Key takeaways:
The most common Xarelto (rivaroxaban) side effect is minor bleeding. Other side effects include stomach pain, back pain, and itchy skin. Fatigue and dizziness are also possible.
More serious Xarelto side effects include liver problems and serious bleeding. Seek emergency care if you have bleeding that doesn’t stop or blood in your stool or urine.
Stopping Xarelto too early can make blood clots more likely. Don’t stop taking it without talking to your prescriber, even if side effects are bothersome.
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Xarelto (rivaroxaban) is a blood thinner that helps prevent dangerous blood clots. It’s often prescribed for people who are living with atrial fibrillation (an irregular heartbeat) or who have a history of deep vein thrombosis (DVT). It’s also prescribed after certain surgeries. While Xarelto can be life-saving, it’s not without its risks. Like all medications, it can cause side effects.
If you’re taking Xarelto — or considering it — it’s important to understand what to expect and when to call your prescriber about side effects. Here, we’ll break down common and rare Xarelto side effects and what to do if they occur.
Xarelto side effects at a glance
Below are lists of common and rare Xarelto side effects reported in clinical studies. Keep in mind that these lists don’t include all possible side effects. So it’s best to talk to your healthcare team about any Xarelto side effects you’re concerned about.
Mild Xarelto side effects include:
Minor bleeding
Stomach pain
Fatigue
Back pain
Muscle spasms
Dizziness
Trouble sleeping
Itchy skin
Pain in extremities (such as the arms, hands, or feet)
Fainting
Blisters
Cough (more common in children)
Vomiting (more common in children)
Inflammation of the stomach and intestines (more common in children)
Rash (more common in children)
Rare but serious Xarelto side effects and risks include:
Serious or severe bleeding
Mood changes
Anxiety
Liver or kidney problems
Anaphylaxis (severe allergic reaction)
Severe skin reactions
Xarelto also has two boxed warnings, the FDA’s strictest type of warning for medications. These warnings are about the following rare side effects:
An increased risk of blood clots if you stop taking Xarelto earlier than prescribed
An increased risk of bleeding (spinal or epidural hematomas) during certain spinal procedures
Let’s take a closer look at seven Xarelto side effects and how to manage them if they occur.
1. Increased risk of bleeding
Since Xarelto is a blood thinner, bleeding is the most common side effect when taking it.
You may be at a greater risk of bleeding if you:
Have a history of bleeding
Are living with certain medical conditions, such as high blood pressure, kidney disease, or diabetes
Drink alcohol often or in large amounts
Take other medications that make bleeding more likely, such as ibuprofen (Advil, Motrin) or certain antidepressants
Are age 65 or older
Bleeding from Xarelto is usually mild. Nose bleeds, light bruising, or bleeding from the gums while brushing your teeth are common examples. It’s best to let your prescriber know if you experience mild bleeding symptoms.
It’s less common, but bleeding from Xarelto can also be severe or even life-threatening. Signs of serious bleeding include:
Bleeding that doesn’t stop
Bruising that happens without a known cause or covers a large area
Blood in your stool (either bright-red or black, tarry stool)
Vomiting blood, which may look like coffee grounds
A sudden, severe headache
Seek medical attention immediately if you experience any of these symptoms.
Good to know: Be sure to tell your healthcare team you’re taking Xarelto before having any type of medical or dental surgery. You may need to stop taking it for a certain number of days before the procedure to lower your risk of bleeding. But you should only stop taking Xarelto if a healthcare professional tells you to.
2. Back pain and muscle spasms
Some people reported back pain while taking Xarelto in clinical trials. Muscle spasms can also happen, but neither side effect is common.
You can likely manage these Xarelto side effects with simple at-home treatments such as heat, ice, and gentle stretching. But you shouldn’t take certain over-the-counter pain medications, such as ibuprofen or naproxen (Aleve), without talking to your prescriber first. Some medications can increase the chance of bleeding if you take them with Xarelto.
Contact your prescriber right away if you notice back pain along with tingling, numbness, or muscle weakness. This could be a sign of a more serious issue, such as a blood clot or stroke.
3. Stomach pain
Stomach pain can happen while taking Xarelto, but it’s not common. Taking Xarelto with food may help prevent this side effect.
Stomach pain can also be an early symptom of bleeding in the stomach, so be sure to keep an eye out for any signs of bleeding. And if your stomach pain doesn’t go away or gets worse, be sure to let your prescriber know. They might perform tests to help determine the cause and best course of action.
4. Fatigue and dizziness
Some people report feeling tired or dizzy while taking Xarelto. These aren’t common Xarelto side effects, but they’re still possible.
Exercising regularly and eating a balanced diet can help you keep your energy up. Staying hydrated can also help with energy and it may improve dizziness, too.
If you’re feeling lightheaded or dizzy while taking Xarelto, it’s best to avoid driving and other activities that require coordination. Take your time when changing positions to avoid falls.
Keep in mind that fatigue and dizziness can also be signs of blood loss. So keep an eye out for other signs of bleeding. And seek emergency care if these symptoms worsen or become severe.
5. Itchy skin
Some people may experience itchy skin while taking Xarelto. The reason Xarelto causes itchiness isn’t clear. But it can be unpleasant and impact your quality of life. Thankfully, there are some simple ways to help manage this Xarelto side effect.
Itchiness is often the result of dry skin. Creams and lotions can lock in moisture and soothe itchy skin. Apply these products several times a day (or according to package directions) for best results. Using a humidifier in the bedroom may also help keep your skin from drying out at night.
If needed, talk to your healthcare team about taking an antihistamine such as loratadine (Claritin) or diphenhydramine (Benadryl). Some case reports show that this may help reduce itchiness caused by Xarelto.
Itchy skin may make you want to stop taking your medication. But don’t stop taking Xarelto without talking to your prescriber first. They can help you figure out the cause of the itchiness and discuss ways to manage your symptoms. If you need to switch to a different blood thinner, they can help you do so safely without raising your risk of blood clots.
6. Blood clots
Xarelto helps prevent blood clots. But if you stop taking Xarelto sooner than you should, blood clots can occur. This is especially true if you’re considered at high risk for a blood clot. Blood clots are dangerous because they can lead to a life-threatening heart attack or stroke.
Your prescriber will let you know when it’s safe to stop taking Xarelto. Some people take Xarelto for just a few weeks or months. For others, it’s a lifelong medication. You may have to temporarily stop taking Xarelto for a medical test or procedure, but you’ll likely restart it afterward. Even if you’re experiencing side effects, don’t stop taking Xarelto without talking to your prescriber first.
Blood clots can also happen if you’re taking certain medications that interact with Xarelto and make it less effective. This includes oral ketoconazole and Paxlovid (nirmatrelvir / ritonavir).
Seek medical attention if you have any signs or symptoms of a blood clot while taking Xarelto. This includes:
Swelling, pain, or redness in an arm or leg
Difficulty breathing
Fast or irregular heartbeat
Coughing up blood
Chest pain
Low blood pressure
7. Liver problems
In rare cases, Xarelto can cause liver problems for some people. In most cases, liver problems appear within the first 2 months (8 weeks) of starting Xarelto. But they usually resolve once treatment stops.
Signs of liver problems include feeling more tired than usual and a yellowing of your skin and eyes (jaundice). If you notice these symptoms, contact your prescriber right away. They’ll be able to check your liver function to see if there’s a problem.
Frequently asked questions
No, there don’t seem to be any weight-related side effects associated with taking Xarelto. But keep in mind that it’s often prescribed after a serious health event. Reduced activity levels and emotional eating are common after a major health event. And both of these may lead to weight gain. Focusing on a healthy exercise and eating plan can help you stay on track and keep weight changes to a minimum. But if unwanted weight gain occurs, talk to your healthcare team for guidance.
Taking Xarelto in the evening may help protect you during early morning hours, when your risk of dangerous blood clots is higher. Evening Xarelto doses also seem to provide higher and longer-lasting blood levels of the medication, which may help it work better. Finally, taking Xarelto doses of 15 mg or more with your largest meal of the day (which is in the evening for most people) helps your body absorb the medication better.
No, you don’t have to avoid specific foods while taking Xarelto the way you do with warfarin (Coumadin, Jantoven). But you should limit the amount of grapefruit and grapefruit juice you consume. Large amounts of grapefruit may raise Xarelto levels in the body and increase your risk of bleeding. But small amounts now and then aren’t likely to cause an issue.
No, there don’t seem to be any weight-related side effects associated with taking Xarelto. But keep in mind that it’s often prescribed after a serious health event. Reduced activity levels and emotional eating are common after a major health event. And both of these may lead to weight gain. Focusing on a healthy exercise and eating plan can help you stay on track and keep weight changes to a minimum. But if unwanted weight gain occurs, talk to your healthcare team for guidance.
Taking Xarelto in the evening may help protect you during early morning hours, when your risk of dangerous blood clots is higher. Evening Xarelto doses also seem to provide higher and longer-lasting blood levels of the medication, which may help it work better. Finally, taking Xarelto doses of 15 mg or more with your largest meal of the day (which is in the evening for most people) helps your body absorb the medication better.
No, you don’t have to avoid specific foods while taking Xarelto the way you do with warfarin (Coumadin, Jantoven). But you should limit the amount of grapefruit and grapefruit juice you consume. Large amounts of grapefruit may raise Xarelto levels in the body and increase your risk of bleeding. But small amounts now and then aren’t likely to cause an issue.
The bottom line
Xarelto (rivaroxaban) is a blood thinner used to treat and prevent blood clots. The most common Xarelto side effect is minor bleeding, but it can also cause back pain, stomach pain, and itchy skin. You may feel dizzy or tired while taking Xarelto, but this isn’t common.
More serious Xarelto side effects include serious bleeding and liver problems. If you have mild bleeding while taking Xarelto, such as nosebleeds or light bruising, contact your prescriber. Seek emergency care if you have bleeding that doesn’t stop or blood in your stool or urine.
Even if side effects are bothersome, don’t stop Xarelto without talking to your prescriber first. This could make you more likely to experience a life-threatening blood clot.
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References
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