7 Xarelto Side Effects You Should Know About

Xarelto (rivaroxaban) is a blood thinner medication. It’s part of a group of medications called direct-acting oral anticoagulants (DOACs). They’re often a first-choice medication for preventing blood clots because they’re more convenient and have fewer side effects than older treatment options.

But since Xarelto treats and prevents unwanted blood clots, it can also make you bleed more easily. Here, we’ll review this and other Xarelto side effects to keep in mind.

Xarelto side effects at a glance

Below is a list of common and rare Xarelto side effects reported in clinical studies. Keep in mind that this doesn’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 (i.e. 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 include:

• Serious or severe bleeding

• Mood changes

• Liver or kidney problems

• Anaphylaxis (severe allergic reaction)

• Severe skin reactions

Xarelto also has two boxed warnings, the FDA’s strictest warning for medications. While rare, these warnings include:

• An increased risk of blood clots if you stop taking Xarelto earlier than your prescriber tells you to

• An increased risk of bleeding during certain spinal procedures

Let’s take a closer look at seven Xarelto side effects and how to manage them if they occur.

EXPERT PICKS: WHAT TO READ NEXT

• Xarelto FAQs: Learn more about how long it takes Xarelto to work and how long you’ll need to take it.

• Blood thinner 101: Curious about the difference between antiplatelet versus anticoagulant medications? We’ve got you covered.

• Signs of bleeding: How to recognize the signs and symptoms of internal bleeding, and when to seek help.

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

• Have 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 aspirin or certain antidepressants

• Are age 65 and over

Bleeding from Xarelto is usually mild. Nose bleeds, light bruising, or bleeding from the gums while brushing your teeth are examples of mild bleeding. It’s best to let your prescriber know if you experience mild bleeding symptoms. They may decide to monitor you more often.

Sometimes, bleeding from Xarelto can 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 urine

• Blood in your stool (either bright red or black, tarry stool)

• Coughing up blood

• Vomiting blood (may look like coffee grounds)

Seek medical attention immediately if you experience any of these symptoms. There are treatments available to help reverse life-threatening bleeding, such as Andexxa (andexanet alfa). These treatments are given in a hospital setting.

Good to know: Be sure to tell your healthcare team you’re taking Xarelto before having any medical or dental procedure that involves 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

Back pain was reported by people taking Xarelto in clinical trials. Muscle spasms can also happen, but neither side effect is common.

You can often manage these side effects with simple at-home treatments like heat, ice, and gentle stretching. But you shouldn’t take some over-the-counter (OTC) pain medications, such as ibuprofen (Advil, Motrin) or naproxen (Aleve), without talking to your prescriber first. They 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. These could be signs 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 as well.

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 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 or 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 become severe or worsen.

5. Itchy skin

Some people may experience a feeling of itchiness while taking Xarelto. The reason Xarelto causes itchy skin isn’t clear.

Itchiness can be unpleasant and impact your quality of life. Thankfully, there are some easy ways to help manage this 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 they may help reduce itchiness caused by Xarelto.

Itching may make you want to stop taking Xarelto. But don’t stop taking Xarelto on your own — talk 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

You’re more likely to experience a blood clot if you stop taking Xarelto too early. 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 will take Xarelto for just a few weeks or months. For others, it’s a lifelong medication. You may have to stop taking Xarelto for a medical test or procedure, but you’ll typically restart it again 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.

Seek medical attention if you have any signs or symptoms of a blood clot while taking Xarelto. These include:

• 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 you stop taking the medication.

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.

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Written by:

Justin DeFlorian, PharmD, BCPS

Justin DeFlorian, PharmD, BCPS, is a board-certified clinical pharmacist. He received his Doctor of Pharmacy degree from the University of Wisconsin-Madison.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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