All About Xarelto

What is Xarelto?

Your healthcare provider may suggest Xarelto to help prevent or manage blood clots. In adults, Xarelto is prescribed to:

• reduce the chance of stroke or blood clots in nonvalvular atrial fibrillation (A-fib) (an irregular heartbeat not caused by a valve problem)
• treat deep vein thrombosis (DVT), which is a clot in a leg vein
• treat pulmonary embolism (PE), which is a clot in the lung
• lower the risk of DVT, PE, or both after treatment for either condition
• prevent DVT or PE following hip or knee replacement surgery
• prevent venous thromboembolism (VTE) and VTE-related death in people hospitalized for acute (short-term) illness
• reduce the risk of major heart problems if you have coronary artery disease (CAD)
• reduce the risk of clots and related complications in peripheral artery disease (PAD)

Xarelto is also approved for certain pediatric uses, including:

• treating VTE and lowering the chance of recurrent VTE after at least 5 days of another anticoagulant
• preventing clots in children with congenital heart disease who’ve had the Fontan procedure (a type of open-heart surgery)

See the section “What is Xarelto used for?” below for more detail on approved uses.

Xarelto basics

Xarelto’s active ingredient is rivaroxaban. It belongs to a class of medications called factor Xa inhibitors, which reduce the blood’s ability to clot.

The medication is available as an oral tablet and as an oral liquid suspension for children. Currently, there is no generic rivaroxaban available.

This article covers Xarelto’s dosing, potential side effects, price considerations, and other key information.

What are Xarelto’s side effects?

Like other medications, Xarelto can cause both minor and serious side effects. The lists below include some commonly reported adverse effects but aren’t exhaustive.

Keep in mind that side effects can vary based on:

• your age
• other medical conditions you have
• other medications you take

Your doctor or pharmacist can explain potential side effects and suggest ways to minimize them.

Mild side effects

Some mild side effects of Xarelto reported in adults include (see Xarelto’s prescribing information  for more):

• fatigue (low energy)*
• abdominal or back pain
• dizziness
• insomnia (difficulty falling or staying asleep)
• itchiness
• muscle spasms  (involuntary tightening)

Many mild side effects resolve within days to a couple of weeks. If they persist or bother you, contact your healthcare provider.

Serious side effects

Serious adverse effects can occur with Xarelto. Contact your doctor immediately if you experience serious symptoms. For emergencies, call 911 or your local emergency number.

Reported serious side effects in adults include:

• bleeding, which can be severe or life-threatening
• depression or anxiety
• boxed warnings :*risk of clotting if Xarelto is stopped prematurelyrisk of hematoma (blood collection) near the spine or brain after certain spinal procedures
• allergic reaction*

In children, the most commonly reported effects were:

• cough
• vomiting
• bleeding
• gastroenteritis (inflamed stomach and intestines)

*See the “Side effect focus” section below for more details.

Side effect focus

More information about notable side effects of Xarelto follows. You can also consult a dedicated article about Xarelto’s adverse effects for deeper coverage.

Boxed warnings

Xarelto carries boxed warnings  from the FDA.

Risk of blood clots if Xarelto is stopped too soon. Abruptly stopping Xarelto without medical guidance may raise your chance of developing clots. Your provider will likely advise against stopping the medication without a treatment plan.

Risk of spinal or epidural hematoma after certain procedures. Xarelto may increase the risk of a spinal hematoma  (blood collection near the spine) or an epidural hematoma (near the brain) following spinal or epidural anesthesia or lumbar puncture.

A hematoma can lead to serious outcomes such as paralysis. Seek medical attention if you develop sudden back pain, numbness, weakness, tingling, or loss of bladder or bowel control.

What may help

Do not discontinue Xarelto without discussing it with your doctor. If stopping is necessary, your provider may switch you to another anticoagulant to maintain protection against clots.

If you require spinal or epidural procedures while on Xarelto, your clinician may time the procedure when drug levels are lowest to minimize risk and will monitor you for hematoma symptoms.

Fatigue (tiredness)

Some people taking Xarelto report fatigue, though it wasn’t a frequent finding in clinical studies .

What may help

If you notice increased tiredness while taking Xarelto, speak with your doctor. They can help identify the cause and advise on ways to manage it.

Side effects in older adults

People aged 65 and older may have a higher risk of certain complications from Xarelto, such as serious bleeding or clotting. However, effectiveness in older adults appears similar to that in younger people.

What may help

Familiarize yourself with signs of bleeding (easy bruising, blood in stool/urine/vomit) and clotting (chest or leg pain, difficulty breathing). Discuss concerns about bleeding or clotting risk with your doctor or pharmacist to ensure Xarelto is appropriate for you.

Allergic reactionSome individuals may have an allergic response to Xarelto. Mild allergic signs include:

• skin rash
• itching
• flushing (temporary warmth or reddening)

A severe allergic reaction is uncommon but possible and may include swelling under the skin (often around eyelids, lips, hands, or feet) or swelling of the tongue, mouth, or throat, which can cause breathing difficulties. Seek immediate medical care if you suspect a severe allergic reaction. For urgent emergencies, call 911 or your local emergency number.

What is Xarelto’s dosage?

Your provider will determine the right Xarelto dose for you. The sections below summarize common formulations and dosing schedules, but always follow the exact instructions your doctor gives.

Forms

Xarelto is available as:

• an oral tablet
• an oral liquid suspension

Strengths: 2.5 mg, 10 mg, 15 mg, 20 mg

Tablets come in these strengths:

• 2.5 milligrams (mg)
• 10 mg
• 15 mg
• 20 mg

The suspension is available as:

• 1 mg per milliliter (mg/mL)

Recommended dosages

Dosing frequency depends on the condition being treated. For instance, dosing for A-fib differs from that for DVT or PE.

Your provider may prescribe Xarelto once daily or twice daily. The following table summarizes typical adult uses:

In children, dosing is weight-based and may be once, twice, or three times daily depending on weight and indication.

Your doctor may adjust dosing for renal (kidney) function or other factors; for kidney impairment they may reduce the dose or suggest a different therapy.

*For these indications, Xarelto is taken twice daily for the first 21 days, then once daily thereafter.

Questions about Xarelto’s dosage

• What if I miss a dose of Xarelto? Guidance varies by schedule: If you take Xarelto once daily and miss a dose, take it as soon as you remember the same day but do not double up the next day. For 15 mg twice-daily regimens, take the missed dose as soon as you recall to achieve the total daily 30 mg; taking two tablets at once is acceptable in this case. If you take 2.5 mg twice daily and miss a dose, skip the missed dose and resume the regular schedule. Children on three-times-daily dosing should skip the missed dose and continue as scheduled. If in doubt, contact your doctor or pharmacist.
• Will I need Xarelto long term? Depends on your condition: For A-fib, CAD, PAD, or long-term prevention after DVT/PE, Xarelto is often continued long term. After hip replacement, typical duration is 35 days; after knee replacement, about 12 days. For VTE prevention in the hospital setting, treatment is usually 31–39 days. Children treated for VTE often take Xarelto for at least 1–3 months, up to 12 months. Children post-Fontan procedure may require long-term therapy.
• How long does Xarelto take to work? Xarelto begins working after the first dose, although you may not notice changes because it prevents or treats clots. Continue therapy as prescribed even if you don’t feel different.

What are some frequently asked questions about Xarelto?

Below are answers to common questions about Xarelto.

Is Xarelto an anticoagulant or blood thinner? Does it affect INR blood tests?

Yes. Xarelto is an anticoagulant (blood thinner).

Xarelto can influence INR (international normalized ratio), a lab measure of clotting time. However, routine INR monitoring is not recommended for people taking Xarelto, unlike with warfarin, which requires INR checks.

Your clinician can explain how Xarelto affects clotting tests and monitoring.

How does Xarelto work? What’s its half-life and how long does it stay in your system?

Xarelto blocks a clotting protein called factor Xa, reducing your body’s ability to form clots and helping prevent existing clots from growing.

In people aged 20–45, the half-life is about 5–9 hours; drugs typically remain in the body for around 4–5 half-lives, so Xarelto may persist for roughly 20–45 hours in this age group (source ). In older adults (60–76), the half-life is 11–13 hours, so the drug may remain for approximately 44–65 hours.

Is there a way to reverse Xarelto’s effects? How do you stop a bleed while taking Xarelto?

Yes. Andexxa (recombinant coagulation factor Xa) is a reversal agent for rivaroxaban.

Because Xarelto reduces clotting, it raises bleeding risk. Andexxa can counteract Xarelto to restore clotting when necessary.

Your provider will discuss bleeding risks and how to manage bleeding before you start Xarelto. For minor cuts, applying pressure may be advised. For bleeding that won’t stop or major injuries, seek emergency care.

How does Xarelto compare with alternatives like Pradaxa and Plavix?

Xarelto, Pradaxa, and Plavix  all reduce clotting but work differently and have distinct indications, dosing, and side effect profiles. All are oral medications. Discuss with your doctor which option fits your needs best.

See sections comparing Xarelto to Eliquis or warfarin for more information.

Does Xarelto cause liver problems, weight gain, or hair loss?

No—these effects were not observed in Xarelto’s clinical studies . Other anticoagulants, such as warfarin, have been associated with hair loss or liver issues. If you have liver problems, weight changes, or hair loss, consult your doctor for evaluation and guidance.

Can I take Xarelto if I’m having surgery? Will I need to “hold” the drug around my surgery?

It depends on the procedure. For surgeries with significant bleeding risk, your provider may advise pausing Xarelto at least 24 hours before the operation to reduce bleeding risk. After healing begins and wounds have clotted, your doctor will recommend when to resume Xarelto.

Do not stop or alter Xarelto without your doctor’s direction.

What are some alternatives to Xarelto?

Depending on the condition, your clinician may suggest alternatives to Xarelto. Some drugs are used off-label for certain indications.

Alternatives for treating or preventing clots and related complications

Options include:

• aspirin 
• warfarin (Jantoven)
• apixaban (Eliquis)
• dabigatran (Pradaxa)
• edoxaban (Savaysa)
• dalteparin (Fragmin)
• enoxaparin (Lovenox)
• fondaparinux (Arixtra)

What should I know about Xarelto vs. Eliquis?

For a detailed comparison of Xarelto and Eliquis , see this explanation , and discuss options with your doctor.

What does Xarelto cost?

Prescription costs vary by insurance coverage, pharmacy, and location. See a dedicated article on Xarelto pricing for more details.

What is Xarelto used for?

Xarelto is approved for multiple clot-prevention and treatment purposes. In adults it’s used to:

• reduce stroke and clot risk in nonvalvular atrial fibrillation
• treat deep vein thrombosis (DVT)
• treat pulmonary embolism (PE)
• reduce recurrence of DVT or PE after treatment for at least 6 months
• prevent DVT or PE after hip or knee replacement
• prevent VTE in hospitalized patients at risk of clots (who are not at high bleeding risk)
• reduce major cardiovascular events in coronary artery disease (when used with aspirin)*
• reduce clot risk in peripheral artery disease

In children, Xarelto is approved to:

• treat VTE and reduce recurrence after at least 5 days of another anticoagulant (from birth to under 18 years)
• prevent clots in children aged 2 years and older after the Fontan procedure

*For the CAD indication, Xarelto is taken alongside aspirin.

What should be considered before taking Xarelto?

Talk with your doctor about your medical history and all medications, supplements, and vaccines you use to determine whether Xarelto is appropriate for you.

Interactions

Many substances can alter how a medicine works. Tell your provider about prescription, over-the-counter medications, vitamins, herbs, and supplements so they can advise on interactions.

Interactions with drugs or supplements

Xarelto can interact with:

• other anticoagulants or drugs that increase bleeding risk (e.g., enoxaparin [Lovenox], aspirin , ibuprofen [Advil])
• certain antifungals (e.g., ketoconazole)
• some antiviral agents (e.g., ritonavir)
• some antibiotics (e.g., erythromycin, rifampin)
• certain seizure drugs (e.g., carbamazepine, phenytoin)

Xarelto may also interact with the herbal supplement St. John’s wort.

This list is not exhaustive. Consult your doctor or pharmacist for a full review of interactions.

Boxed warnings

Xarelto includes FDA boxed warnings  about:

• Risk of clots if Xarelto is stopped too soon. Discuss with your doctor before discontinuing treatment.
• Risk of spinal or epidural hematoma with certain procedures. Inform providers about Xarelto if you’re receiving spinal/epidural anesthesia or a lumbar puncture, as these procedures increase hematoma risk (source ).

See the side effects section above for more on these warnings.

Other warnings

Xarelto may not be suitable if you have certain conditions. Discuss your history with your clinician. Important considerations include:

• Prosthetic heart valves. Xarelto is generally not recommended for people with artificial heart valves.
• Active bleeding. If you have ongoing bleeding, Xarelto is usually avoided until bleeding is controlled.
• Liver disease. Impaired liver function may slow breakdown of Xarelto, increasing side effect risk.
• Allergic reaction. If you’ve had an allergy to Xarelto or its ingredients, your doctor will choose an alternative.
• Kidney disease. Poor kidney function can cause drug accumulation; dose adjustments or alternative treatments may be needed.
• Triple positive antiphospholipid syndrome. People with this condition may have higher clot risk on Xarelto and may be steered to other therapies.

This is not a complete list—your clinician can discuss additional warnings relevant to you.

Xarelto and alcohol

No specific interaction between Xarelto and alcohol has been established, but alcohol can increase bleeding risk. Drinking while on Xarelto may therefore compound bleeding risk. Consult your doctor about safe alcohol use while taking Xarelto.

Pregnancy and breastfeeding

Safety of Xarelto in pregnancy or breastfeeding is unclear. Taking Xarelto during pregnancy may raise bleeding risk for you and the fetus. If you are pregnant or planning pregnancy, discuss treatment options with your doctor. If Xarelto is used in pregnancy, closer monitoring may be recommended.

Xarelto passes into breast milk, and effects on a nursing infant are unknown. Talk with your provider before breastfeeding while taking Xarelto.

What should I know about Xarelto vs. warfarin?

See this article  for a comparison of Xarelto and warfarin. Xarelto contains rivaroxaban, while warfarin (generic, formerly brand Coumadin) is a different anticoagulant that requires INR monitoring. Discuss with your doctor which agent is best for you.

How is Xarelto taken?

Follow your provider’s instructions about dose and frequency.

Taking Xarelto

Tablets are swallowed. Depending on the dose, you may be advised to take certain strengths with food. The liquid suspension is an option for children or adults who cannot swallow tablets.

Accessible medication containers and labels

If you have difficulty reading labels, ask your pharmacist about options such as large-print labels, braille, or scannable codes that convert text to audio. If opening containers is hard, request an easy-open vial or tools that aid opening.

Taking Xarelto with other drugs

For CAD or PAD, your provider may recommend Xarelto together with daily aspirin .

Questions about taking Xarelto

• Can Xarelto tablets be chewed, crushed, or split? Adults can crush tablets and mix with water or applesauce and take immediately if swallowing is difficult. Children may be given the liquid suspension instead. Discuss options with your clinician.
• Should I take Xarelto with food? For 15 mg or 20 mg tablets, take with food. For 2.5 mg or 10 mg tablets, food is not required. Children treating VTE should take doses with food; children post-Fontan can take with or without food.

Questions for your doctor

Prepare questions for your appointment, such as: How will Xarelto affect my body, mood, or daily activities? Bring someone with you if helpful. Ask for clarification if you don’t understand something. Your healthcare team is there to help—don’t hesitate to ask questions.

What should be done in case of overdose?

Do not take more Xarelto than prescribed, as overdose can cause serious complications.

Symptoms of overdose

Overdosing on Xarelto can lead to severe hemorrhage (major bleeding), which is life-threatening.

What to do if you take too much Xarelto

Contact your doctor if you suspect an overdose. You can call 800-222-1222 for the American Association of Poison Control Centers or use their online resource. For severe symptoms, call 911 or go to the nearest emergency department immediately.

What to ask your doctor

Before starting Xarelto, talk with your clinician. Sample questions include:

• Can I take acetaminophen (Tylenol) with Xarelto?
• How might I feel if I stop Xarelto?
• If Xarelto isn’t effective, can my dose be adjusted?
• What should I do if I become pregnant while on this medication?

For more reading, see these related resources:

• Side Effects of Xarelto: What You Need to Know
• Xarelto Interactions: Alcohol, Medication, and Others
• Dosage for Xarelto: What You Need to Know
• Xarelto and Cost: What You Need to Know

To learn about common A-fib treatments, DVT or PE recovery, or preventing clots after surgery, explore related articles. You can also join online communities like Bezzy for support.

Ask a pharmacist

Q:

If I have side effects from Xarelto, can my doctor adjust my dose?

A:

Yes. Depending on the side effect, your clinician may alter your Xarelto dose or stop the medication. Mild side effects may resolve, while serious ones require immediate attention. Dose changes may also be made for kidney issues or upcoming surgery. Always follow your prescriber’s instructions and contact them if you have concerns.

Disclaimer: This information aims to be accurate and current, but it’s not a substitute for professional medical advice. Always consult a licensed healthcare provider about medications, conditions, or treatment decisions.

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