1. Rivaroxaban oral tablet is available as a brand-name drug. It’s not available as a generic drug. Brand name: Xarelto.
  2. Rivaroxaban comes only as a tablet you take by mouth.
  3. Rivaroxaban oral tablet is used to treat and prevent blood clots. It’s also used to reduce the risk of stroke in people with atrial fibrillation without an artificial heart valve. In addition, it’s used with aspirin to reduce the risk of major heart problems in people with chronic coronary artery disease (CAD) or peripheral artery disease (PAD).

Rivaroxaban is a prescription drug. It comes as an oral tablet.

Rivaroxaban oral tablet is available as the brand-name drug Xarelto. It’s not available as a generic drug.

Why it’s used

Rivaroxaban is a blood thinner. It’s used to:

How it works

Rivaroxaban belongs to a class of drugs called anticoagulants, specifically factor Xa inhibitors (blockers). A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Rivaroxaban helps prevent blood clots from forming by blocking a substance known as factor Xa. When factor Xa is blocked, it decreases the amount of an enzyme called thrombin in your body. Thrombin is a substance in your blood that’s needed to form clots. When thrombin is decreased, this prevents a clot from forming.

Heart attack, stroke, and other major heart problems can be caused by a blood clot. Because this drug reduces the risk of forming a blood clot, it also reduces the risk of these problems.

Rivaroxaban oral tablet can cause mild or serious side effects. The following list contains some of the key side effects that may occur while taking rivaroxaban. This list does not include all possible side effects.

For more information on the possible side effects of rivaroxaban, or tips on how to deal with a troubling side effect, talk with your doctor or pharmacist.

More common side effects

The more common side effects that can occur with rivaroxaban include:

  • bleeding, with symptoms such as:
    • bruising more easily
    • bleeding that takes longer to stop

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

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 and their symptoms can include the following:

  • Severe bleeding. Symptoms can include:
    • unexpected bleeding or bleeding that lasts a long time, such as frequent nosebleeds, unusual bleeding from your gums, menstrual bleeding that’s heavier than normal, or other vaginal bleeding
    • bleeding that’s severe or that you can’t control
    • red-, pink-, or brown-colored urine
    • bright red or black stools that look like tar
    • coughing up blood or blood clots
    • vomiting blood or vomit that looks like coffee grounds
    • pain, swelling, or new drainage at wound sites
  • Spinal or epidural blood clots. People who take rivaroxaban and have another medication injected into their spinal and epidural area, or have a spinal puncture, have a risk of forming a severe blood clot. This can cause long-term or permanent paralysis. Symptoms can include:
    • pain, tingling, or numbness
    • muscle weakness, especially in your legs and feet
    • incontinence (loss of control of the bowels or bladder)

Rivaroxaban oral tablet can interact with several other medications. Different interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.

Below is a list of medications that can interact with rivaroxaban. This list does not contain all drugs that may interact with rivaroxaban.

Before taking rivaroxaban, be sure to tell your doctor and pharmacist 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.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Use caution when taking rivaroxaban with NSAIDs. Taking these medications together may increase your risk of bleeding, because they both prevent your blood from clotting. Examples of these drugs include:

  • diclofenac
  • etodolac
  • fenoprofen
  • flurbiprofen
  • ibuprofen
  • indomethacin
  • ketoprofen
  • ketorolac
  • mefenamic acid
  • meloxicam

Antiplatelet drug

Use caution when taking clopidogrel with rivaroxaban. Both of these medications work to decrease your blood from clotting. If you take them together, you may be more likely to bleed.

Aspirin

Use caution when taking aspirin with rivaroxaban. Both of these medications work to make your blood clot less. If you take them together, your blood may become too thin, and you may be more likely to bleed.

Blood thinners

Don’t take rivaroxaban with blood thinners. Anticoagulant drugs and rivaroxaban work to make your blood clot less. If you take these medications together, your blood may become too thin, and you may be more likely to bleed.

Examples of these drugs include:

  • warfarin
  • heparin
  • enoxaparin

HIV drugs

Don’t take rivaroxaban with HIV medications called protease inhibitors. These drugs can increase the amount of rivaroxaban in your body. If your blood levels are increased, you may be more likely to bleed.

Examples of these drugs include:

  • atazanavir
  • darunavir
  • fosamprenavir
  • indinavir
  • lopinavir/ritonavir
  • nelfinavir
  • ritonavir
  • saquinavir
  • tipranavir

Antifungal drugs

Taking antifungal drugs with rivaroxaban can cause the amount of rivaroxaban in your body to increase. This may make your blood too thin, and you may be more likely to bleed. Don’t take these drugs with rivaroxaban.

Examples of these drugs include:

  • ketoconazole
  • itraconazole

Tuberculosis drugs

Don’t take rivaroxaban with these drugs. Doing so may reduce the amount of rivaroxaban in your body and make it less effective. Examples of these drugs include:

  • rifampin
  • rifabutin
  • rifapentine

Herbal supplement

Don’t take rivaroxaban with St. John’s wort. Doing so may reduce the amount of rivaroxaban in your body and make it less effective.

Seizure drugs

Don’t take these drugs with rivaroxaban. Doing so may reduce the amount of rivaroxaban in your body and make it less effective. Examples of these drugs include:

  • carbamazepine
  • ethotoin
  • fosphenytoin
  • phenytoin
  • phenobarbital

Other drugs

These drugs should not be taken with rivaroxaban if you have poor kidney function, unless the benefit is greater than the increased risk of bleeding. Your doctor will determine if these drugs are safe for you to take with rivaroxaban. Examples of these drugs include:

  • erythromycin
  • diltiazem
  • verapamil
  • dronedarone

When to call the doctor

  • Call your doctor right away if you fall or hurt yourself, especially if you hit your head. Your doctor may need to check you for bleeding that might be happening inside your body.
  • If you plan to have surgery or a medical or a dental procedure, tell your doctor or dentist that you’re taking this drug. You may have to stop taking this drug for a short time. Your doctor will let you know when to stop taking the drug and when to start taking it again. They may prescribe another medication to help prevent blood clots from forming.

The rivaroxaban dosage your doctor prescribes will depend on several factors. These include:

  • the type of the condition you’re using rivaroxaban to treat
  • your age
  • other medical conditions you may have, such as kidney damage

Typically, your doctor will start you on a low dosage and adjust it over time to reach the dosage that’s right for you. They’ll ultimately prescribe the smallest dosage that provides the desired effect.

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 suit your needs.

Drug form and strengths

Brand: Xarelto

  • Form: oral tablet
  • Strengths: 2.5, 10 mg, 15 mg, 20 mg

Dosage for prevention of stroke and blood clots in people with nonvalvular atrial fibrillation

Adult dosage (ages 18 years and older)

  • Typical dosage: 20 mg once per day with the evening meal.

Child dosage (ages 0–17 years)

This medication hasn’t been studied in children. It shouldn’t be used in children younger than 18 years.

Special dosage considerations

  • For people with moderate to severe kidney problems: Your dosage will likely be 15 mg taken once per day with your evening meal.
  • For people with very severe kidney problems: You shouldn’t use this drug.

Dosage for treatment of DVTs or PEs

Adult dosage (ages 18 years and older)

  • Typical dosage: 10 mg once per day with or without food, after at least 6 months of standard anticoagulation treatment.

Child dosage (ages 0–17 years)

This medication hasn’t been studied in children. It shouldn’t be used in children younger than 18 years.

Special dosage considerations

  • For people with severe kidney problems: You shouldn’t use this drug.

Dosage for prevention of recurrence of DVTs or PEs

Adult dosage (ages 18 years and older)

  • Typical dosage: 10 mg once per day with food.

Child dosage (ages 0–17 years)

This medication hasn’t been studied in children. It shouldn’t be used in children younger than 18 years.

Special dosage considerations

  • For people with severe kidney problems: You shouldn’t use this drug.

Dosage for prevention of DVTs or PEs in people who have just had hip or knee replacement surgery

Adult dosage (ages 18 years and older)

  • After a hip replacement: Take 10 mg once per day with or without food for 35 days.
  • After a knee replacement: Take 10 mg once per day with or without food for 12 days.

Child dosage (ages 0–17 years)

This medication hasn’t been studied in children. It shouldn’t be used in children younger than 18 years.

Special dosage considerations

  • For people with severe kidney problems: You shouldn’t use this drug.

Dosage for reducing the risk of major heart problems in people with chronic coronary artery disease (CAD) or peripheral artery disease (PAD)

Adult dosage (ages 18 years and older)

  • Typical dosage: Take 2.5 mg twice daily, plus aspirin (75 to 100 mg) once daily. Take with or without food.

Child dosage (ages 0–17 years)

This medication hasn’t been studied in children. It shouldn’t be used in children younger than 18 years.

FDA Warning

  • This drug has black box warnings. These are the most serious warnings from the Food and Drug Administration (FDA). Black box warnings alert doctors and patients about drug effects that may be dangerous.
  • Warning for stopping treatment: Don’t stop taking this drug without talking to your doctor first. When you stop taking a blood thinner, you’re likely to form a clot or have a stroke.
  • Spinal or epidural blood clots (hematoma) warning: People who take this drug and have another drug injected into their spinal area or have a spinal puncture have a risk of forming a severe blood clot. This can cause long-term or permanent paralysis. Your risk of this problem is higher if you have a thin tube (epidural catheter) placed in your back to give you medication. It’s also higher if you take nonsteroidal anti-inflammatory drugs (NSAIDs) or another medication to prevent your blood from clotting. In addition, your risk is higher if you have a history of epidural or spinal punctures, or a history of spinal surgery or of problems with your spine.
  • If you take this drug and receive spinal anesthesia or have a spinal puncture, your doctor should watch you for symptoms of spinal or epidural blood clots. Tell your doctor right away if you have symptoms such as pain, tingling, or numbness, or loss of control of your bowels or bladder. Also tell your doctor if you have muscle weakness, especially in your legs and feet.

Bleeding risk warning

This drug increases your risk of bleeding. This can be serious or even fatal. This is because this medication is a blood-thinning drug that lowers the risk of blood clots forming in your body.

Call your doctor or go to the emergency room right away if you have symptoms of serious bleeding. If needed, a healthcare provider can administer a treatment to reverse the blood-thinning effects of rivaroxaban. Symptoms of bleeding to watch for include:

  • unexpected bleeding or bleeding that lasts a long time, such as frequent nosebleeds, unusual bleeding from your gums, menstrual bleeding that’s heavier than normal, or other vaginal bleeding
  • bleeding that’s severe or that you can’t control
  • red-, pink-, or brown-colored urine
  • bright red- or black-colored stools that look like tar
  • coughing up blood or blood clots
  • vomiting blood or vomit that looks like coffee grounds
  • headaches, dizziness, or weakness
  • pain, swelling, or new drainage at wound sites

Artificial heart valve risk warning

Don’t take this drug if you have an artificial (prosthetic) heart valve. This drug hasn’t been studied in people with artificial heart valves.

Surgery or procedure warning

You may need to stop taking this drug for a time before any surgery or medical or dental procedure. Your doctor will let you know when to stop taking the drug and when to start taking it again. Your doctor may prescribe another medication to help prevent blood clots from forming.

Allergy warning

This drug can cause a severe allergic reaction. Symptoms can include:

  • trouble breathing
  • swelling of your throat or tongue

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Warnings for people with certain health conditions

For people with bleeding problems: If you have abnormal bleeding, don’t take this drug. This drug is a blood thinner and may increase your risk of serious bleeding. Talk to your doctor if you have unusual bleeding while taking this drug.

For people with liver problems: You shouldn’t take this drug if you have moderate to severe liver disease or liver disease associated with bleeding problems. If you have liver problems, your body may not be able to clear this drug from your body well. This can cause the drug to build up in your body, which may put you at risk of bleeding.

For people with kidney problems: You may need a lower dosage of this drug, or you may not be able to take it at all. If your kidneys aren’t working right, your body won’t be able to clear out the drug as well. This can cause the drug to build up in your body, which may put you at risk of bleeding.

For people with artificial heart valves: Don’t take this drug if you have an artificial (prosthetic) heart valve. This drug hasn’t been studied in people with artificial heart valves.

Warnings for other groups

For pregnant women: Research in animals has shown negative effects to the fetus when the mother takes this drug. However, there haven’t been enough studies done in humans to be certain how the drug might affect a human fetus.

This drug should be used with caution in pregnant women. It may cause severe bleeding and premature delivery. This drug should be used during pregnancy only if the potential benefit justifies the potential risk.

If you take this drug during pregnancy, tell your doctor right away if you have any bleeding or symptoms of blood loss.

Tell your doctor if you’re pregnant or plan to become pregnant. If you become pregnant while taking this drug, call your doctor right away.

For women who are breastfeeding: This drug passes through breast milk. You and your doctor may need to decide if you’ll take this drug or breastfeed.

For seniors: The risk of stroke and bleeding increases with age, but the benefits of using this drug in seniors may outweigh the risks.

For children: This drug has not been established as safe and effective in people younger than 18 years.

Rivaroxaban oral tablet is used for both short-term and long-term drug treatment. Your doctor will decide how long you should take it. This drug comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug or don’t take it at all: Don’t stop taking this drug without talking to your doctor first. When you stop taking a blood thinner, you’re likely to form a clot or have a stroke.

Be careful not to run out of this drug. Refill your prescription before you run out.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: If you take more than your prescribed dose of this drug, you have a greater risk of bleeding, which can be fatal.

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

What to do if you miss a dose: If you take this drug:

  • Two times per day: Take it as soon as you remember on the same day. You may take two doses at the same time to make up for the missed dose. Take your next dose at its regularly scheduled time.
  • Once per day: Take it as soon as you remember on the same day. Take your next dose at its regularly scheduled time. Don’t take two doses at once to try to make up for the missed dose.

How to tell if the drug is working: Your symptoms from a DVT or PE should go away or improve:

  • For a DVT, the swelling, pain, warmth, and redness should improve.
  • For a PE, your shortness of breath and chest pain when breathing should get better.
  • If you have CAD or PAD and are taking this drug to prevent major heart problems, you may not be able to tell if this drug is working.

Keep these considerations in mind if your doctor prescribes rivaroxaban for you.

General

  • Take the 15-mg and 20-mg tablets with food. You can take the 2.5-mg and 10-mg tablet with or without food.
  • If you have nonvalvular atrial fibrillation and take this drug to prevent stroke and blood clots, you need to take it with your evening meal.
  • You can crush the tablet. If you crush it, mix it with a small amount of applesauce. Eat the applesauce and then eat your meal right afterward.

Storage

  • Store rivaroxaban at 77°F (25°C).
  • Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t harm your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
  • Be sure that you have enough medication before you leave on your trip. It may be difficult to fill this prescription because not every pharmacy keeps it in stock.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

During treatment with rivaroxaban, your doctor may check:

  • Whether you have active bleeding. If you have signs of bleeding, your doctor may do some tests to see if you’re actively bleeding.
  • Your kidney function. If your kidneys aren’t working properly, your body won’t be able to clear out the drug as well. This causes more of the drug to stay in your body, which may put you at risk of bleeding. Your doctor may decrease your dosage of this drug or switch you to a different blood thinner.
  • Your liver function. If you have liver problems, rivaroxaban won’t be processed by your body well. This causes levels of the drug to increase in your body, which may put you at risk of bleeding. Your doctor may switch you to a different blood thinner.

Availability

Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.

Prior authorization

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

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 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.