Your doctor may recommend that you take Xarelto to prevent or treat blood clots. Specifically, Xarelto is used in adults to:

Xarelto is also approved for use in some children to:

To learn more about the specific uses of Xarelto, see “What is Xarelto used for?” below.

Xarelto basics

Xarelto contains the active drug rivaroxaban. Its classification (the group of drugs that Xarelto belongs to) is a factor Xa inhibitor. This type of drug works to decrease blood clotting.

Xarelto comes as a tablet that you take by mouth. It also comes as a liquid suspension (mixture) that children can take by mouth. At this time, there’s no generic form of Xarelto available.

In this article, we’ll describe Xarelto’s dosage, side effects, cost, and more.

Like most drugs, Xarelto may cause mild or serious side effects. The lists below describe some of the more common side effects that Xarelto may cause. These lists don’t include all possible side effects.

Keep in mind that side effects of a drug can depend on:

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

Your doctor or pharmacist can tell you more about the potential side effects of Xarelto. They can also suggest ways to help reduce side effects.

Mild side effects

Here’s a short list of some of the mild side effects that Xarelto can cause. To learn about other mild side effects, talk with your doctor or pharmacist, or read Xarelto’s prescribing information.

Mild side effects of Xarelto that have been reported in adults include:

  • fatigue (tiredness and low energy)*
  • belly pain or back pain
  • dizziness
  • insomnia (trouble falling asleep or staying asleep)
  • feeling itchy
  • muscle spasms (tightening that you can’t control)

Mild side effects of many drugs may go away within a few days to a couple of weeks. But if they become bothersome, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Xarelto can occur. If you have serious side effects from Xarelto, call your doctor right away. But, if you think you’re having a medical emergency, you should call 911 or your local emergency number.

Serious side effects of Xarelto that have been reported in adults include:

The most common side effects reported in children were:

* For more information about this, see the “Side effect focus” section below.

Side effect focus

Learn more about some of the side effects Xarelto may cause. You can also see this article about Xarelto’s side effects for more in-depth information.

Boxed warnings

Xarelto has the following boxed warnings, which are serious warnings from the Food and Drug Administration (FDA).

Risk of blood clots when stopping Xarelto too soon. Stopping Xarelto without the guidance of your doctor may increase your risk of blood clots. Due to this risk, your doctor will likely recommend that you do not stop taking Xarelto without first discussing your treatment plan with them.

Risk of spinal or epidural hematoma after certain spinal injections. Xarelto may increase your risk of a spinal hematoma (buildup of blood around your spine) or an epidural hematoma (buildup of blood around your brain). This can occur after spinal or epidural anesthesia or a lumbar puncture.

A hematoma can cause serious problems, such as paralysis (inability to move part of your body). Tell your doctor right away if you have possible symptoms of a hematoma. These can include sudden back pain, numbness, muscle weakness or tingling, or loss of control over your bladder or bowels.

What might help

Do not stop taking Xarelto without talking with your doctor first. If you do need to stop Xarelto, your doctor will likely recommend a different medication to prevent or treat your blood clots.

If you need any spinal or epidural injections while you’re taking Xarelto, your doctor may recommend timing it around your Xarelto dose. If you get your procedure done when the amount of Xarelto in your body is lowest, you have the lowest risk of complications. Your doctor will likely monitor you during your procedure to be sure you’re not having any symptoms of a hematoma.

Fatigue (tiredness)

You may feel fatigue (tiredness or low energy) from taking Xarelto. Although this was not a common side effect reported in studies, it can occur.

What might help

If you’re feeling more tired than usual while you’re taking Xarelto, talk with your doctor. They can help determine what the cause of your fatigue is and how to prevent it from occurring.

Side effects in older people

If you’re 65 or older, you may have an increased risk of certain side effects from Xarelto, such as serious bleeding or blood clots. But Xarelto seems to work as well in older people as it does in younger people.

What might help

Know the symptoms of bleeding or a blood clot while you’re taking Xarelto. Bruising more easily than usual or having blood in your stool, urine, or vomit are some possible signs that you may be experiencing bleeding. And a blood clot could cause symptoms such as pain in your chest or leg, or trouble breathing.

If you’re concerned about your risk of bleeding or clotting with Xarelto, talk with your doctor or pharmacist. They can help you determine if Xarelto is a safe treatment for you.

Allergic reaction

Some people may have an allergic reaction to Xarelto.

Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (temporary warmth, redness, or deepening of skin color)

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. They can also include swelling of your tongue, mouth, or throat, which can cause trouble breathing.

Call your doctor right away if you have an allergic reaction to Xarelto. But if you think you’re having a medical emergency, call 911 or your local emergency number.

Your doctor will recommend the dosage of Xarelto that’s right for you. Below are commonly used dosages, but always take the dosage your doctor prescribes.

Forms

Xarelto comes as:

  • a tablet that’s taken by mouth
  • a liquid suspension (mixture) that’s taken by mouth

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

Xarelto tablets come in the following strengths:

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

Xarelto suspension comes in the following strength:

  • 1 mg per milliliter (mg/mL)

Recommended dosages

How often you take your dose of Xarelto will depend on your condition. For example, Xarelto’s A-fib dosage differs from the dosage for deep vein thrombosis (DVT) or pulmonary embolism (PE).

Your doctor may recommend taking Xarelto once or twice per day, as shown in the following chart for adults:

Xarelto is taken once daily to:Xarelto is taken twice daily to:
• decrease risk of stroke or blood clots with nonvalvular atrial fibrillation (A-fib)
• decrease risk of DVT or PE after being treated for either
• prevent DVT or PE if you’ve recently had a hip or knee replacement
• prevent venous thromboembolism (VTE) during or after hospitalization for acute (short-term) illness 		• treat DVT*
• treat PE*
• decrease risk of serious heart problems due to coronary artery disease (CAD)
• decrease risk of blood clots and related problems due to peripheral artery disease (PAD)

For use in children, Xarelto dosing is based on the child’s body weight. Children might take Xarelto once, twice, or three times per day, depending on their weight and the condition being treated.

For detailed dosing information about Xarelto, you can see this article.

In some cases, your doctor may recommend a dosage adjustment for you or your child. For example, if you have renal (kidney-related) problems, your doctor may prescribe a lower dose of Xarelto or may recommend a different treatment. Your doctor will recommend the correct renal dosing for you.

* For this indication, Xarelto is taken twice daily for the first 21 days, and then is taken once daily for the rest of treatment.

Questions about Xarelto’s dosage

  • What if I miss a dose of Xarelto? What to do if you miss a Xarelto dose depends on how often you take the drug:
    • If you take Xarelto once daily (in any dose) and you forget a dose, take it as soon as you remember on the same day. But do not take two doses during the same day to make up for a missed dose. This also applies for children who take their Xarelto dose once per day.
    • If you take 15 mg of Xarelto twice daily, take your missed dose as soon as you remember, to make sure you get your total daily dose of 30 mg. If you remember that you missed your previous dose while taking your next dose, it’s okay to take 2 doses at once. This also applies for children who take their Xarelto doses twice daily.
    • If you take 2.5 mg of Xarelto twice daily and you miss a dose, skip the missed dose. Take your next dose at your usual time.
    • If your child takes Xarelto three times daily, they should skip their missed dose and continue with their usual dosing schedule.
    • If you miss your dose of Xarelto and you’re unsure when to take your next dose, talk with your doctor or pharmacist and they can help.
  • Will I need to use Xarelto long term? It depends on your condition:
    • For A-fib, CAD, PAD, or to prevent DVT or PE after you’ve had either, you’ll likely take Xarelto long term.
    • For DVT prevention after hip replacement surgery, you’ll likely take Xarelto for 35 days.
    • For DVT prevention after knee replacement surgery, you’ll likely take Xarelto for 12 days.
    • For VTE prevention during or after hospitalization, you’ll likely take Xarelto for 31 to 39 days.
    • Children taking Xarelto for VTE treatment or prevention will typically take Xarelto for at least 1 to 3 months, and up to 12 months.
  • How long does Xarelto take to work? Xarelto begins working after you take your first dose of medication. But since the drug works to prevent or treat blood clots, you may not notice any changes with treatment. It’s important to continue taking Xarelto even if you don’t notice a difference in how you feel.

Find answers to some commonly asked questions about Xarelto.

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

Yes, Xarelto is considered an anticoagulant, also called a blood thinner.

Xarelto can affect your international normalized ratio (INR) levels. INR is a measurement of the time it takes your blood to clot, using a blood test.

It’s not recommended to monitor your INR while you’re taking Xarelto. In comparison, other anticoagulants such as warfarin do require INR monitoring.

Your doctor can help answer other questions you have about Xarelto’s blood thinning effects.

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

Xarelto’s mechanism of action (the way the drug works) is by blocking a clotting factor called factor Xa. A clotting factor is a protein that your body needs to form blood clots. By blocking factor Xa, Xarelto decreases your body’s ability to form a clot. It also prevents existing blood clots from worsening.

Xarelto has a half-life of 5 hours to 9 hours in people 20 to 45 years old. A half-life is the amount of time it takes for your body to get rid of half a dose of the drug. In most cases, a drug stays in your system for between 4 and 5 half-lives. So Xarelto may stay in your system for 20 to 45 hours if you’re in this age range.

In older people, Xarelto might be removed from the body more slowly. In people 60 to 76 years old, Xarelto’s half-life is 11 to 13 hours. So Xarelto may stay in your system for 44 to 65 hours if you’re older.

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

Yes, there is a way to reverse Xarelto’s effects. A medication called Andexxa (recombinant coagulation factor Xa) can be used for this purpose.

Since Xarelto works by preventing clotting from occurring, it increases your risk of bleeding. Andexxa works to block Xarelto (and other medications like it), which allows your blood to clot if needed.

Before you start taking Xarelto, your doctor will discuss your bleeding risk and how to stop bleeding if needed. If you get a small cut while you’re taking Xarelto, your doctor will likely recommend that you apply pressure to the area to try and stop the bleeding. If you have bleeding that doesn’t stop or if you have a major cut or injury, they’ll likely recommend that you go to the hospital or get emergency care.

How does Xarelto compare with alternative drugs, such as Pradaxa and Plavix?

Xarelto, Pradaxa, and Plavix are all medications that can prevent blood clotting. But these drugs work in different ways and are approved for different specific uses.

These medications are all taken by mouth. But they have different dosages, and different possible side effects and interactions. Before starting Xarelto, Pradaxa, or Plavix, talk with your doctor about the best treatment plan for you.

For more information on how Xarelto compares with other treatment options, see the “What should I know about Xarelto vs. Eliquis?” or the “What should I know about Xarelto vs. warfarin?” sections below.

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

No. Liver problems, weight gain, and hair loss were not reported in Xarelto’s studies.

But these side effects may occur from taking other anticoagulant (blood thinner) medications. For example, warfarin can cause hair loss or liver problems.

If you’re experiencing liver problems, weight gain, or hair loss, talk with your doctor about what may be causing it. They may be able to recommend ways to decrease these symptoms.

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

It depends on the type of surgery. If you’re having a procedure that may cause serious bleeding, your doctor may recommend holding (pausing) Xarelto at least 24 hours before the procedure. Holding Xarelto lowers the risk of bleeding.

After your surgery is complete and your wound has clotted, your doctor will likely recommend restarting Xarelto.

If you’re having surgery, talk with your doctor about whether or not you should stop taking Xarelto. They’ll recommend the best treatment plan for you. Do not change your Xarelto treatment or stop taking the drug without your doctor’s recommendation.

In some cases, your doctor may recommend that you take a drug other than Xarelto, depending on the condition you’re being treated for.

Some of the drugs listed below are prescribed off-label for these conditions. With off-label use, a drug that’s approved for certain conditions is prescribed for another condition.

Alternatives for treating or preventing blood clots and for lowering risk of related problems

Alternative drugs for treating or preventing blood clots and for lowering the risk of problems related to blood clots include:

If you’d like to know how Xarelto and Eliquis compare, see this detailed explanation. Also, talk with your doctor about which drug is right for you.

Costs of prescription drugs can vary depending on many factors. These factors include what your insurance plan covers and which pharmacy you use. You can see this article about Xarelto and cost for more detailed information.

Xarelto has many different approved uses for preventing and treating blood clots. It’s prescribed for use in adults to:

Xarelto is approved for use in children to:

  • Treat VTE and lower risk of getting VTE again, after at least 5 days of treatment with another blood thinner. For this use, Xarelto can be used in children from birth to less than 18 years old.
  • Prevent blood clots in children 2 years and older who have congenital heart disease and have had the Fontan procedure. This is a type of open-heart surgery.

* For this use, Xarelto is taken with aspirin.

Before you start taking Xarelto, talk with your doctor about your other medications and medical conditions. They can help you determine if Xarelto may be a safe medication for you.

Interactions

Taking a medication with certain vaccines, foods, and other things can affect how the medication works. These effects are called interactions.

Before taking Xarelto, be sure to tell your doctor about all medications you take, including prescription and over-the-counter types. Also describe any vitamins, herbs, or supplements you use. Your doctor or pharmacist can tell you about any interactions these items may cause with Xarelto.

Interactions with drugs or supplements

Xarelto can interact with several types of drugs. These drugs include:

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

This list does not contain all types of drugs that may interact with Xarelto. You can see this article about Xarelto’s interactions for more information. Your doctor or pharmacist can tell you more about these interactions and any others that may occur with the use of Xarelto.

Boxed warnings

Xarelto has boxed warnings, which are serious warnings from the Food and Drug Administration (FDA). Xarelto’s boxed warnings include:

  • Risk of blood clots when stopping Xarelto too soon. It’s important to talk with your doctor if you’re considering stopping Xarelto treatment.
  • Risk of spinal or epidural hematoma with certain procedures. If you’re having any spinal or epidural anesthesia or having a lumbar puncture, tell your doctor that you’re taking Xarelto. These procedures may cause a hematoma (buildup of blood) around your spine or brain, which is dangerous.

See “What are Xarelto’s side effects?” above for details about these warnings.

Other warnings

Xarelto may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you take Xarelto. Factors to consider include those in the list below.

  • Prosthetic (artificial) heart valves. Your doctor will likely recommend that you do not take Xarelto if you have any prosthetic heart valves. Be sure to tell your doctor about any prosthetic heart valves you have so they can determine the best treatment options for your condition.
  • Current bleeding. If you’re currently experiencing bleeding, your doctor will typically not prescribe Xarelto. This is because the drug increases bleeding risk even further. Your doctor will likely recommend managing your bleeding before starting Xarelto.
  • Liver problems. If you have liver problems, your body may not be able to break down Xarelto as quickly as usual. This may cause the drug to build up in your body, which can increase your risk of side effects such as bleeding. Tell your doctor about any liver problems you have. It’s important to note that Xarelto is not typically prescribed for use in children who have liver problems. Your doctor can determine if Xarelto is a safe treatment for your or your child’s condition.
  • Allergic reaction. If you’ve had an allergic reaction to Xarelto or any of its ingredients, your doctor will likely not prescribe Xarelto. Ask your doctor what other medications are better options for your condition.
  • Kidney problems. Tell your doctor about any kidney problems you have before starting Xarelto. This medication can build up in your body if your kidneys aren’t working properly. This can increase your risk of side effects such as bleeding. Your doctor may recommend a lower dose of Xarelto or a different treatment option for you. It’s important to note that Xarelto is not typically prescribed for use in children who have kidney problems. Your child’s doctor will recommend a different medication for your child if this is the case.
  • Triple positive antiphospholipid syndrome. If you have a condition called triple positive antiphospholipid syndrome, you may have an increased risk of blood clots with Xarelto. Due to this risk, your doctor may recommend a treatment other than Xarelto for your condition.

This list does not contain all the warnings associated with Xarelto. Your doctor or pharmacist can tell you more about these warnings and any others that may occur with the use of Xarelto.

Xarelto and alcohol

There aren’t any known interactions between Xarelto and alcohol. But alcohol can increase your risk of bleeding. Since Xarelto can also cause bleeding, drinking alcohol while taking this medication can further increase your risk.

If you’d like to drink alcohol while you’re taking Xarelto, talk with your doctor. They can recommend how much alcohol, if any, is safe for you to have.

Pregnancy and breastfeeding

It’s not known if Xarelto is safe to take while pregnant or breastfeeding. Taking Xarelto while pregnant may increase your risk of bleeding and the risk of bleeding for the fetus. If you’re pregnant or planning to become pregnant, talk with your doctor about the best treatment options for your condition.

If you and your doctor decide that Xarelto is safe for you to take during pregnancy, your doctor may monitor you more closely than usual throughout your pregnancy. This may involve blood tests, blood pressure checks, and tests to monitor the fetus.

Xarelto passes into breast milk if taken while breastfeeding. It’s not currently known what effects Xarelto may have on a child who is breastfed. If you’re breastfeeding or considering breastfeeding, talk with your doctor about your options before starting Xarelto.

Check out this article to learn how Xarelto and warfarin are similar and different.

Xarelto contains the active drug rivaroxaban. Warfarin is an active drug that comes as a generic medication. It used to be available as the brand-name drug Coumadin. But Coumadin isn’t available anymore.

If you’d like to know more about these drugs and find out which one is recommended for you, ask your doctor.

Your doctor will explain how you should take Xarelto. They’ll also explain how much to take and how often. Be sure to follow their instructions.

Taking Xarelto

Xarelto comes as a tablet that you take by mouth. Depending on the reason you’re taking Xarelto, you may be able to take your dose of Xarelto with or without food. Follow your doctor’s recommendations.

Xarelto also comes as a liquid suspension (mixture), which children can take by mouth if they have trouble swallowing the tablets.

Accessible medication containers and labels

If it’s hard for you to read the label on your prescription, tell your doctor or pharmacist. Certain pharmacies may provide medication labels that:

  • have large print
  • use braille
  • contain a code you can scan with a smartphone to change the text into audio

Your doctor or pharmacist may be able to recommend a pharmacy that offers these options if your current pharmacy doesn’t.

Also, if you’re having trouble opening your medication bottles, let your pharmacist know. They may be able to put Xarelto in an easy-open container. Your pharmacist may also recommend tools to help make it simpler to open the drug’s container.

Taking Xarelto with other drugs

If you’re taking Xarelto for coronary artery disease (CAD) or peripheral artery disease (PAD), your doctor will recommend that you also take aspirin once daily.

Questions about taking Xarelto

  • Can Xarelto tablets be chewed, crushed, or split? Yes, adults taking Xarelto can crush the tablets and mix them with water or applesauce if they cannot swallow the tablets. It’s important to take your dose of Xarelto right away by mouth once it’s crushed and mixed with water or applesauce. For more information on how to swallow a pill, see this article. Children taking Xarelto can be prescribed the liquid suspension (mixture) form of the drug if they have trouble swallowing tablets. If you’re having trouble taking Xarelto, talk with your doctor about the best options for you.
  • Should I take Xarelto with food? The need to take Xarelto with food depends on the dose being taken. If you’re taking a Xarelto 15 mg or 20 mg tablet, the dose should be taken with food right away. You can take your dose of a Xarelto 2.5 mg or 10 mg tablet with or without food. Children who are taking Xarelto for VTE should take their doses with food. Children who have had the Fontan procedure can take Xarelto with or without food.
Questions for your doctor

You may have questions about Xarelto and your treatment plan. It’s important to discuss all your concerns with your doctor.

Here are a few tips that might help guide your discussion:

  • Before your appointment, write down questions such as:
    • How will Xarelto affect my body, mood, or lifestyle?
  • Bring someone with you to your appointment if doing so will help you feel more comfortable.
  • If you don’t understand something related to your condition or treatment, ask your doctor to explain it to you.

Remember, your doctor and other healthcare professionals are available to help you. And they want you to get the best care possible. So, don’t be afraid to ask questions or offer feedback on your treatment.

Do not take more Xarelto than your doctor prescribes. Using more than this can lead to serious side effects.

Symptoms of overdose

An overdose of Xarelto can cause a hemorrhage (severe bleeding that leads to blood loss). This is a medical emergency that can be life threatening.

What to do in case you take too much Xarelto

Call your doctor if you think you’ve taken too much Xarelto. You can also call 800-222-1222 to reach the American Association of Poison Control Centers, or use its online resource. But if you have severe symptoms, immediately call 911 or your local emergency number. Or, go to the nearest emergency room.

Before you start Xarelto, discuss the medication with your doctor. Here are some examples of questions to help get you started:

  • Can I take acetaminophen (Tylenol) with Xarelto?
  • How can I expect to feel if I stop taking Xarelto?
  • If Xarelto isn’t working for me, can my doctor increase my dose?
  • What should I do if I become pregnant while taking this medication?

To learn more about Xarelto, refer to these articles:

If you’d like to learn more about common treatments for atrial fibrillation (A-fib), read this article. You can also learn about treatment and recovery from deep vein thrombosis (DVT) or pulmonary embolism (PE). If you’re taking Xarelto after surgery, you may want to read about how to prevent blood clots after surgery.

To get information on different conditions and tips for improving your health, subscribe to any of Healthline’s newsletters. You may also want to check out the online communities at Bezzy. It’s a place where people with certain conditions can find support and connect with others.

Q:

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

Anonymous

A:

This is possible. Depending on the side effect you’re having, your doctor may adjust your Xarelto dosage. Or, they may have you stop taking the medication.

Some side effects are mild and may go away within a few days to a couple of weeks. Others are more serious. If you have serious side effects from Xarelto, call your doctor right away. If you think you’re having a medical emergency, you should call 911 or your local emergency number.

Your doctor may also adjust your Xarelto dose based on other factors, such as kidney problems or an upcoming surgery. Always take the dose that your doctor prescribes for you. If you have concerns about side effects from Xarelto, talk with your doctor to discuss the next steps in your treatment plan.

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

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