Xarelto (Rivaroxaban) - Oral

Additional Content Provided and Reviewed by IBM Micromedex

What Is Xarelto?

Xarelto (rivaroxaban) is a prescription oral anticoagulant used to treat and prevent certain types of blood clots in adults at risk. Depending on your condition, you will take it once or twice per day, either short-term or long-term. Xarelto is available in tablet form.

Rivaroxaban is also referred to as a “blood thinner,” although it does not actually thin your blood. Xarelto works by inhibiting free factor Xa and prothrombinase activity, which play a role in blood clotting, to help prevent and treat certain blood clots.

Xarelto increases the risk of bleeding, so you have to be careful to avoid injuries while taking it. If you are taking Xarelto, you should stop only under the direction of your healthcare provider.

Drug Facts

  • Generic Name: Rivaroxaban
  • Brand Name(s): Xarelto
  • Drug Availability: Prescription
  • Therapeutic Classification: Anticoagulant
  • Available Generically: No
  • Controlled Substance: N/A
  • Administration Route: Oral
  • Active Ingredient: Rivaroxaban
  • Dosage Form(s): Tablet

What Is Xarelto Used For?

Xarelto helps prevent serious health problems that can result from impaired blood flow due to blood clots. It is also used to treat some types of blood clots that have already formed.

The Food and Drug Administration (FDA) has approved Xarelto for the following indications:

  • Treatment of nonvalvular atrial fibrillation (a type of heart rhythm problem) to reduce the risk of stroke or blood clots in the body 
  • Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE)
  • To reduce the risk of DVT and/or PE in people who have had one or more of these events and have a risk of recurrent DVT and/or PE after completing initial treatment lasting at least six months 
  • To prevent DVT or PE after knee or hip replacement surgery

A combination of symptoms, physical examination, and diagnostic tests can help determine your risk of these types of blood clots––whether you have already experienced a blood clot or not. 

How to Take Xarelto

Xarelto is prescribed to be taken once or twice per day, depending on the indication. The 2.5-milligram (mg) and 10-mg tablets can be taken with or without food, and the 15- or 20-mg tablets should be taken with food.

Storage

This medication should be stored at a room temperature of 77 degrees F  However, it is OK to expose Xarelto to temperatures between 59 and 86 degrees F.

Off-Label Uses

Healthcare providers may prescribe Xarelto off-label for medical conditions other than those approved by the FDA.

Some of the most common off-label uses are:

  • After heart surgery 
  • After a heart valve or other vascular valve placement 
  • To treat blood clots in the heart 
  • For children with heart disease or blood clotting disease, or who have undergone heart or vascular surgery
  • At a different dose than recommended

Off-label doses prescribed by your health provider may be beneficial in some instances, but inappropriate dosing can lead to health risks for certain patients.

How Long Does Xarelto Take to Work?

Xarelto can take two to four hours after your first dose to reach its full blood-thinning effect. Its effects begin to wear off within 24 hours after you stop taking it.

What Are the Side Effects of Xarelto?

This is not a complete list of side effects, and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 1-800-FDA-1088.

Bleeding is the most common side effect of Xarelto. The extent and effects of bleeding can vary when taking Xarelto.

Minor bleeding without adverse health effects is common. Extensive bleeding can be dangerous. 

Common Side Effects

Mild bleeding can manifest with bruising, with or without a known injury. Additionally, prolonged bleeding after a cut can occur while taking Xarelto.

Severe Side Effects

Serious side effects due to taking Xarelto include:

These issues require medical treatment. For example, severe GI bleeding can cause blood loss that may necessitate treatment with a blood transfusion.

Long-Term Side Effects

Long-term side effects of taking Xarelto are not common but can occur due to organ damage caused by bleeding.

Report Side Effects

Xarelto may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting Program or by phone (1-800-332-1088).

Dosage: How Much Xarelto Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage form (tablets):

For prevention of deep venous thrombosis (hip replacement surgery):

  • Adults—10 milligrams (mg) once a day for 35 days. The starting dose should be taken at least 6 to 10 hours after surgery.
  • Children—Use and dose must be determined by your doctor.

For prevention of deep venous thrombosis (knee replacement surgery):

  • Adults—10 milligrams (mg) once a day for 12 days. The starting dose should be taken at least 6 to 10 hours after surgery.
  • Children—Use and dose must be determined by your doctor.

For prevention of reoccurring deep venous thrombosis and pulmonary embolism:

  • Adults—10 milligrams (mg) once a day with or without food after at least 6 months of treatment with a blood thinner medicine.
  • Children—Use and dose must be determined by your doctor.

For prevention of heart attack, stroke, and serious heart problems in patients with coronary artery disease:

  • Adults—2.5 milligrams (mg) 2 times a day together with aspirin (75 to 100 mg once a day), taken with or without food.
  • Children—Use and dose must be determined by your doctor.

For prevention of sudden decrease in blood flow to the legs, major amputation, heart attack, and stroke in patients with peripheral artery disease:

  • Adults—2.5 milligrams (mg) 2 times a day together with aspirin (75 to 100 mg once a day), taken with or without food.
  • Children—Use and dose must be determined by your doctor.

For prevention of stroke and blood clots in patients with nonvalvular atrial fibrillation:

  • Adults—15 or 20 milligrams (mg) once a day, taken with the evening meal.
  • Children—Use and dose must be determined by your doctor.

For prevention of blood clots in people who are hospitalized for an acute illness:

  • Adults—10 milligrams (mg) once a day in hospital and after hospital discharge for a total recommended duration of 31 to 39 days, taken with or without food.
  • Children—Use and dose must be determined by your doctor.

For treatment of deep venous thrombosis and pulmonary embolism:

  • Adults—At first, 15 milligrams (mg) 2 times a day, taken with food for the first 21 days. Then, your doctor may give you 20 mg once a day, taken at the same time each day with food.
  • Children—Use and dose must be determined by your doctor.

Modifications

If you are pregnant, use Xarelto with caution only when it is needed due to the potential for pregnancy-related hemorrhage and/or emergent delivery. Talk to your healthcare provider to weigh the benefits and risks of treatment while pregnant. 

Additionally, this medication may pass into breast milk. Consult with your healthcare provider if you plan on breastfeeding. 

Older adults are at higher risk of bleeding events, and so they may be more sensitive to the effects of rivaroxaban.

Missed Dose

If you miss a dose, take the dose as soon as possible on the same day.

If you take 15 mg twice a day and you miss a dose, take the missed dose immediately. In this case, you can take two 15-mg tablets at once if needed to ensure you take 30 mg of Xarelto that day. Continue with your recommended regimen on the following day.

If you take 2.5 mg twice a day and you miss a dose, take a single 2.5-mg dose at the next scheduled time; then resume therapy as usual.

If you take 20 mg, 15 mg, or 10 mg once a day and you miss a dose, take the missed dose as soon as you remember.

Overdose: What Happens If I Take Too Much Xarelto?

Taking too much Xarelto can cause dangerous bleeding complications. The medication is absorbed in the body and binds to the clotting factors rapidly. Andexanet alfa is an FDA-approved reversal agent specifically for life-threatening bleeding associated with rivaroxaban and apixaban, another anticoagulant.

Treatment of a Xarelto overdose involves close medical observation. A healthcare professional may need to treat any bleeding complications. Plasma products might be considered to reduce the risk of bleeding in some instances.

What Happens If I Overdose On Xarelto

If you think you or someone else may have overdosed on Xarelto (rivaroxaban), call a healthcare provider or the Poison Control Center (1-800-222-1222).

If someone collapses or isn't breathing after taking rivaroxaban, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood and urine tests will be needed to check for unwanted effects. Be sure to keep all appointments.

You may bleed or bruise more easily while you are using this medicine. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Be careful when using sharp objects, including razors and fingernail clippers. Avoid nose picking and forceful nose blowing.

Make sure any doctor or dentist who treats you knows that you are using this medicine.

This medicine may cause bleeding problems. This risk is higher if you have a catheter in your back for pain medicine or anesthesia (sometimes called an "epidural"), or if you have kidney problems. The risk of bleeding increases if your kidney problems get worse. Check with your doctor right away if you have any unusual bleeding or bruising, black, tarry stools, bleeding gums, blood in the urine or stools, tingling, numbness, or weakness of the lower legs, or pinpoint red spots on your skin.

Check with your doctor right away if you have a decreased urine output, confusion, dizziness, nausea, rapid weight gain, swelling of the face, ankles, or hands, or unusual tiredness or weakness after receiving the medicine. These may be symptoms of a serious kidney problem.

Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.

Do not suddenly stop taking this medicine without first checking with your doctor. Doing so, may increase your risk of having a stroke.

Make sure your doctor knows if you are pregnant or planning to become pregnant during treatment with this medicine.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

What Are Reasons I Shouldn’t Take Xarelto?

You should not take Xarelto if you have active pathological bleeding or have had a severe hypersensitivity reaction (e.g., anaphylactic reaction) to the treatment.

What Other Medications Interact With Xarelto?

Other medications that can prevent blood clots or cause bleeding may increase the risk of harmful side effects if taken with Xarelto. However, in some instances, your healthcare provider might recommend that you continue to take them if necessary.

Additionally, certain medications can affect the action of or be affected by Xarelto due to their chemical interactions.

Medications that can interact with Xarelto include:

Other medications that can add to the risk of bleeding if taken with Xarelto include:

  • Chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Aspirin
  • Warfarin 
  • Clopidogrel
  • Enoxaparin

Dosing changes may be necessary if you need to take any of these medications along with Xarelto.

What Medications Are Similar?

Several medications can help to prevent blood clots, each with its own mechanism of action.

Medications similar to Xarelto include:

  • Anticoagulants: Apixaban, edoxaban, warfarin, heparin, enoxaparin
  • Antiplatelet agents: Clopidogrel, aspirin, ticlopidine

These medications all have their own approved indications, but they might be used off-label as well.

Antiplatelet medications use different mechanisms than anticoagulants to prevent blood clots. While anticoagulants work by inhibiting blood clotting proteins, antiplatelet agents prevent platelets from clumping together. Both anticoagulants and antiplatelet medications are often referred to as blood thinners.

Because anticoagulants and antiplatelet medications work differently, your healthcare provider may consider one to be better for your situation than the other. Various aspects of blood clotting tests may also guide or contraindicate the use of a specific blood thinner.

Frequently Asked Questions

  • What is Xarelto used for?

    This medication is used to treat deep vein thrombosis (DVT) and pulmonary embolism (PE) and to prevent certain types of blood clots in people at risk.

  • How does Xarelto work?

    This anticoagulant prevents blood clot formation by inhibiting free factor Xa and prothrombinase.

  • What drugs should not be taken with Xarelto?

    Do not take any other blood thinners while taking Xarelto unless your healthcare provider instructs you to do so. Additionally, several medications should not be taken with Xarelto or should only be used with caution and as instructed by your provider.

    These medications include: 

    • Ketoconazole 
    • Ritonavir 
    • Erythromycin 
    • Carbamazepine 
    • Phenytoin 
    • Rifampin
    • St. John’s wort
  • What are the side effects of Xarelto?

    Bleeding is the main side effect of Xarelto. Usually, this results in bruises or prolonged bleeding from a cut, but it can cause severe organ bleeding or blood loss.

  • How do I safely stop taking Xarelto?

    You should stop taking Xarelto only as instructed by your healthcare provider. Abruptly stopping Xarelto after consistent use can result in a higher risk of stroke if you have atrial fibrillation.

How Can I Stay Healthy While Taking Xarelto?

If you are taking Xarelto, it is important that you reduce your risk of side effects and get medical attention if you develop symptoms of bleeding.

Things you can do to reduce your risk: 

  • Avoid activities with a high risk of falling. 
  • Reduce your risk of trauma or injuries, such as in contact sports.
  • Use a cane or walker if you have balance problems.
  • Tell anyone who will perform a procedure on you—such as a medical or surgical procedure, acupuncture, piercing, or tattoo—that you are taking Xarelto.

Also, be sure to follow instructions regarding care for your underlying condition that puts you at risk of blood clots.

Medical Disclaimer

Verywell Health's drug information is meant for education purposes only and not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare professional. Consult your doctor before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

Was this page helpful?
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Samama MM. The mechanism of action of rivaroxaban--an oral, direct Factor Xa inhibitor--compared with other anticoagulants. Thromb Res. 2011 Jun;127(6):497-504. doi:10.1016/j.thromres.2010.09.008

  2. Kvasnicka T, Malikova I, Zenahlikova Z, Kettnerova K, Brzezkova R, Zima T, Ulrych J, Briza J, Netuka I, Kvasnicka J. Rivaroxaban - Metabolism, pharmacologic properties and drug interactions. Curr Drug Metab. 2017;18(7):636-642.

  3. Food and Drug Administration. Xarelto label. Updated January 2021. 

  4. Pina LM, Dong X, Zhang L, Samtani MN, Michelson AD, Justino H, Bonnet D, Harris KC, Jefferies J, McCrindle BW, Li JS. Rivaroxaban, a direct Factor Xa inhibitor, versus acetylsalicylic acid as thromboprophylaxis in children post-Fontan procedure: Rationale and design of a prospective, randomized trial (the UNIVERSE study). Am Heart J. 2019 Jul;213:97-104. doi:10.1016/j.ahj.2019.04.009

  5. Suwa M, Morii I, Kino M. Rivaroxaban or Apixaban for non-valvular atrial fibrillation - Efficacy and safety of off-label under-dosing according to plasma concentration. Circ J. 2019 Apr 25;83(5):991-999. doi:10.1253/circj.CJ-18-1282

  6. Shastay A. Clear instructions and patient education key for Xarelto. Home Healthc Now. 2020 Jul/Aug;38(4):225-226. doi:10.1097/NHH.0000000000000887