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Xarelto Patient Tips

Medically reviewed by C. Fookes, BPharm. Last updated on Nov 13, 2018.

How it works

  • Xarelto is a brand (trade) name for rivaroxaban. Rivaroxaban is a selective inhibitor of factor Xa (FXa), an enzyme that plays a key role in the formation of substances that cause blood clotting. Through its action on FXa, rivaroxaban makes blood less likely to clot.
  • Xarelto belongs to the class of drugs known as factor Xa inhibitors. It may also be called an anticoagulant (this means it stops blood from clotting).


  • Xarelto may be used to reduce the risk of stroke and blood clot formation in people with nonvalvular Atrial Fibrillation (AF) (a condition characterized by a specific heart rhythm disturbance).
  • May also be used to protect against the development of deep vein thrombosis (DVT) (blood clots in the deep veins) following hip or knee replacement surgery.
  • Xarelto is also used in the treatment of DVT and pulmonary embolism (PE) (where blood clots lodge in the lungs), and to lower the risk of recurrent DVT and PE.
  • In 2018, Xarelto was approved to reduce the risk of major cardiovascular events (such as death, a heart attack, or a stroke) in people with long-term coronary artery disease (CAD) or peripheral arterial disease (PAD).
  • Xarelto does not need to be monitored with regular blood tests.
  • It is less likely than warfarin to interact with other drugs or foods; however, it does interact with some medicines.
  • Xarelto is taken as an oral tablet once or twice daily.


If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Serious and sometimes fatal bleeding. The risk may be increased if Xarelto is taken with other drugs (such as aspirin, NSAIDs, SSRIs) that also increase the risk of bleeding. However, Andexxa may be used to reverse the effects of Xarelto in people with uncontrolled or life-threatening bleeding.
  • Abdominal pain, dyspepsia, toothache, fatigue, back or muscle pain, sinusitis, itching, and urinary tract infection are other reported side effects.
  • May increase the risk of stroke when discontinued - do not discontinue except on a doctor's advice. Consider coverage with another anticoagulant if Xarelto needs to be stopped for any reason other than significant bleeding or completion of the course of therapy because premature discontinuation has been associated with thrombotic events (the formation of a blood clot within a blood vessel).
  • May need to be temporarily discontinued prior to surgery.
  • Dosage needs reducing in people with kidney disease, and a person should be monitored for the development of kidney disease while on Xarelto.
  • There is an increased risk of spinal or epidural hematomas resulting in long-term or permanent paralysis forming in people taking Xarelto who are also undergoing spinal puncture or epidural or spinal anesthesia. The risk is greater in those taking other medications that affect blood clotting (such as NSAIDs, aspirin), with a history of traumatic or repeated spinal procedures or a history of spinal deformity or surgery.
  • May not be suitable for people with pre-existing bleeding disorders, with artificial heart valves, or in women who are pregnant or planning to become pregnant.
  • May interact with several drugs including other anticoagulants or blood thinners, medicines used to treat HIV, some antibiotics, and some anticonvulsants.
  • There is currently no generic version of Xarelto.

Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.

Bottom Line

Xarelto limits the ability of the blood to clot and is effective at treating or preventing conditions where the risk of blood clotting is high (such as atrial fibrillation, DVT, PE); however, it may cause severe bleeding but an antidote (Andexxa) is now available.


  • Take the 15mg and 20mg tablets with food. The 10mg tablet can be taken with or without food. May be taken with the evening meal.
  • Take exactly as directed by your doctor. If you miss a dose and you take Xarelto once daily, take as soon as you remember, but do not double up the dose if you don't remember until the next day.
  • Tablets may be crushed and mixed with applesauce immediately prior to use in people who have difficulty swallowing. Follow up the dose with food.
  • Avoid any activities that may increase your risk of bleeding or injury. Be careful when shaving or brushing your teeth.
  • Do not stop suddenly without your doctor's advice as this increases the risk of blood clots.
  • Report any unusual bleeding or bruising to your doctor, such as nosebleeds, bleeding gums, heavy menstrual bleeding, urine that looks pink or brown, blood in your stools, or bleeding that will not stop. Also, tell your doctor if you feel dizzy or weak or feel like you may pass out.
  • Advise all doctors and dentists that you are taking Xarelto before any invasive or dental procedure is scheduled.
  • Xarelto may also increase your risk of bleeding from a minor fall or bump on the head. Contact your doctor if you experience an injury or have bleeding that will not stop. Call 911 if you experience severe or unstoppable bleeding, pink or brown urine, red or black tar-like stools, coughing or vomiting up blood or blood clots (may look like coffee grounds). Also seek urgent medical help with any symptoms of a stroke (such as sudden dizziness, headache or loss of vision; difficulty with speech or slurring of your words, one-sided facial drooping) or signs of a blood clot (sudden, severe shortness of breath; pain, heat or swelling in a limb).
  • Always check with your doctor or pharmacist that Xarelto is compatible with other medications (including herbal remedies or products bought over the counter) before taking them.
  • Do not stop taking Xarelto suddenly. Your doctor will advise you on how to discontinue Xarelto when or if you no longer require it.

Response and Effectiveness

  • Xarelto starts to inhibit blood clotting within one to two hours. Peak effects are seen two to four hours after taking a tablet. Effects start to wear off after 24 hours.


Xarelto (rivaroxaban) [Package Insert] Revised 10/2018. Janssen Pharmaceuticals, Inc.

  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Xarelto only for the indication prescribed.

Copyright 1996-2018 Revision Date: 2018-11-13 01:30:05

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.