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Jul 10, 2024

Heart Health

What You Should Know About Xarelto

Xarelto is a prescription medication whose active ingredient is Rivaroxaban. It belongs to a class of drugs known as direct factor Xa (“10a”) inhibitors, often referred to as blood thinners. These medications are designed to prevent the formation of blood clots to reduce the risk of stroke and other serious conditions.

Xarelto is part of a newer category of anticoagulants called novel oral anticoagulants (NOACs). These drugs offer several benefits compared to older anticoagulants, including fewer dietary restrictions and no need for regular blood monitoring.

How Xarelto Works

Xarelto works by inhibiting the action of factor Xa, a key component in the blood clotting process. Factor Xa plays a crucial role in the conversion of prothrombin to thrombin, an essential step in the formation of blood clots. By blocking factor Xa, Xarelto slows down the clotting process and helps prevent the formation of new clots as well as the growth of existing ones.

Unlike some older anticoagulants, Xarelto and other factor Xa inhibitors have a predictable anticoagulant effect, meaning they do not require routine blood tests to monitor their efficacy. This makes them a convenient option for many patients who need long-term anticoagulation therapy.


Xarelto is commonly used to treat and assist in preventing blood clots linked to specific heart and blood vessel disorders:

  • Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE): Xarelto is used to treat or prevent blood clots associated with DVT (clots in the legs) and PE (clots in the lungs).
  • Atrial Fibrillation (AFib): Xarelto helps prevent strokes or serious blood clots in adults with AFib (irregular heartbeat) that is not caused by heart valve disease.
  • Hip or Knee Replacement Surgery: It is used to prevent DVT and PE in adults undergoing hip or knee replacement surgery or in people hospitalized for serious illnesses who are at risk of developing a clot due to decreased mobility or other risk factors.
  • Coronary Artery Disease and Peripheral Arterial Disease: Xarelto, when taken along with aspirin, lowers the risk of heart attack, stroke, or death in adults with coronary artery disease (narrowing of blood vessels supplying the heart) or peripheral arterial disease (poor circulation in blood vessels supplying the arms and legs).

Dosage and Administration

Xarelto is available in tablet form. It can be taken with or without food, depending on your specific medical condition.

  • 2.5 mg: Taken twice daily
  • 10 mg: Can be taken with or without food
  • 15 mg and 20 mg: Taken with food

For children, the dosage is determined by their weight. If you have trouble swallowing whole pills, you can break them and mix them with applesauce. Consume the entire combination immediately; do not save it for later use.

Side Effects

Common side effects include:

  • Minor bleeding, including nose bleeds, and/or bleeding gums
  • Back pain or muscle pain
  • Itching, particularly pain in your legs and/or arms
  • Easily bruised
  • Lower body numbness or muscular weakness

Serious side effects include:

  • Bleeding that will not stop, including heavy menstrual periods
  • Weakness
  • Lightheadedness
  • Urine that appears to be pink, red, or brown
  • Black or bloody stools
  • Vomit that looks like coffee grounds
  • Coughing up blood
  • Loss of bladder control

If you’re experiencing any of the serious side effects listed above, immediately call your doctor and stop taking this medication.

Warning: Risk of Thrombotic Events and Bleeding
  • Premature or sudden discontinuation of Xarelto may increase the risk of thrombotic events (blood clots).
  • Xarelto significantly raises the risk of bleeding, which can be major or even fatal.
  • Take precautions to prevent bleeding or harm (e.g., be careful when shaving or cleaning your teeth).


Inform your physician about all of your current medications, as well as those you start or discontinue taking while taking Xarelto, in particular:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, naproxen, and/or celecoxib
  • Antifungal medications, such as Itraconazole or ketoconazole
  • Other blood thinners including warfarin
  • Erythromycin
  • Rifampin
  • Phenytoin
  • St. John’s wort

Your physician may need to adjust the dosage of mycophenolate or other medications you are taking to ensure that each drug works effectively without causing adverse effects. If you start or stop taking any medications while on mycophenolate, let your doctor know immediately.

Blood Donation and Xarelto

You should avoid donating blood while taking Xarelto because it could prevent your donated blood from clotting properly. If your healthcare provider determines you no longer need Xarelto, you must wait at least 2 days after stopping the medication before donating blood.

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