Xarelto (rivaroxaban) is an anticoagulant, which is also known as a blood thinner. It is used to help prevent or treat blood clots in certain situations, including reducing the risk of stroke in people with atrial fibrillation (AFib).
Like all medicines, Xarelto can cause side effects and may interact with other medicines, supplements, or alcohol. Because Xarelto works by reducing the blood’s ability to clot, many of its side effects and interactions are related to an increased risk of bleeding.
Keep reading to learn about possible Xarelto side effects, how to manage them, and which medicines may interact with Xarelto.
Xarelto Side Effects
The most common side effect of Xarelto is bleeding. Bleeding can range from mild, such as easy bruising or a brief nosebleed, to more serious bleeding that requires medical attention.
Other potentially serious side effects of Xarelto include allergic reactions and risk of blood clots or stroke if Xarelto is stopped too early. If you have symptoms that feel serious or life-threatening, seek medical care right away.
This article does not include all possible side effects or interactions. Tell your health care provider about any symptoms that concern you or do not improve.
How to Manage Xarelto Side Effects
In the sections below, we’ll cover what to know about some Xarelto side effects, including tips to help prevent or manage them.
1. Bleeding and bruising
Mild bleeding and bruising are common while taking Xarelto. Because Xarelto reduces your blood’s ability to clot, it can make you bleed or bruise more easily than usual.
Possible symptoms include:
- Easy bruising
- Nosebleeds
- Bleeding gums
- Small cuts that take longer to stop bleeding
- Heavier bleeding from minor injuries
To help prevent or manage bleeding and bruising:
- Use a soft toothbrush, and brush gently.
- Be careful when shaving. Consider using an electric razor if possible.
- Limit activities that could result in injury or falls.
- Check with your health care provider or pharmacist before starting any new medicines, vitamins, or supplements. Some over-the-counter medicines, such as ibuprofen or naproxen, can increase the risk of bleeding.
- Before having any injections, procedures, or dental work, tell all your health care providers and dentists that you take Xarelto.
Contact your health care provider if you have frequent bleeding, bleeding that lasts longer than usual, or bruising that is severe, painful, or worsening. Your provider can check whether your symptoms need further evaluation or your treatment plan needs to be changed.
2. Serious bleeding
Although less common, Xarelto can cause serious bleeding that may require emergency medical treatment. In rare cases, severe bleeding can be life-threatening.
Possible symptoms include:
- Bleeding that does not stop or keeps coming back
- Red, pink, or brown urine
- Bright red stools or black, tar-like stools
- Vomiting blood or material that looks like coffee grounds
- Coughing up blood or blood clots
- Severe headache
- Dizziness, lightheadedness, or fainting
- Unusual pain or swelling around a wound
Seek medical care right away if you have symptoms of serious bleeding. You may need emergency medical treatment, a blood transfusion, or surgery to treat or stop the bleeding.
To reduce your risk of serious bleeding, follow the recommendations mentioned in the section above.
3. Increased risk of stroke or blood clots after stopping Xarelto
Stopping Xarelto too soon can increase your risk of blood clots, stroke, or other serious complications.
Seek medical care right away if you have any of the following symptoms:
- Sudden weakness or numbness, especially on one side of the body
- Trouble speaking or understanding speech
- Sudden vision changes
- Severe headache
- Chest pain
- Shortness of breath
Contact your health care provider before stopping Xarelto for any reason. If treatment needs to be stopped, your provider may recommend another blood thinner or make a plan to help reduce your risk of blood clots during the transition.
Xarelto Interactions
Xarelto can interact with other medicines, supplements, and certain foods or drinks.
An interaction happens when a substance changes how a medicine affects the body. Because Xarelto affects the body’s clotting process, some interactions involve medicines that also affect bleeding or blood clotting. Other medicines can make Xarelto less effective by changing how the body processes it.
This is not a full list of interactions, but the following are important to know about while taking Xarelto.
1. Medicines that increase bleeding risk
Some Xarelto interactions may increase the risk of bleeding. These medicines can affect blood clotting on their own. If taken with Xarelto, the risk of bleeding can further increase.
Examples include:
- Aspirin
- Other blood thinners, such as apixaban, enoxaparin, and warfarin
- Antiplatelet medicines, such as clopidogrel
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen
- Some antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)
Your health care provider can review your medicines with you and let you know whether any changes or extra monitoring are needed. Do not stop any prescribed medicines on your own.
2. Medicines that can increase Xarelto levels
Some medicines can slow down how quickly your body breaks down Xarelto. This can raise the levels of Xarelto in your bloodstream and increase the risk of bleeding.
Examples include:
- Various antifungal medicines, such as itraconazole, ketoconazole, and posaconazole
- Certain medicines used to treat HIV, such as ritonavir
- Some antibiotics, such as erythromycin
These medicines may increase the effects of Xarelto and make bleeding more likely.
Tell your health care provider about all of your medicines. Depending on your situation, your provider may recommend closer monitoring, changes to your treatment plan, or a different medication.
3. Medicines that make Xarelto less effective
Some medicines can make your body break down Xarelto more quickly than normal. This can lower the levels of Xarelto in your bloodstream and reduce how well it works for treating or preventing blood clots.
Examples include:
- Some seizure medicines, such as carbamazepine and phenytoin
- Rifampin, an antibiotic
Taking these medications with Xarelto may increase the risk of blood clots because Xarelto may not work as well as expected. Your health care provider may recommend a different treatment or extra monitoring. Do not stop or change any medicines without talking with your health care provider first.
FAQs: Xarelto Interactions
Does grapefruit affect Xarelto?
Possibly. Grapefruit or grapefruit juice may increase the amount of Xarelto in your bloodstream, which can raise the risk of bleeding. But this interaction has not been well studied, so it is not known exactly how much grapefruit affects Xarelto. Your health care provider may recommend limiting or avoiding grapefruit products while taking Xarelto.
Does Xarelto interact with alcohol?
It is not known whether alcohol directly affects how Xarelto works. But both alcohol and Xarelto can increase the risk of bleeding. If you drink alcohol, talk with your health care provider about how much alcohol, if any, may be safe for you.
Does Xarelto interact with any supplements?
Yes. One example is St. John’s wort, an herbal supplement sometimes used for depression. It can make your body break down Xarelto more quickly than normal. This may lower the amount of Xarelto in your bloodstream and reduce its effectiveness.
Some supplements may affect the body’s clotting process. For example, dehydroepiandrosterone (DHEA) supplements may affect blood-clotting hormones and bleeding or clotting risk. If you are interested in taking DHEA or any other supplement, talk with your health care provider first.
Other supplements may increase bleeding risk. Always tell your health care provider and pharmacist about any vitamins, herbs, or supplements you use. They can review your medications and supplements for possible interactions and help you decide whether any changes are needed.
Reducing Your Risk of Side Effects and Interactions
You can help reduce your risk of side effects and interactions by following all instructions from your health care provider.
Helpful tips include:
- Take Xarelto exactly as directed, and do not stop taking it without medical guidance.
- Always tell your health care provider and pharmacist about all prescription drugs, over-the-counter medicines, and any vitamins, herbs, or other supplements you use.
- Watch for signs of bleeding, and report any unusual or persistent symptoms to your health care provider.
- Before any procedure or surgery, tell all your health care providers and dentists that you take Xarelto.
- Keep all follow-up appointments and recommended lab tests.
Many side effects and interactions can be prevented or managed when they are identified early. Your health care provider can review your treatment plan and make changes, if needed, to help keep Xarelto as safe and effective as possible.
