Xarelto Explained: 10 Must-Knows About This Life-Saving Drug
Medically reviewed on May 7, 2018 by L. Anderson, PharmD.
1. Xarelto: It's Not Just a Tongue-Twister
Xarelto (pronounced zah-REL-toe) is a drug that may be easier to understand than pronounce. But for many, it's a life-saving drug.
Here's what it does:
- Xarelto (rivaroxaban), an anticoagulant (blood thinner), is a tablet given by mouth once or twice a day.
- Xarelto prevents or treats blood clots called a deep vein thrombosis (DVT), which can lead to a lung clot (pulmonary embolism or PE). A clot can also occur after certain surgeries, like knee or hip replacements.
- Xarelto is also an option for people who have an abnormal heart rhythm not caused by a heart valve problem (non-valvular atrial fibrillation) to help prevent clots that may travel to the brain and cause a stroke.
2. How Does Xarelto Work?
Xarelto belongs to a class of drugs known as Factor Xa inhibitors. Factor Xa inhibitors are a type of anticoagulant that blocks the activity of clotting factor Xa and prevents blood clots from developing or getting worse. Factor Xa activates the blood protein prothrombin to thrombin, which triggers the final components of the coagulation pathway to form clots.
Other Factor Xa inhibitors that work like Xarelto include:
However, the newer anticoagulants are costly compared to warfarin, and may not be the right drugs for everyone.
3. Goodbye to Routine Blood Work
Maybe you've used the blood thinner warfarin - now or in the past. For many years, warfarin was the blood thinner of choice. However, for some patients, warfarin can be cumbersome to use. It requires regular trips to the lab for blood work to check the dose. Food interactions are a concern with warfarin, too; such as altering amount of food eaten with high levels of vitamin K.
A big plus with Xarelto is that it does not require regular blood tests or have food restrictions. Studies have shown that blood levels remain constant with Xarelto for a more predictable effect to prevent clots.
A 2017 study showed that over one-third of patients with atrial fibrillation who took warfarin and who also had a cardioversion, stopped taking their warfarin within one year, possibly due to bruising or the required lab tests.
If you are on warfarin, do not stop it without your doctors advice; this could increase your risk for a stroke.
4. Cautious Use: Signs of Bleeding
The most common side effect with Xarelto is bleeding. You may bruise easily or take longer to stop bleeding from a minor cut.
Get medical help immediately if you have:
- Frequent nose bleeds or bleeding gums
- Heavy menstrual or vaginal bleeding
- Uncontrollable bleeding
- Red, pink or brown urine
- Bright red or black, tarry stools
- Cough up blood or vomit looks like “coffee grounds”
- Headaches, dizzy or weak
- Pain, swelling
Some patients may be concerned that the bleeding risk with Xarelto is greater than with warfarin. A 2017 study published in BMJ looked at nearly 60,000 patients who had been diagnosed with venous thromboembolism (VTE) and were prescribed warfarin or one of the newer drugs like Xarelto, Pradaxa and Eliquis between January 2009 and March 2016. After 3 months, roughly 3% of the patients had an episode of major bleeding and nearly 2% died. However, the risk of major bleeding was similar for both the newer anticoagulants and warfarin, and there was no difference in the risk of death.
These findings didn't change when patients were followed for up to six months, according to researchers.
5. Drugs Interactions: Risky Business With Xarelto
It's important to know that if you take Xarelto with another blood-thinning medication, both drugs added together may increase your bleeding risk.
Examples of other drugs that may increase your bleeding risk include:
- Aspirin or aspirin-containing products
- Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
- Warfarin (Coumadin, Jantoven)
- Clopidogrel (Plavix)
- Any other medicine for blood clots
Tell your doctor and pharmacist if you take any of these medicines, give them a full list of your current prescription medications, over-the-counter treatments, and herbal remedies, and have a drug interaction review completed by a healthcare provider.
6. Xarelto: Other Drug Interactions
Xarelto drug interactions can occur with many other medicines, too.
It's important to tell your doctor if you take:
- Ketoconazole (Nizoral)
- Itraconazole (Onmel, Sporanox)
- Ritonavir (Norvir)
- Lopinavir/ritonavir (Kaletra)
- Indinavir (Crixivan)
- Carbamazepine (Tegretol and others)
- Phenytoin (Dilantin)
- Rifampin (Rifadin)
- St. John’s wort (Hypericum perforatum)
Be sure your doctor or pharmacist checks for drug interactions with each of your prescriptions.
7. Andexxa: Antidote for Reversal of Factor Xa Inhibitors
Vitamin K is a quick reversal agent to help treat bleeding with the older anticoagulant warfarin. But it doesn't work for drugs like Xarelto.
In 2016, there were approximately 117,000 U.S. hospital admissions due to Factor Xa inhibitor-related bleeding and nearly 2,000 bleeding-related deaths per month. Andexxa (coagulation factor Xa [recombinant], inactivated-zhzo), from Portola Pharmaceuticals, is a Factor Xa inhibitor reversal agent approved in 2018.
- Andexxa is an altered form of the human Factor Xa molecule, a human enzyme that helps blood to clot and lowers the risk from serious bleeding from Xa inhibitors.
- Andexxa is the first antidote available for patients being treated with rivaroxaban (Xarelto) and apixaban (Eliquis), when reversal of anticoagulation is needed due to life-threatening or uncontrolled bleeding.
- Andexxa received both U.S. Orphan Drug and FDA Breakthrough Therapy designations and was approved under the FDA's Accelerated Approval pathway.
How does Andexxa work?
Andexxa works by acting as a trap for oral and injectable Factor Xa inhibitors, binding to the Factor Xa inhibitor to reverse the anticoagulant effect. In Phase III studies, Andexxa rapidly and significantly reversed anti-Factor Xa activity. The median decrease in anti-Factor Xa activity from baseline was 97% for rivaroxaban (Xarelto) and 92% for apixaban (Eliquis).
8. Food and Xarelto: Know Your Dose
How you take Xarelto in relation to eating may be important for you.
- The higher doses of Xarelto -- the 15 and 20 milligram (mg) tablets -- should be taken with food to increase the absorption of the medicine.
- If you are taking Xarelto for stroke prevention in atrial fibrillation, take your dose with the evening meal.
- If you are taking the 15 or 20 mg tablets for treatment of deep vein thrombosis (DVT) or pulmonary embolism (PE), or to reduce the risk for occurrence of a DVT or PE, take your tablets with food as directed by your doctor.
- The lower 10 mg dose, used to prevent a DVT after knee or hip replacement surgery, can be taken with or without food.
9. Warnings and Tips for Xarelto
Certain groups need to pay attention to special warnings with Xarelto. Talk with your doctor about taking Xarelto if:
- You are pregnant or plan on becoming pregnant
- If you are breastfeeding or plan to breastfeed
- If you have kidney or liver disease; drug doses may need to be changed
Do not stop taking Xarelto on your own, as this may increase the risk for a serious or life-threatening blood clot. Speak to your doctor first if think you should stop Xarelto. Be sure to keep up with your refills so you do not miss any doses. Refill your Xarelto prescription before it runs outs.
10. Get to Know Your Pharmacist
If you are using Xarelto, it's important to communicate regularly with your doctor and pharmacist about treatment, even though you are not having regular lab tests.
A recent study showed that patients whose prescriptions were filled by a Veteran's Affairs (VA) pharmacist -- who also educated them about the drug and reviewed their therapy -- were 80% more likely to take the drug correctly and without missing doses than those who didn't receive such assistance.
Stopping Xarelto, missing a dose, or taking it incorrectly can greatly boost your risk of a stroke or lung embolism, which can be deadly. Talk to your doctor before you change your Xarelto treatment in any way.
Finished: Xarelto Explained: 10 Must-Knows About This Life-Saving Drug
- Xarelto Prescribing Information. Janssen Pharmaceuticals. Drugs.com. Nov. 2017. Accessed May 7, 2018 at https://www.drugs.com/pro/xarelto.html
- Newer Blood Thinners May Not Bring Higher Bleeding Risk. Drugs.com. Oct. 18, 2017. Accessed May 7, 2018 at https://www.drugs.com/news/newer-blood-thinners-may-not-bring-higher-bleeding-risk-67413.html
- Pharmacists Key to Whether Patients Take Blood Thinners. Drugs.com. April 14, 2015. Accessed May 7, 2018 at https://www.drugs.com/news/pharmacists-key-whether-patients-blood-thinners-56406.html
- Xarelto drug interactions. Drugs.com. Accessed May 7, 2018 at https://www.drugs.com/drug-interactions/rivaroxaban,xarelto.html
- FDA Approves Portola Pharmaceuticals’ Andexxa, First and Only Antidote for the Reversal of Factor Xa Inhibitors. Press Release. Portola Pharmaceuticals. Drugs.com. Accessed May 9, 2018 at https://www.drugs.com/newdrugs/fda-approves-portola-pharmaceuticals-andexxa-first-only-antidote-reversal-factor-xa-inhibitors-4736.html