a while before any planned surgeries. (Stopping the drug for a short time around surgery is also sometimes referred to as “holding your dose.”)

Usually, your doctor will recommend that you stop taking the drug at least 24 hours before your surgery. But be sure to talk with your doctor for specific instructions on stopping Xarelto before you have any surgeries.

If you need emergency surgery while you’re taking Xarelto, and you don’t have time to hold your dose, you may need to be given an antidote to Xarelto. (Antidotes reverse the effect of another drug or substance.) See the section “Reversal of Xarelto” below for more information about this.

What if I miss a dose?

If you miss a dose of Xarelto, what you’ll need to do depends on the dose you usually take. The following information describes how you should handle a missed dose based on your typical dosage of Xarelto:

  • 2.5 mg of Xarelto twice daily. If you typically take 2.5 mg twice daily, and you miss a dose, just skip the missed dose. Then take your next dose at the usual time. Don’t take a double dose to make up for a missed dose.
  • 15 mg of Xarelto twice daily. If you typically take 15 mg twice daily, and you miss a dose, take it as soon as you remember that day. Then take your next dose at the usual time. If you miss a dose, but you don’t remember until your next dose is due that day, you can take two doses together. But don’t take more than 30 mg on any day.
  • 20 mg, 15 mg, or 10 mg of Xarelto once daily. If you typically take 20 mg, 15 mg, or 10 mg once daily, and you forget to take a dose at your usual time, take it as soon as you remember that day. If you don’t remember until the next day, just skip the missed dose. Then take your next dose as usual. Don’t take a double dose to make up for the missed dose.

To help make sure that you don’t miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.

Will I need to use this drug long term?

You might, but it depends on why you’re taking Xarelto. The length of time Xarelto treatment is used is based on why you’re taking the drug. Typical treatment lengths are as follows:

  • If you’re taking Xarelto after having a knee replacement, you’ll take the drug for 12 days after your surgery.
  • If you’re taking Xarelto after having a hip replacement, you’ll take the drug for 35 days after your surgery.
  • If you’re taking Xarelto because you were admitted to a hospital for an acute illness, you’ll take the drug for 31 to 39 days.
  • If you’re taking Xarelto to treat a deep vein thrombosis (DVT) or pulmonary embolism (PE), you’ll take the drug for 6 to 12 months.

However, when it’s prescribed to prevent blood clots, heart attack, and stroke, Xarelto is meant to be used as a long-term treatment. If you and your doctor determine that Xarelto is safe and effective for you, you’ll likely take it long-term for these purposes.

The Food and Drug Administration (FDA) approves prescription drugs such as Xarelto to treat certain conditions. Xarelto may also be used off-label for other conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Xarelto for reducing the risk of stroke and blood clots in people with A-fib

Xarelto is FDA-approved to reduce the risk of strokes and blood clots in people with atrial fibrillation (A-fib) that’s not caused by a heart valve problem.

A-fib is a type of irregular heartbeat. It can disrupt the flow of blood around your body and increase your risk of having a blood clot. Blood clots can sometimes be dangerous. For example, a blood clot that travels to your brain can cause a stroke.

Xarelto is an anticoagulant (blood thinner). It lowers your risk of having strokes and blood clots.

Effectiveness for reducing the risk of stroke and blood clots in people with A-fib

One clinical study found Xarelto was as effective as warfarin (Coumadin, Jantoven) in preventing stroke and blood clots in people with A-fib. (Warfarin is a different type of anticoagulant that’s recommended as a treatment option for A-fib in current guidelines.)

In this study, 3.8% of people taking Xarelto had a stroke or blood clot. In comparison, 4.3% of patients taking warfarin had a stroke or blood clot.

Xarelto for treating DVT and PE

Xarelto is FDA-approved to treat the following types of blood clots:

  • Deep vein thrombosis (DVT). A DVT is a blood clot that forms in a vein deep inside your body. DVTs usually form in your leg, but they can also form in your arm.
  • Pulmonary embolism (PE). A PE is a blood clot that blocks blood flow to your lungs. PEs develop when a DVT gets dislodged from your vein and travels in your bloodstream toward your lungs.

Xarelto is an anticoagulant (blood thinner). It treats DVT and PE by preventing the clots from getting larger. This allows your body to work on breaking down and clearing the clots.

Effectiveness for treating DVT and PE

One clinical study found Xarelto to be as effective as enoxaparin (Lovenox) plus another blood thinner drug, such as warfarin, for treating DVT and PE. (Enoxaparin and warfarin are other anticoagulant medicines that are recommended options for treating DVT and PE in current guidelines.)

When treating blood clots, these anticoagulant drugs all work by stopping the clot from getting bigger. So their effectiveness is compared by looking at the number of people who develop new blood clots during treatment.

In this study, 2.1% of people who took Xarelto had another DVT or a new PE during treatment. In comparison, 1.8% to 3% of people taking enoxaparin plus another blood thinner drug, such as warfarin, had another DVT or new PE during treatment.

Xarelto for reducing the risk of recurrent DVT or PE

Xarelto is FDA-approved to reduce your risk of having another blood clot if you’ve had one in the past. It’s prescribed for this use after you’ve taken another anticoagulant drug for at least 6 months to treat a DVT or PE. Your doctor will prescribe Xarelto for this purpose if they think you’re at high risk of having another blood clot.

Xarelto is an anticoagulant (blood thinner). It prevents DVT and PE by lowering your risk of having blood clots.

Effectiveness for reducing the risk of recurrent DVT or PE

In a clinical study, Xarelto was given to people who’d taken an anticoagulant for at least 6 months to treat a DVT or PE. In this study, treatment with Xarelto was compared to treatment with aspirin. (Aspirin is a blood thinner that’s a standard treatment option to help prevent blood clots. In current guidelines, aspirin is recommended to reduce the risk of getting another blood clot if you stop taking an anticoagulant to treat a DVT or PE.)

In this study, Xarelto was more effective than aspirin (taken at a dosage of 100 mg daily) in preventing further blood clots. In fact, people who took Xarelto were 74% less likely to get another DVT or PE than people who took aspirin.

For example, recurrent DVT or PE occurred in 1.2% of people who took Xarelto. However, in people who took aspirin, 4.4% had a recurrent DVT or PE.

Xarelto for preventing DVT and PE after hip or knee replacement

Xarelto is FDA-approved to prevent DVT and PE following hip or knee replacement surgery. These types of surgeries can damage the blood vessels around the area of your joint replacement. And after surgery, your ability to move is restricted for a while. Both of these issues increase your risk of having a blood clot.

Xarelto is an anticoagulant (blood thinner). It prevents DVT and PE after certain surgeries by lowering your risk of having blood clots.

Effectiveness for preventing DVT or PE after surgery

Clinical studies found Xarelto was more effective than enoxaparin (Lovenox) in preventing blood clots following hip or knee replacement surgery. (Enoxaparin is an anticoagulant drug that’s recommended for preventing DVT and PE in current guidelines.)

One study looked at people who took Xarelto for an average of 33 days following hip replacement surgery. These people were 71% less likely to have a blood clot than were people who took enoxaparin for the same amount of time. For example, blood clots occurred in 1.1% of people taking Xarelto. In comparison, 3.9% of people taking enoxaparin had blood clots.

Another study looked at people who took Xarelto for an average of 12 days following knee replacement surgery. These people were 48% less likely to have a blood clot than were people who took enoxaparin for the same amount of time. For example, blood clots occurred in 9.7% of people taking Xarelto. In comparison, 18.8% of people taking enoxaparin had blood clots.

Xarelto for preventing VTE in people who are ill

Xarelto is FDA-approved to prevent venous thromboembolism (VTE) in people who are admitted to a hospital with an acute medical illness. The drug is approved for this use in people who have an increased risk of blood clots, but who don’t have a high risk of bleeding. (Xarelto can raise your risk of bleeding.)

A VTE is a blood clot that forms in one of your veins (usually in your leg). VTEs can travel throughout your body, including to your lungs. You’re at an increased risk of having a VTE if you’re on bedrest or you can’t move around very much.

Other risk factors for VTE include:

  • having had a blood clot in the past
  • a history of cancer
  • a history of heart failure
  • being 75 years of age or older
  • obesity

Xarelto is an anticoagulant (blood thinner). It’s taken to prevent blood clots during your hospital stay. You’ll also take it for a while after you’re discharged from the hospital.

Effectiveness for preventing VTE in people who are ill

One clinical study compared treatment with Xarelto to treatment with enoxaparin for preventing VTE in people who were admitted to a hospital. (Enoxaparin is an anticoagulant drug that’s recommended for preventing VTE in current guidelines.)

In this study, Xarelto was more effective than enoxaparin followed by a placebo (no active drug) in preventing blood clots in people admitted to the hospital.

For both Xarelto and enoxaparin, treatment was started in the hospital and continued after people were discharged from the hospital. One group of people took Xarelto for 31 to 39 days. A second group took enoxaparin for 6 to 14 days while in they were in the hospital. This second group of people were then given a placebo (no active drug) to take after they’d been discharged.

After 10 days of treatment, 2.7% of people taking either Xarelto or enoxaparin had a blood clot.

After 35 days of treatment, people who took Xarelto had a 23% lower risk of blood clots than did people who took enoxaparin followed by the placebo. For example, by day 35 of treatment, 4.4% of people taking Xarelto had a blood clot. In comparison, 5.7% of people taking enoxaparin had a blood clot.

Xarelto for reducing the risk of cardiovascular events in people with CAD or PAD

Xarelto is FDA-approved to reduce the risk of cardiovascular events, such as heart attack and stroke. For this use, it’s given to people with chronic (long-lasting) coronary artery disease (CAD) or peripheral artery disease (PAD). Xarelto is taken in combination with aspirin, given at a dosage of 100 mg daily, for this purpose.

With CAD, you have narrowed arteries in your heart. With PAD, you have narrowed arteries in your legs. Both of these conditions increase your risk of having blood clots that can cause a heart attack or stroke.

Xarelto is an anticoagulant (blood thinner). It reduces your risk of blood clots, which also reduces your risk of heart attack, stroke, or death caused by a cardiovascular event.

Effectiveness for reducing the risk of cardiovascular events in people with CAD or PAD

One clinical study found that when Xarelto was taken with aspirin for 23 months, it was more effective than aspirin alone in reducing the risk of heart attack and stroke in people with either CAD or PAD.

In fact, people who took Xarelto plus aspirin were 24% less likely to have a heart attack or stroke, or to die from a cardiovascular event, than were people who took aspirin alone.

Off-label use for Xarelto

In addition to the uses listed above, Xarelto may be used off-label. Off-label drug use is when a drug that’s approved for one use is used for a different one that’s not approved.

Xarelto for reducing the risk of travel-related blood clots

Sometimes when you’re travelling for a long period of time, you can’t get up and move around like usual. Being seated over a long period of time increases your risk of having blood clots.

Xarelto isn’t FDA-approved to prevent travel-related blood clots. Sometimes it’s used off-label for this purpose. But your doctor is unlikely to prescribe Xarelto to prevent travel-related clots unless you’re at high risk of having blood clots. Conditions that increase your risk of having a blood clot include having had a blood clot in the past, recent major surgery, or cancer.

Xarelto hasn’t been studied to prevent travel-related blood clots. Because of this, a dose for flying hasn’t been established.

Talk with your doctor if you’re interested in taking Xarelto to reduce your risk for blood clots when you’re travelling. Your doctor will help you to weigh the risks of getting a blood clot against the risk of bleeding with Xarelto treatment.

And if you aren’t able to take Xarelto, talk with your doctor about other ways you can lower your risk of blood clots while travelling. These may include:

  • getting up and moving around from time to time
  • flexing your feet forward and backward to encourage blood flow in your calves
  • wearing compression socks or stockings
  • drinking plenty of water

If you have coronary artery disease (CAD) or peripheral artery disease (PAD), you’ll take Xarelto with aspirin. With CAD, you have narrowed arteries in your heart. With PAD, you have narrowed arteries in your legs. Both of these conditions increase your risk of having blood clots that can cause a heart attack or stroke.

Using a combination of Xarelto and aspirin is more effective for preventing heart attack and stroke in people with CAD or PAD than using aspirin alone.

The recommended dosage of aspirin for this use is 75 mg to 100 mg taken once a day.

You may wonder how Xarelto compares with other medications that are prescribed for similar uses. Here we look at how Xarelto and Eliquis are alike and different.

Ingredients

Xarelto contains the drug rivaroxaban, while Eliquis contains the drug apixaban. Both drugs are anticoagulants, which are also sometimes called blood thinners. Xarelto and Eliquis work in the same way in your body to prevent blood clots from forming.

Uses

Xarelto and Eliquis are both approved for use in adults to:

  • treat deep vein thrombosis (DVT), which is a blood clot that forms in a vein deep inside your body
  • treat pulmonary embolism (PE), which is a blood clot that blocks blood flow to your lungs
  • reduce the risk of having another DVT or PE, if you’re still at risk of blood clots after initial treatment for a DVT or PE
  • prevent DVT and PE following hip or knee replacement surgery
  • prevent blood clots and stroke in people with atrial fibrillation (A-fib)* that’s not caused by a heart valve problem

In addition, Xarelto is also approved for use in adults to:

  • prevent blood clots in people admitted to a hospital with an acute medical illness. For this use, Xarelto is prescribed for people with a high risk of blood clots and a low risk of bleeding. (In this case, the drug is used during your hospital stay and for a period of time after you’ve been discharged.)
  • prevent blood clots that can cause a heart attack, stroke, or death in people with chronic (long-lasting) coronary artery disease (CAD)** or peripheral artery disease (PAD).*** For this use, Xarelto is taken with low-dose daily aspirin.

* A-fib is a type of irregular heartbeat. With A-fib, you’re at an increased risk of having blood clots and stroke.

** With CAD, you have narrowed arteries in your heart.

*** With PAD, you have narrowed arteries in your legs.

Drug forms and administration

Xarelto and Eliquis both come as tablets that are taken by mouth. Eliquis is typically taken twice daily. However, Xarelto may be taken once or twice each day, depending on why you’re taking the drug.

Side effects and risks

Xarelto and Eliquis contain drugs from the same class of medications. Therefore, these medications can cause very similar side effects. Below are examples of these side effects.

Mild side effects

These lists contain examples of mild side effects that can occur with Xarelto, with Eliquis, or with both drugs (when taken individually).

  • Can occur with Xarelto:
    • fatigue (lack of energy)
    • belly pain
    • back pain
    • muscle spasm
    • dizziness
    • anxiety
    • trouble sleeping
    • itching
  • Can occur with Eliquis:
    • nausea
  • Can occur with both Xarelto and Eliquis:
    • fainting

Serious side effects

The following list contains examples of serious side effects that can occur with both Xarelto and Eliquis, when they’re taken individually.

  • increased risk of bleeding
  • allergic reaction
  • risk of blood clots if you stop treatment*
  • risk of spinal or epidural blood clots if you have a spinal injection during treatment*

* Xarelto and Eliquis both have a boxed warning from the FDA regarding the risks of blood clots if treatment is stopped and of spinal or epidural blood clots if you have certain procedures done while using these drugs. A boxed warning is the strongest warning the FDA requires. It alerts doctors and patients about drug effects that may be dangerous.

Effectiveness

Xarelto and Eliquis have different approved uses, but they’re both used to:

  • treat deep vein thrombosis (DVT) and pulmonary embolism (PE)
  • reduce your risk of getting another DVT or PE after initial treatment
  • prevent DVT and PE following hip or knee replacement surgery
  • prevent blood clots and stroke in people with atrial fibrillation (A-fib) that’s not caused by a heart valve problem

Separate studies have found both Xarelto and Eliquis to be effective for all these uses. In addition, one review of studies found Xarelto and Eliquis to be similarly effective in treating and preventing DVT and PE. And a direct comparison found Xarelto and Eliquis to be similarly effective in preventing blood clots and stroke in people with A-fib.

Costs

Xarelto and Eliquis are both brand-name drugs. There are currently no generic forms of either drug. Brand-name medications usually cost more than generics.

According to estimates on GoodRx.com, Xarelto and Eliquis generally cost about the same. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Other drugs are available that can reduce your risk of having blood clots and cardiovascular events, such as heart attack and stroke. Some drugs may be a better fit for you than others. If you’re interested in finding an alternative to Xarelto, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed below are used off-label to treat these specific conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Alternatives for reducing the risk of stroke and blood clots in people with A-fib

Examples of other drugs that may be used to reduce the risk of stroke and blood clots in people with atrial fibrillation (A-fib)* include:

* A-fib is a type of irregular heartbeat. With A-fib, you’re at an increased risk of having blood clots and stroke.

Alternatives for treating DVT and PE

Examples of other drugs that may be used to treat deep vein thrombosis (DVT)* or pulmonary embolism (PE)** include:

* DVT is a blood clot that forms in a vein deep inside your body.

** PE is a blood clot that blocks blood flow to your lungs.

Alternatives for reducing the risk of recurrent DVT or PE

Examples of other drugs that may be used to reduce the risk of recurrent deep vein thrombosis (DVT)* or pulmonary embolism (PE)** include:

* DVT is a blood clot that forms in a vein deep inside your body.

** PE is a blood clot that blocks blood flow to your lungs.

Alternatives for preventing DVT and PE after hip or knee replacement

Examples of other drugs that may be used to prevent deep vein thrombosis (DVT)* or pulmonary embolism (PE)** in people who’ve had a hip or knee replacement include:

* DVT is a blood clot that forms in a vein deep inside your body.

** PE is a blood clot that blocks blood flow to your lungs.

Alternatives for preventing VTE in people who are ill

Examples of other drugs that may be used to prevent venous thromboembolism (VTE)* in people who are ill include:

* VTE is a blood clot that forms in one of your veins (usually in your leg) and may travel to your lungs.

Alternatives for reducing the risk of cardiovascular events in people with CAD or PAD

Examples of other drugs that may be used to reduce the risk of cardiovascular events, such as heart attack and stroke, in people with coronary artery disease (CAD)* or peripheral artery disease (PAD)** include:

* With CAD, you have narrowed arteries in your heart.

** With PAD, you have narrowed arteries in your legs.

You may wonder how Xarelto compares with other medications that are prescribed for similar uses. Here we look at how Xarelto and warfarin (Coumadin, Jantoven) are alike and different.

Ingredients

Xarelto contains the drug rivaroxaban. Warfarin is a generic drug that’s also available as the brand-name medications Coumadin and Jantoven. Both Xarelto and warfarin are anticoagulants. They’re also sometimes called blood thinners. But these drugs each work in different ways inside your body.

Uses

Xarelto is approved for use in adults to:

  • treat deep vein thrombosis (DVT), which is a blood clot that forms in a vein deep inside your body.
  • treat pulmonary embolism (PE), which is a blood clot that blocks blood flow to your lungs.
  • reduce the risk of having another DVT or PE, if you’re still at risk of blood clots after initial treatment for a DVT or PE.
  • prevent DVT and PE following hip or knee replacement surgery.
  • prevent blood clots and stroke in people with atrial fibrillation (A-fib)* that’s not caused by a heart valve problem.
  • prevent blood clots in people admitted to a hospital with an acute medical illness. For this use, Xarelto is prescribed for people with a high risk of blood clots and a low risk of bleeding. (In this case, the drug is used during your hospital stay and for a period of time after you’ve been discharged.)
  • prevent blood clots that can cause a heart attack, stroke, or death in people with chronic (long-lasting) coronary artery disease (CAD)** or peripheral artery disease (PAD).*** For this use, Xarelto is taken with low-dose daily aspirin.

* A-fib is a type of irregular heartbeat. With A-fib, you’re at an increased risk of having blood clots and stroke.

** With CAD, you have narrowed arteries in your heart.

*** With PAD, you have narrowed arteries in your legs.

Warfarin is approved to:

  • treat and prevent DVT and PE
  • prevent blood clots and stroke in people with A-fib
  • prevent blood clots and stroke in people who’ve had a heart valve replacement
  • reduce the risk of further heart attacks, strokes, blood clots, and death in people who’ve had a heart attack in the past

Drug forms and administration

Xarelto and warfarin both come as tablets that are taken by mouth. Xarelto may be taken once or twice each day, depending on why you’re taking the drug. But dosages of warfarin vary, depending on how your body is responding to the drug.

Side effects and risks

Xarelto and warfarin are both anticoagulant drugs. They can cause some similar and some different side effects. Below are examples of these side effects.

Mild side effects

These lists contain examples of mild side effects that can occur with Xarelto, with warfarin, or with both drugs (when taken individually).

  • Can occur with Xarelto:
    • fatigue (lack of energy)
    • belly pain
    • back pain
    • muscle spasm
    • dizziness
    • anxiety
    • depression
    • trouble sleeping
    • itching
    • fainting
  • Can occur with warfarin:
    • rash
    • hair loss
    • nausea
    • vomiting
    • diarrhea
  • Can occur with both Xarelto and warfarin:
    • no common mild side effects

Serious side effects

These lists contain examples of serious side effects that can occur with Xarelto, with warfarin, or with both drugs (when taken individually).

  • Can occur with Xarelto:
    • risk of blood clots if you stop treatment*
    • risk of spinal or epidural blood clots if you have a spinal injection during treatment*
  • Can occur with warfarin:
    • skin necrosis or gangrene (death of skin tissue)
    • purple toes syndrome (a condition where tiny particles of cholesterol block blood supply to your toes, causing your toes to be painful and look dark or purple in color)
    • kidney problems, such as kidney damage
    • liver problems, such as hepatitis (inflammation in your liver)
  • Can occur with both Xarelto and warfarin:
    • increased risk of bleeding**

* Xarelto has a boxed warning from the FDA regarding the risks of blood clots if treatment is stopped and of spinal or epidural blood clots if you have certain procedures done while using this drug.

** Warfarin has a boxed warning from the FDA regarding the risk of bleeding. A boxed warning is the strongest warning the FDA requires. It alerts doctors and patients about drug effects that may be dangerous.

Effectiveness

Xarelto and warfarin have different approved uses, but they’re both used to:

  • treat and prevent deep vein thrombosis (DVT) and pulmonary embolism (PE)
  • prevent blood clots and stroke in people with atrial fibrillation (A-fib)

In a clinical study, Xarelto and warfarin were similarly effective in preventing stroke and blood clots in people with A-fib. In the study, 3.8% of people taking Xarelto had a stroke or blood clot. In comparison, 4.3% of people taking warfarin had a stroke or blood clot.

Also in clinical studies, Xarelto was as effective as enoxaparin (Lovenox) plus another blood thinner drug, such as warfarin, in treating DVT and PE. (Enoxaparin is a fast-acting anticoagulant that’s given with warfarin at the start of treatment for blood clots. It starts treating the blood clot right away, while warfarin takes a few days to have its full effect in your body.)

When treating blood clots, these anticoagulant drugs all work by stopping the clot from getting bigger. So their effectiveness is compared by looking at the number of people who develop new blood clots during treatment.

In the studies, 2.1% of people who took Xarelto had another DVT or a new PE during treatment. In comparison, 1.8% to 3% of people taking enoxaparin plus another blood thinner drug, such as warfarin, had another DVT or new PE during treatment.

Costs

Xarelto is a brand-name drug. Warfarin is available in a generic form as well as brand-name forms. Brand-name medications usually cost more than generics.

According to estimates on GoodRx.com, the generic form of warfarin generally costs much less than Xarelto costs. Brand-name forms of warfarin also cost less than Xarelto. But the actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Drinking a lot of alcohol all at once could increase your risk of bleeding while you’re taking Xarelto. In particular, taking Xarelto and drinking too much alcohol could cause bleeding in your stomach or digestive tract. Taking Xarelto and drinking too much alcohol could also lead to bleeding if you happen to injure yourself.

However, drinking alcohol within certain dietary guidelines doesn’t usually cause problems while you’re taking Xarelto. If you do drink alcohol, talk with your doctor about how much is safe for you to drink during Xarelto treatment.

Here are answers to some frequently asked questions about Xarelto.

Is Xarelto a blood thinner or an anticoagulant?

Actually, it’s both. Xarelto is an anticoagulant drug. These types of drugs are also sometimes called blood thinners. But keep in mind that they don’t actually make your blood thinner than usual. Instead, anticoagulants just make your blood less likely to form clots.

Will Xarelto have an effect on my liver or cause liver damage?

It’s unlikely that it will. In fact, liver-related side effects weren’t reported in people who took Xarelto during clinical studies. However, liver issues have been reported in some people taking Xarelto after it was released onto the market. These liver issues included:

  • liver damage
  • hepatitis (liver inflammation)
  • jaundice (yellowing of your skin or the whites of your eyes)

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

How can I stop bleeding if I have a bleed while I’m taking Xarelto?

While you’re taking Xarelto, you can usually stop any minor bleeding you may have with basic first aid techniques. For example, if you get a cut, apply pressure to the area with a clean cloth for about 10 minutes. And if possible, lie down and raise the cut above the level of your heart.

If you get a nosebleed, pinch your nose just above your nostrils for about 10 minutes. Meanwhile, lean forward and breathe through your mouth.

However, if you have severe bleeding, you should call 911. Be sure to get emergency medical help for bleeding that:

  • seems very excessive (heavy)
  • doesn’t stop after 10 minutes of applying pressure
  • is caused by a serious injury or trauma to your head
  • is coming from wounds that may need stitches
  • is coming from wounds that may have a foreign body (object) stuck inside

It’s also possible to have internal bleeding while you’re taking Xarelto. See the “Xarelto side effects” section above for details on possible symptoms of internal bleeding. If you have any symptoms of internal bleeding while taking Xarelto, call your doctor right away. But if your symptoms feel life threatening, call 911.

If you have severe or life threatening bleeding, you may need an antidote to Xarelto. (Antidotes reverse the effect of another drug or substance.) For more information about reversing the effects of Xarelto, see the “Reversal of Xarelto” section below.

Can Xarelto cause high blood pressure?

That’s very unlikely. In fact, high blood pressure wasn’t reported in people who took Xarelto during clinical studies.

If you have questions about whether Xarelto may affect your blood pressure, talk with your doctor.

Can I take Xarelto if I’m having a dental extraction?

If you’re having a tooth extraction (removal), you may need to temporarily stop taking Xarelto. Otherwise, continuing to take the drug could increase your risk of bleeding from the procedure.

If you’re going to have any dental procedures, talk with your doctor and dentist. They may want you to stop taking Xarelto at least 24 hours before having certain procedures, such as a tooth extraction.

If I have chronic kidney disease, can I take Xarelto?

Typically, yes, although this may depend on how well your kidneys are working.

Your doctor will check your kidney function by calculating your creatinine clearance. (Creatinine is measured in certain lab tests. It’s used to calculate your creatinine clearance, which helps your doctor to see how well your kidneys are working.)

If you have chronic kidney disease and your creatinine clearance is at least 15 mL/min, it’s fine to take Xarelto to treat or prevent blood clots such as deep vein thrombosis (DVT)* and pulmonary embolism (PE).** But if your creatinine clearance is lower than this, Xarelto isn’t usually recommended.

If you have chronic kidney disease, and you’re taking Xarelto to reduce the risk of heart attacks and stroke, it’s fine to take the drug regardless of your creatinine clearance. This includes people who are having dialysis for end stage kidney disease.

However, if you have atrial fibrillation (A-fib)*** and your creatinine clearance is 50 mL/min or less, you’ll be prescribed a dosage of Xarelto that’s lower than the typical dosage.

The clinical studies of Xarelto for reducing the risk of heart attack and stroke didn’t include people who were having dialysis for end stage kidney disease. So it’s not known how effective the drug is for reducing the risk of heart attacks and stroke in this group of people.

If you have kidney disease, talk with your doctor about whether you’ll be able to take Xarelto.

* DVT is a blood clot that forms in a vein deep inside your body.

** PE is a blood clot that blocks blood flow to your lungs.

*** A-fib is a type of irregular heartbeat. With A-fib, you’re at an increased risk of having blood clots and stroke.

If I’m going to have a colonoscopy, is it safe for me to take Xarelto?

That depends on your doctor’s recommendation.

With a colonoscopy, a doctor looks inside your bowel. They do this using a camera on a long, thin, flexible tube that’s inserted through your anus. With this procedure, there’s a small risk of bleeding in your bowel. This risk is increased if samples of tissue are taken, or if you have growths (called polyps) removed during the procedure.

Because Xarelto makes it harder for your blood to form clots and can increase your risk of bleeding, your doctor may recommend that you stop taking it for a while before your colonoscopy.

If you’re planning to have a colonoscopy, talk with your doctor about if and when you should stop taking Xarelto.

Xarelto can interact with several other medications. It can also interact with certain supplements as well as certain foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Xarelto and other medications

Below are lists of medications that can interact with Xarelto. These lists don’t contain all the drugs that may interact with Xarelto.

Before taking Xarelto, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Xarelto and certain pain relievers

It’s fine to take the pain reliever acetaminophen (Tylenol) with Xarelto. However, there are certain pain relievers that increase your risk of bleeding when taken with Xarelto. Because of this risk, you shouldn’t take the following pain medications while you’re using Xarelto:

Also, certain cold and flu medications contain pain relievers. Ask your doctor or pharmacist about which cold and flu medications are safe for you to use while you’re taking Xarelto. But in general, you should avoid any medications that contain the drugs listed above.

If you need to take any pain relievers while you’re using Xarelto, talk with your doctor or pharmacist. It’s important to do this before you start taking any new medication.

Xarelto and other anticoagulant drugs

Taking Xarelto with other anticoagulants (blood thinners) can increase your risk of bleeding. Examples of other anticoagulant drugs include:

If you need to take one of these drugs with Xarelto, call your doctor right away if you have any symptoms of serious bleeding. For information about possible symptoms of severe bleeding, see the section “Xarelto side effects” above.

Xarelto and certain antidepressants

Taking Xarelto with certain antidepressants can increase your risk of bleeding. Examples of these antidepressants include:

If you need to take an antidepressant with Xarelto, talk with your doctor about whether it’s safe for you to use the medications together. And be sure to call your doctor right away if you have any symptoms of serious bleeding. For information about possible symptoms of severe bleeding, see the section “Xarelto side effects” above.

Xarelto and certain antibiotics

If you have kidney problems, taking certain antibiotics with Xarelto can cause Xarelto to build up in your body. This can increase your risk of having bleeding from Xarelto.

Examples of antibiotics that can make Xarelto build up in your body include:

If you have kidney problems, you should avoid using these medications while you’re taking Xarelto. But if your kidney function is healthy, it’s probably safe for you to take these antibiotics with Xarelto.

On the other hand, taking the antibiotic rifampin (Rifadin) with Xarelto can lower the level of Xarelto in your body. This could make Xarelto less effective, which may be harmful to your health. Because of this possible interaction, you shouldn’t take rifampin with Xarelto.

Xarelto and certain antifungal drugs

Taking certain antifungal drugs with Xarelto can cause Xarelto to build up in your body. This can increase your risk of bleeding from Xarelto.

Examples of antifungals that can make Xarelto build up in your body include:

  • itraconazole (Sporanox, Onmel, Tolsura)
  • ketoconazole

If you’re taking Xarelto, try to avoid using these antifungal medications. If you need to take a medication to treat a fungal infection, talk with your doctor about safe treatment options.

Xarelto and certain HIV drugs

If you take Xarelto with certain drugs used to treat HIV, you may have an increased risk of bleeding from Xarelto. This is because certain HIV drugs can increase the level of Xarelto in your body.

Examples of HIV drugs that increase Xarelto levels include:

  • atazanavir (Reyataz)
  • darunavir (Prezista)
  • fosamprenavir (Lexiva)
  • lopinavir/ritonavir (Kaletra)
  • nelfinavir (Viracept)
  • ritonavir (Norvir)

These HIV drugs should usually be avoided while you’re taking Xarelto. If you need to take a medication to treat HIV, talk with your doctor about safe treatment options.

Xarelto and certain seizure medications

Taking Xarelto with certain drugs used to treat seizures can lower the level of Xarelto in your body. This could make Xarelto less effective in treating and preventing blood clots.

Examples of seizure drugs that can make Xarelto less effective include:

  • carbamazepine (Carbatrol, Equetro, Tegretol)
  • fosphenytoin (Cerebyx)
  • oxcarbazepine (Trileptal)
  • phenobarbital
  • phenytoin (Dilantin, Phenytek)
  • primidone (Mysoline)

You should avoid taking any of these seizure drugs with Xarelto. If you need to take a medication to treat seizures, talk with your doctor about safe treatment options.

Xarelto and vitamin K (not an interaction)

The effect of Xarelto in your body isn’t affected by taking vitamin K. In some cases, other drugs that prevent and treat blood clots, such as warfarin (Coumadin, Jantoven), are affected by vitamin K. But this isn’t so with Xarelto.

If you have questions about taking vitamin K with Xarelto, talk with your doctor.

Xarelto and herbs and supplements

It’s possible that some herbs and supplements may interact with Xarelto. Interactions could affect the way Xarelto is either absorbed into or removed from your body. To be safe, you should check with your doctor or pharmacist before using any herbal products or supplements while you’re taking Xarelto.

Xarelto and St. John’s wort

St. John’s wort (Hypericum perforatum) is known to interact with Xarelto. In fact, this herb can lower the level of Xarelto in your body, which makes Xarelto less effective for you.

Because of this, you should avoid taking St. John’s wort while you’re using Xarelto.

Xarelto and foods

You may wonder if certain foods interact with Xarelto. Actually, there aren’t any foods that you’ll need to avoid while you’re taking Xarelto. Unless your doctor tells you otherwise, you should be able to continue with your usual diet.

Xarelto and grapefruit (not an interaction)

Drinking grapefruit juice or eating grapefruit doesn’t affect how Xarelto works in your body. So there’s no need to avoid grapefruit while you’re taking Xarelto.

In some cases, other drugs that prevent and treat blood clots, such as warfarin (Coumadin, Jantoven), are affected by grapefruit. But Xarelto isn’t affected by the fruit.

If you have questions about consuming grapefruit with Xarelto, talk with your doctor.

Xarelto and coffee or other products that contain caffeine (not an interaction)

Drinking coffee or consuming other products that contain caffeine isn’t known to affect how Xarelto works in your body.

In some cases, other drugs that prevent and treat blood clots, such as warfarin (Coumadin, Jantoven), are affected by caffeine. But Xarelto isn’t affected by it. So there’s no need to avoid food or beverages that contain caffeine while you’re taking Xarelto.

If you have questions about consuming caffeine with Xarelto, talk with your doctor.

Xarelto and lab tests

Xarelto isn’t known to interact with any lab tests. It’s unlikely that you’ll have labs with incorrect results caused by this drug during treatment.

Xarelto and PT or INR (not an interaction)

Xarelto doesn’t affect the results of a lab test called prothrombin time (PT), which is sometimes reported as international normalized ratio (INR). PT is often used to monitor your blood’s ability to clot while you’re taking warfarin (Coumadin), which is a different type of anticoagulant drug.

But you won’t take these drugs together, so you won’t have PT tests while you’re taking Xarelto.

In fact, you won’t need to have any lab tests done to monitor your clotting ability while you’re taking Xarelto. Unlike with warfarin, your dosage of Xarelto won’t be adjusted based on these types of lab tests.

Xarelto is an anticoagulant drug that makes your blood less able to form clots. Because of this, there’s a risk of bleeding while taking this drug. Sometimes the bleeding can be severe or even life threatening. Fortunately, the anticoagulant effect of Xarelto can be reversed using a medication called Andexxa.

What is Andexxa?

Andexxa is an antidote to Xarelto and other anticoagulant drugs that work the same way that Xarelto does. Antidotes are drugs that reverse the effects of another drug or substance.

Andexxa is given as an injection into your vein. It’s used to treat severe, uncontrolled, or life threatening bleeding while you’re taking Xarelto.

You’ll usually need to stop taking Xarelto for at least 24 hours before any planned medical, surgical, or dental procedures. This is done to reduce your risk of severe or uncontrolled bleeding during the procedure. But if you need to have an emergency procedure that has an increased risk of bleeding, you might be given Andexxa at the time of your procedure to quickly reverse the effect of Xarelto.

If you have questions about the use of Andexxa, talk with your doctor.

You should take Xarelto according to your doctor’s or healthcare provider’s instructions.

When to take

When you’ll need to take Xarelto depends on why you’re taking the drug and how often you’ve been instructed to take it.

If you’re taking Xarelto once a day, you can usually take it at any time of day. But you should try to be consistent each day with the time that you choose.

The only exception to this is if you have atrial fibrillation (A-fib)* and you’re taking Xarelto once a day to reduce your risk of stroke and blood clots. In this case, Xarelto must be taken in the evening, with your evening meal.

If you’re taking Xarelto twice a day, you should take it in the morning and evening, at around the same times each day. Your doses should be about 12 hours apart.

To help make sure that you don’t miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.

* A-fib is a type of irregular heartbeat. With A-fib, you’re at an increased risk of having blood clots and stroke.

How to stop taking Xarelto

You should keep taking Xarelto for as long as your doctor recommends that you do so.

Don’t stop taking Xarelto without first discussing it with your doctor. Stopping Xarelto increases your risk of having a blood clot. If you’re taking Xarelto because you have heart disease or disease in your arteries, stopping the drug increases your risk of having a stroke or heart attack.

If you need to stop taking Xarelto temporarily because you’re going to have a surgical, medical, or dental procedure, you should usually stop taking it at least 24 hours before the procedure. However, always follow the instructions given by your doctor. (Your doctor will also tell you when to start taking Xarelto again after your procedure.)

If you need to stop taking Xarelto for any other reason, talk with your doctor about when to stop taking it. Your doctor will usually prescribe a different anticoagulant drug to help prevent blood clots while you’re not taking Xarelto.

Taking Xarelto with food

If you’re taking 2.5-mg or 10-mg tablets of Xarelto, you can take them with or without food. However, if you’re taking either 15-mg or 20-mg tablets of Xarelto, you must take them with food.

Can Xarelto be crushed, split, or chewed?

If you have trouble swallowing Xarelto tablets whole, they can be crushed and mixed with applesauce before taking. But even if you crush 15-mg or 20-mg tablets of Xarelto and take them mixed with applesauce, you’ll still need to eat some food after taking your dose.

Xarelto is an anticoagulant medication that’s used to stop dangerous blood clots from forming inside your blood vessels. It’s sometimes also called a blood thinner.

What happens with blood clots?

Blood clots form when certain blood cells and other substances stick together. If a blood clot forms inside one of your arteries, it can travel in your bloodstream to your heart or brain. Once there, the clot can cause a heart attack or stroke.

Blood clots can also form in the veins deep inside your body. These types of clots are called deep vein thrombosis (DVT). If these clots break loose, they can travel in your bloodstream and block blood flow to your lungs. This condition is called a pulmonary embolism (PE).

Your risk of getting dangerous blood clots is increased by certain conditions and situations, such as:

  • having a type of irregular heartbeat called atrial fibrillation (A-fib)
  • having coronary artery disease (CAD); with CAD, the arteries in your heart are narrowed
  • having peripheral artery disease (PAD); with PAD, the arteries in your legs are narrowed
  • a history of DVT
  • staying in a hospital or not being able to move around much after leaving a hospital; this risk is particularly important if you:
    • are 75 years of age or older
    • are overweight
    • smoke
    • have a history of either cancer or heart failure
  • having hip or knee replacement surgery

In all of these situations, your blood is prevented from flowing freely around your body. When this happens, your platelets can start clumping together inside your blood vessels. Platelets produce substances that activate clotting factors in your blood. (Clotting factors are proteins made by your liver.) When activated, clotting factors lead to the formation of blood clots.

What does Xarelto do?

Xarelto is a type of drug called a direct-acting anticoagulant (DOAC). It works by attaching to the activated blood clotting factor called factor Xa. When Xarelto attaches to factor Xa, it stops the clotting factor from working. This makes your blood less able to form clots.

Xarelto is used to both treat and prevent certain types of clots. When you take Xarelto to treat a DVT or PE that you already have, the drug stops these clots from getting bigger. This allows your body to dissolve the clots naturally.

How long does it take to work?

Xarelto starts to work within a couple of hours after you’ve started taking it. But because Xarelto is used to treat and prevent blood clots, you probably won’t notice that the drug is working. (However, you may notice side effects from Xarelto during treatment.)

How long does Xarelto stay in your system?

Xarelto may last in your body for 1 to 3 days after you stop taking it. In healthy adults ages 20 to 45 years, the drug lasts for about 25 to 45 hours after their last dose. In people ages 60 to 75 years, the drug lasts for about 55 to 65 hours after their last dose.

As with all medications, the cost of Xarelto can vary.

The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Your insurance plan may require you to get prior authorization before approving coverage for Xarelto. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the request and let you and your doctor know if your plan will cover Xarelto.

If you’re not sure if you’ll need to get prior authorization for Xarelto, contact your insurance company.

Financial and insurance assistance

If you need financial support to pay for Xarelto, or if you need help understanding your insurance coverage, help is available.

Janssen Pharmaceuticals, Inc., the manufacturer of Xarelto, offers the Janssen CarePath Savings Program, which may help lower the cost of your prescription. If you don’t meet the criteria for this program, Jansen Prescription Assistance may be able to help you find other ways to save.

For more information and to find out if you’re eligible for support, call 888-XARELTO (888-927-3586) or visit the program website.

If Xarelto is taken during pregnancy, it could increase the risk of bleeding in both the mother and her fetus. But there’s not enough information available to say whether Xarelto increases the risk of birth defects or miscarriage.

In animal studies, fetal harm was seen when the drug was given to pregnant females. However, animal studies don’t always predict what will happen in humans.

Anticoagulants other than Xarelto are usually preferred for treating and preventing blood clots in pregnant women. This is because more is known about the safety of using certain other anticoagulants during pregnancy.

If you’re pregnant or may become pregnant, talk with your doctor about whether Xarelto is right for you. And if you’re already taking Xarelto, be sure to see your doctor right away if you become pregnant.

If you do take Xarelto during pregnancy, see your doctor right away if you have any vaginal bleeding, feel dizzy or weak, or have any other symptoms of bleeding. See the “Xarelto side effects” section above for more information.

It’s not known if Xarelto is safe to take during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using Xarelto.

Xarelto may pass into breast milk, but it’s not known how this may affect a child who’s breastfed.

If you’re breastfeeding, talk with your doctor before taking Xarelto. They can recommend whether it’s safe for you to breastfeed while using this drug.

This drug comes with several precautions.

FDA warnings

This drug has boxed warnings. 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. The boxed warnings for Xarelto are described below.

Risk of blood clots if you stop taking Xarelto

Stopping Xarelto treatment increases your risk of having a blood clot. And if you have heart disease or disease in your arteries, stopping Xarelto increases your risk of heart attack and stroke. Don’t stop taking Xarelto unless your doctor recommends that you do.

Sometimes Xarelto needs to be stopped temporarily. For example, this may be recommended before you have a surgical, medical, or dental procedure. In this case, your doctor will tell you when to stop Xarelto and when to start taking it again. In the meantime, your doctor may prescribe another drug for you to take to help prevent blood clots while you’re not taking Xarelto.

Risk of spinal or epidural hematoma

If you have a spinal or epidural injection* while you’re taking Xarelto, there’s a risk that the injection could cause bleeding around your spine or brain. This could lead to either a spinal or epidural hematoma. (With a spinal hematoma, you have a buildup of blood around your spine. With an epidural hematoma, you have a buildup of blood around your brain.) Developing a hematoma in your spine or brain could cause long-lasting or even permanent paralysis.

Having a lumbar puncture (spinal tap) also increases the risk of spinal or epidural hematoma. The risk is also higher if you take drugs that affect your ability to form blood clots. (These medications include nonsteroidal anti-inflammatory drugs [NSAIDs] and blood thinners.) The risk is also higher if you have had difficult or repeated epidural or spinal punctures in the past, have a history of problems with your spine, or have had surgery on your spine.

If you need a spinal or epidural injection while you’re using Xarelto, your doctor will monitor you for spinal blood clots. Tell your doctor right away if you have any back pain, tingling, numbness, or muscle weakness, especially in your legs and feet, while you’re taking Xarelto. Also tell your doctor right away if you lose control of your bladder or bowels.

* Spinal and epidural injections are used to give certain medications, such as anesthetics or pain relievers. With either injection, a needle is inserted in your back, into the area around your spine. The risk of spinal or epidural hematoma is higher if you have a thin tube (called a catheter) placed into your spine to deliver medication.

Other precautions

Before taking Xarelto, talk with your doctor about your health history. Xarelto may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

  • Kidney problems. If your kidneys don’t work well, Xarelto can build up in your body. Because of this, your doctor may prescribe a lower dosage of Xarelto for you. But if you have severe kidney problems, you may not be able to take Xarelto. Talk with your doctor about any kidney issues you have before starting this drug.
  • Liver problems. You shouldn’t take Xarelto if you have moderate or severe liver problems. You should also avoid taking this drug if you have any blood clotting problems related to liver disease. Talk with your doctor about any liver issues you have before starting this drug.
  • Bleeding problems. Taking Xarelto raises your risk of bleeding. You shouldn’t take Xarelto if you currently have any abnormal bleeding, such as a bleeding stomach ulcer. If you have a history of bleeding problems, talk with your doctor about whether Xarelto is right for you.
  • Triple positive antiphospholipid syndrome (APS). APS is a rare condition that makes you more likely to get blood clots. (It’s also called Hughes syndrome.) APS is caused by a problem with your immune system. You shouldn’t take Xarelto if you have APS because doing so may increase your risk of blood clots. This is especially important if you have triple positive APS. (With this condition, your blood has tested positive for lupus anticoagulant, anticardiolipin, and anti-β2-glycoprotein antibodies.) If you have APS, talk with your doctor before taking Xarelto.
  • Having an artificial heart valve. Xarelto hasn’t been studied in people with an artificial valve in their heart. And Xarelto treatment isn’t recommended if you have an artificial valve. Talk with your doctor about any issues you’ve had with your heart before starting Xarelto.
  • Pulmonary embolism that needs treatment with surgery or medications to dissolve the blood clot. Xarelto isn’t recommended for treating pulmonary embolisms (PEs) that need either surgery for removal or medications to dissolve the clot. If you’re taking Xarelto to treat a PE, talk with your doctor about whether Xarelto is right for your unique case.
  • Severe allergic reaction to Xarelto in the past. You shouldn’t take Xarelto if you’ve taken it before and had a serious allergic reaction, such as anaphylaxis. If you’re not sure about your medication allergies, talk with your doctor.
  • Pregnancy. It’s not known if Xarelto is safe to take during pregnancy. For more information, please see the “Xarelto and pregnancy” section above.
  • Breastfeeding. Xarelto passes into breast milk. If you are breastfeeding, talk with your doctor before taking Xarelto. For more information, please see the “Xarelto and breastfeeding” section above.

Note: For more information about the potential negative effects of Xarelto, see the “Xarelto side effects” section above.

Using more than the recommended dosage of Xarelto can lead to serious side effects. Don’t use more Xarelto than your doctor recommends.

Overdose symptoms

Symptoms of an overdose can include:

  • bleeding
  • having blood in your urine, which may be red, pink, or brown in color
  • having blood in your stool, which may be red or black in color, or look like tar
  • vomiting blood, which may be red or pink in color, or look like coffee grounds
  • belly pain
  • coughing up blood
  • severe headache
  • dizziness, which could be a sign of low blood pressure that’s caused by internal bleeding
  • joint pain
  • pain, swelling, or bleeding at any wounds
  • eye effects, such as red eyes or changes in your vision
  • weakness or numbness on one side of your body
  • slurred speech

What to do in case of overdose

If you think you’ve taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

When you get Xarelto from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication.

Xarelto tablets should be stored at room temperature (about 77°F/25°C) in a tightly sealed container away from light. Avoid storing this medication in areas where it could get damp or wet, such as in bathrooms.

Disposal

If you no longer need to take Xarelto and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

The FDA website provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.

The following information is provided for clinicians and other healthcare professionals.

Indications

Xarelto is approved to:

  • treat deep vein thrombosis (DVT)
  • treat pulmonary embolism (PE)
  • reduce risk of DVT and PE recurrence in people still at risk for these conditions following initial treatment that lasted for at least 6 months
  • prevent DVT that could lead to PE in people having hip or knee replacement surgery
  • prevent venous thromboembolism (VTE) in people with acute medical illness who are at risk of VTE, and are not at high risk of bleeding, during and following hospital admission
  • reduce the risk of stroke and systemic embolism in people with nonvalvular atrial fibrillation
  • reduce the risk of myocardial infarction, cardiovascular death, and stroke in people with chronic coronary artery disease (CAD) or peripheral artery disease (PAD); for this use, Xarelto should be given with aspirin

Mechanism of action

Xarelto contains the direct-acting anticoagulant (DOAC) rivaroxaban. It works by binding to and inhibiting blood clotting factor Xa. This reduces the production of thrombin, and subsequently fibrin, in the clotting cascade. With lowered production of thrombin, less platelet aggregation occurs.

Pharmacokinetics and metabolism

Absorption and bioavailability of rivaroxaban are dependent on dose and are as follows:

  • Absorption of 2.5-mg and 10-mg tablets is not affected by food; bioavailability of these doses is 80% to 100%.
  • Absorption of 15-mg and 20-mg tablets is increased by food; bioavailability of the 20-mg tablet is about 66% in the fasted state. However, when taken with food, the mean area under the curve (AUC) is increased by 39% and the maximum concentration (Cmax) is increased by 76%.

Cmax is reached 2 to 4 hours after oral dosing. Rivaroxaban is approximately 92% to 95% plasma protein bound.

Approximately half of the oral dose is metabolized to inactive metabolites by CYP3A4/5 and CYP2J2. Metabolites are cleared in the urine and feces. The other half of the dose is excreted as unchanged drug, mainly in the urine and a small amount in the feces. Rivaroxaban is a substrate for the efflux transporter proteins P-gp and ATP-binding cassette Gr (ABCG2).

In healthy adults ages 20 to 45 years, the terminal half-life of rivaroxaban is between 5 and 9 hours. Half-life increases to between 11 and 13 hours in people ages 60 to 76 years.

Renal impairment can increase exposure to rivaroxaban by 44% to 64%. Reduced doses are recommended in people with certain renal issues.

Hepatic impairment can also increase exposure to rivaroxaban. The AUC of rivaroxaban was increased by 127% in people with moderate hepatic impairment, compared to people with normal hepatic function. Xarelto should be avoided in people with moderate to severe hepatic impairment (Child-Pugh B or C) and in people with hepatic disease involving coagulopathies.

Contraindications

Xarelto is contraindicated in people with:

  • active bleeding
  • a history of severe hypersensitivity reaction to Xarelto, such as anaphylactic reaction

Storage

Store Xarelto at room temperature (approximately 77°F/25°C).

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 other 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.