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Xarelto

Generic Name: rivaroxaban (RIV a ROX a ban)
Brand Names: Xarelto

Medically reviewed on Oct 15, 2018

What is Xarelto?

Xarelto (rivaroxaban) blocks the activity of certain clotting substances in the blood.

Xarelto is used to prevent or treat a type of blood clot called deep vein thrombosis (DVT), which can lead to blood clots in the lungs (pulmonary embolism). A DVT can occur after certain types of surgery.

Xarelto is sometimes used to lower your risk of a DVT or PE coming back after you have received treatment for blood clots for at least 6 months.

Xarelto is used in people with atrial fibrillation (a heart rhythm disorder) to lower the risk of stroke caused by a blood clot.

Xarelto is also used to reduce the risk of heart attacks and strokes in people with coronary artery disease or peripheral artery disease.

Important Information

Do not stop taking Xarelto without first talking to your doctor. Stopping suddenly can increase your risk of blood clot or stroke.

Xarelto can cause you to bleed more easily. Call your doctor at once if you have signs of bleeding such as: headaches, feeling very weak or dizzy, bleeding gums, nosebleeds, heavy menstrual periods or abnormal vaginal bleeding, blood in your urine, bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds.

You should not use Xarelto if you have an artificial heart valve.

Many other drugs can increase your risk of bleeding when used with rivaroxaban. Tell your doctor about all medicines you have recently used.

Xarelto can cause a very serious blood clot around your spinal cord if you undergo a spinal tap or receive spinal anesthesia (epidural). Tell any doctor who treats you that you are taking rivaroxaban.

Before taking this medicine

You should not use Xarelto if you are allergic to rivaroxaban, or if you have active or uncontrolled bleeding.

Xarelto can cause a very serious blood clot around your spinal cord if you undergo a spinal tap or receive spinal anesthesia (epidural). This type of blood clot could cause long-term paralysis, and may be more likely to occur if:

  • you have a genetic spinal defect;

  • you have a spinal catheter in place;

  • you have a history of spinal surgery or repeated spinal taps;

  • you have recently had a spinal tap or epidural anesthesia;

  • you are taking a NSAID - Advil, Aleve, Motrin, and others; or

  • you are using other medicines to treat or prevent blood clots.

Xarelto may cause you to bleed more easily, especially if you have:

Tell your doctor if you have ever had:

  • an artificial heart valve; or

  • liver or kidney disease.

Taking Xarelto during pregnancy may cause bleeding in the mother or the unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

It may not be safe to breast-feed a baby while you are using this medicine. Ask your doctor about any risks.

How should I take Xarelto?

Take Xarelto exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

The number of times you take Xarelto each day will depend on the reason you are using this medication.

For some conditions, Xarelto should be taken with food. Whether you take the medicine with or without food may also depend on the tablet strength you take. Follow your doctor's dosing instructions very carefully.

Tell your doctor if you have trouble swallowing a Xarelto tablet.

Tell any doctor who treats you that you are using rivaroxaban. If you need surgery or dental work, tell the surgeon or dentist ahead of time that you are using this medication. If you need anesthesia for a medical procedure or surgery, you may need to stop using this medicine for a short time.

Do not change your dose or stop taking this medication without first talking to your doctor. Stopping suddenly can increase your risk of blood clot or stroke.

Store at room temperature away from moisture and heat.

Xarelto dosing information

Usual Adult Dose of Xarelto for Atrial Fibrillation:

Recommended dose: 20 mg orally once a day

Use: Reduction of risk of stroke and systemic embolism in nonvalvular atrial fibrillation

Usual Adult Dose of Xarelto for Deep Vein Thrombosis:

Initial dose: 15 mg orally twice a day for first 21 days of therapy
Maintenance dose: 20 mg orally once a day for the remaining duration of treatment.

Usual Adult Dose for Pulmonary Embolism:

Initial dose: 15 mg orally twice a day for first 21 days of therapy
Maintenance dose: 20 mg orally once a day for the remaining duration of treatment.

Usual Adult Dose for Deep Vein Thrombosis -- Recurrent Event:

Recommended dose: 10 mg orally once a day

Use: Reduction in the risk of recurrence of deep vein thrombosis (DVT) and/or pulmonary embolism (PE) in patients at continued risk for recurrent DVT and/or PE after at least 6 months of standard anticoagulant treatment.

Usual Adult Dose for Pulmonary Embolism -- Recurrent Event:

Recommended dose: 10 mg orally once a day

Use: Reduction in the risk of recurrence of deep vein thrombosis (DVT) and/or pulmonary embolism (PE) in patients at continued risk for recurrent DVT and/or PE after at least 6 months of standard anticoagulant treatment.

Usual Adult Dose for Deep Vein Thrombosis Prophylaxis after Hip Replacement Surgery:

Initial dose: 10 mg orally once a day starting 6 to 10 hours after surgery

Duration of therapy:
Hip replacement surgery: 35 days
Knee replacement surgery: 12 days

Comments: Treatment may be given as long as hemostasis has been established.

Usual Adult Dose for Deep Vein Thrombosis Prophylaxis after Knee Replacement Surgery:

Initial dose: 10 mg orally once a day starting 6 to 10 hours after surgery

Duration of therapy:
Hip replacement surgery: 35 days
Knee replacement surgery: 12 days

Comments: Treatment may be given as long as hemostasis has been established.

See also: Dosage Information (in more detail)

What happens if I miss a dose?

If you take Xarelto 1 time each day: Take the medicine as soon as you remember, and then go back to your regular schedule. Do not take two doses at one time.

If you take Xarelto 2 times each day: Take the missed dose as soon as you remember. You may take 2 doses at the same time to make up a missed dose.

Get your prescription refilled before you run out of medicine completely.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose may cause excessive bleeding.

What should I avoid while taking Xarelto?

Avoid activities that may increase your risk of bleeding or injury. Use extra care to prevent bleeding while shaving or brushing your teeth.

Xarelto side effects

Get emergency medical help if you have signs of an allergic reaction to Xarelto: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Also seek emergency medical attention if you have symptoms of a spinal blood clot: back pain, numbness or muscle weakness in your lower body, or loss of bladder or bowel control.

Rivaroxaban can cause you to bleed more easily. Call your doctor at once if you have signs of bleeding such as:

  • easy bruising or bleeding (nosebleeds, bleeding gums, heavy menstrual bleeding);

  • pain, swelling, or drainage from a wound or where a needle was injected in your skin;

  • bleeding from wounds or needle injections, any bleeding that will not stop;

  • headaches, dizziness, weakness, feeling like you might pass out;

  • urine that looks red, pink, or brown; or

  • bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds.

Bleeding is the most common side effect of rivaroxaban.

Common Xarelto side effects may include:

  • muscle pain;

  • itching; or

  • pain in your arms or legs.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

What other drugs will affect Xarelto?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with Xarelto, especially:

  • erythromycin;

  • rifampin;

  • St. John's wort;

  • antifungal medication - itraconazole or ketoconazole;

  • HIV medication - indinavir, lopinavir, ritonavir; or

  • seizure medication - carbamazepine, phenobarbital, phenytoin.

This list is not complete. Other drugs may interact with rivaroxaban, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Further information

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.

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

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