rivaroxaban
Xarelto (rivaroxaban) is a prescription blood thinner used to prevent and treat blood clots. It can lower the risk of serious problems like stroke, deep vein thrombosis (DVT), or pulmonary embolism (PE). It's comes as a tablet or liquid and is taken by mouth. Your dose depends on why you're taking it, so it could be once or twice a day. The most common side effect is bleeding, which can sometimes be serious or life-threatening. Xarelto (rivaroxaban) is available as both a brand-name and a generic medication.
What is Xarelto (rivaroxaban)?
What is Xarelto (rivaroxaban) used for?
Adults:
Lower the risk of stroke and blood clots in people with atrial fibrillation (AFib) not caused by a heart valve problem
Treat blood clots in the legs (deep vein thrombosis (DVT)) or lungs (pulmonary embolism (PE))
Lower the risk of DVT or PE coming back after treatment
Prevent blood clots in people in the hospital or recently released who are at high risk
Lower the risk of serious heart problems, like heart attack or stroke, in people with coronary artery disease (CAD), taken with aspirin
Lower the risk of blood clots and related problems in people with peripheral artery disease (PAD), taken with aspirin
Children:
Treat blood clots and lower the risk of new clots in children from birth to under 18 years old
Prevent blood clots in children 2 years and older with congenital heart disease (CHD) after a Fontan procedure
How Xarelto (rivaroxaban) works
Xarelto (rivaroxaban) is a direct-acting oral anticoagulant (DOAC) that works by blocking factor Xa, a protein your body uses to form clots. By stopping this protein, Xarelto (rivaroxaban) helps thin your blood and prevent clots from forming or getting bigger.
Drug Facts
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What are the side effects of Xarelto (rivaroxaban)?
Common Side Effects
- Any bleeding (Up to 28%)
- Any bleeding (36%)
- Cough (16%)
- Vomiting (14%)
- Stomach virus (13%)
- Rash (9%)
Other Side Effects
- Stomach pain
- Tiredness
- Pain in the arms and legs
- Muscle pain and spasm
- Dizziness
- Anxiety
- Trouble sleeping
- Itchy skin
Serious Side Effects
- Serious bleeding: bleeding that won’t stop, blood in the urine or stool, coughing or vomiting blood, unexplained bruises, bruises that get bigger, dizziness
- Bleeding around the spine (spinal or epidural hematoma): back pain, weakness, difficulty walking, loss of bowel or bladder control, paralysis
Source: DailyMed
More on Xarelto (rivaroxaban) side effects
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Back pain
bleeding gums
bloody stools
bowel or bladder dysfunction
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
coughing up blood
difficulty with breathing or swallowing
dizziness
headache
increased menstrual flow or vaginal bleeding
leg weakness
nosebleeds
numbness
paralysis
prolonged bleeding from cuts
red or black, tarry stools
red or dark brown urine
vomiting of blood or material that looks like coffee grounds
Incidence not known
Blistering, peeling, or loosening of the skin
blurred vision
chills
clay-colored stools
dark urine
fast or irregular heartbeat
fever with or without chills
general feeling of tiredness or weakness
hoarseness
joint or muscle pain
loss of appetite
lower back or side pain
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
red skin lesions, often with a purple center
red, irritated eyes
severe headache
sores, ulcers, or white spots in the mouth or on the lips
stomach pain or swelling
tightness in the chest
unpleasant breath odor
unusual bleeding or bruising
unusual tiredness or weakness
vomiting
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Xarelto (rivaroxaban)
Pros
No regular blood monitoring required
Available as a tablet or liquid that's taken by mouth
Approved for both children and adults
Cons
Most common side effect is bleeding
Not easily reversible in life-threatening bleeds
Can interact with many medications
Pharmacist tips for Xarelto (rivaroxaban)
Never stop taking Xarelto (rivaroxaban) unless your prescriber tells you to. Stopping the medication too early can lead to dangerous blood clots that might be life-threatening.
If you take the 15 mg or 20 mg Xarelto (rivaroxaban) tablet, always take it with food at around the same time each day. Food helps your body absorb the medication so it can work better. Other doses can be taken with or without food.
If you or your child misses a dose of Xarelto (rivaroxaban), talk to your prescriber or pharmacist. What to do can depend on your specific dose and schedule. Don’t double up without guidance.
If you have trouble swallowing Xarelto (rivaroxaban) tablets, you can crush them and mix with a small amount of applesauce just before taking the medication by mouth. Additionally, Xarelto (rivaroxaban) comes in a liquid form you can drink.
Tell your care team if you're taking Xarelto (rivaroxaban) before any procedure, even dental work. They might need to make changes to your treatment plan to help prevent bleeding problems during or after the procedure.
Let your care team know right away if you notice unusual bleeding or bruising while taking Xarelto (rivaroxaban). This medication can make it take longer for bleeding to stop, and you might bruise or bleed more easily than usual.
Xarelto (rivaroxaban) can interact with many medications. Tell your care team if you're taking any prescription, over-the-counter medications, or supplements during treatment.
If you have CAD or PAD, you'll likely take Xarelto (rivaroxaban) with low-dose aspirin (75 mg to 100 mg) to lower your risk of heart attack, stroke, or other serious problems. Ask your prescriber if this combination is right for you.
Store the Xarelto (rivaroxaban) liquid at room temperature. Only use the syringe that comes with it to measure each dose to make sure you get the correct amount of medication every time.
If your child vomits or spits up Xarelto (rivaroxaban) within 30 minutes of taking it, give the full dose again. If it’s been more than 30 minutes, don't repeat the dose — just wait until the next scheduled one. If vomiting keeps happening, call their prescriber right away.
Xarelto (rivaroxaban) can raise the risk of heavy uterine bleeding. If you're planning to become pregnant, talk to your prescriber before starting this medication.
Xarelto (rivaroxaban) has been found in breast milk. But it's not clear how it affects a breastfed baby. If you're nursing or planning to nurse, talk to your prescriber about the risks and benefits of taking this medication.
Frequently asked questions about Xarelto (rivaroxaban)
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What are the risks and warnings for Xarelto (rivaroxaban)?
Xarelto (rivaroxaban) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Higher risk of blood clots if stopped too early
Risk factors: Certain heart conditions
Don't stop taking Xarelto (rivaroxaban) unless your prescriber tells you to. Stopping too soon can raise your risk of serious blood clots. If you need to stop for any reason other than bleeding or finishing treatment, your prescriber might have you start on another blood thinner to help keep you protected.
Paralysis in the spine
Risk factors: Spinal surgery or spinal tap | Use of indwelling epidural catheter | Anesthesia in the spine (epidural)
If you’re taking Xarelto (rivaroxaban) and need spinal or epidural anesthesia (numbing around your spine) or a spinal tap, you might have a higher risk of bleeding near your spine. This type of bleeding, called a spinal or epidural hematoma, is rare but can cause long-term or permanent paralysis. Your care team will explain how to safely stop Xarelto (rivaroxaban) before the procedure to help lower this risk. Call your prescriber right away if you notice back pain, weakness, numbness, difficulty walking, or a loss of bowel or bladder control.
Bleeding
Risk factors: Taking other blood thinners or NSAIDs | People who are hospitalized with a high risk of bleeding | People with liver or kidney problems | Taking medications that can cause bleeding
Since Xarelto (rivaroxaban) is a blood thinner, it can raise your risk of bleeding, including serious and life-threatening bleeding. You might bruise more easily, and bleeding might take longer to stop. Your risk of bleeding is higher if you have certain other medical conditions or take other medications that cause bleeding. Get medical help right away if you or your child have bleeding that doesn't stop, blood in your urine or stool, coughing or vomiting blood, or feel dizzy or lightheaded.
There are medications, such as Andexxa (andexanet alfa), that can reverse the effects of Xarelto (rivaroxaban) in an emergency. But these reversal medications are given through a vein (intravenously, IV) and are usually only available in the hospital. It's very important that all healthcare professionals, including emergency responders, know you're taking Xarelto (rivaroxaban). Wearing a medical alert bracelet that lists this medication can help keep you safe.
Interactions with other medications
Some medications can change how much Xarelto (rivaroxaban) is in your body. This can lead to more side effects or bleeding (like with ketoconazole, ritonavir), or make the medication not work as well (like with carbamazepine or rifampin). Be sure to tell your prescriber and pharmacist about all prescription, over-the-counter medications, and supplements you're currently taking or have recently stopped.
Risk of pregnancy-related bleeding
Xarelto (rivaroxaban) can cause uterine bleeding, which can be a problem if you're pregnant. Tell your care team right away if you’re pregnant or planning to become pregnant while taking this medication. You should only keep taking it if the benefits are greater than the risks. Let them know immediately if you have signs of bleeding, like feeling weak, having low blood pressure, or if there are any concerns about your baby.
Not recommended in people with prosthetic heart valves
Xarelto (rivaroxaban) isn't recommended for people with prosthetic heart valves. Studies have shown that people with a certain type of heart valve procedure had a higher risk of serious side effects, like bleeding and death, when taking this medication. If you have an artificial heart valve, talk to your care team about safer treatment options.
Not recommended in people with antiphospholipid syndrome
Xarelto (rivaroxaban) isn't recommended for people with triple-positive antiphospholipid syndrome (APS) because it's been linked to a higher chance of blood clots coming back. If you have APS, your prescriber will likely recommend a different medication to help reduce your risk for clots.
Xarelto (rivaroxaban) dosage forms
Typical dosing for Xarelto (rivaroxaban)
Adults:
The dose and how long you take Xarelto (rivaroxaban) will depend on why you're taking it. Your dose might be lower if you have kidney problems.
Lower the risk of a stroke in AFib: The typical dose is 20 mg by mouth once a day in the evening with a meal.
Treat DVT or PE: The typical dose is to start with 15 mg by mouth with food twice a day for 21 days, then switch to 20 mg once a day with food.
Lower the risk of DVT or PE coming back: The typical dose is 10 mg by mouth once a day.
Prevent DVT or PE in people with recent surgery or hospitalization:
Hip replacement surgery: The typical dose is 10 mg by mouth once a day for 35 days.
Knee replacement surgery: The typical dose is 10 mg by mouth once a day for 12 days.
Hospitalization: The typical dose is 10 mg by mouth once a day starting in the hospital and continuing after discharge for a total of 31 to 39 days.
Lower the risk of serious heart-related problems in CAD and PAD: The typical dose is 2.5 mg twice daily by mouth, plus aspirin (75 to 100 mg) once a day by mouth.
Children:
The dose is based on your child's weight. Depending on their weight and the condition being treated, the medication is taken by mouth 1 to 3 times a day.
More on Xarelto (rivaroxaban) dosage forms
Interactions between Xarelto (rivaroxaban) and other drugs
More on Xarelto (rivaroxaban) interactions
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Defibrotide
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abametapir
- Abciximab
- Aceclofenac
- Acemetacin
- Acenocoumarol
- Alipogene Tiparvovec
- Alteplase, Recombinant
- Amtolmetin Guacil
- Anagrelide
- Anistreplase
- Apalutamide
- Apixaban
- Argatroban
- Aspirin
- Bemiparin
- Betrixaban
- Bivalirudin
- Bromfenac
- Bufexamac
- Cangrelor
- Caplacizumab-yhdp
- Capmatinib
- Carbamazepine
- Celecoxib
- Choline Salicylate
- Cilostazol
- Citalopram
- Clarithromycin
- Clonixin
- Clopidogrel
- Cobicistat
- Collagenase, Clostridium histolyticum
- Conivaptan
- Dabigatran Etexilate
- Dalteparin
- Danaparoid
- Darunavir
- Desirudin
- Desvenlafaxine
- Dexibuprofen
- Dexketoprofen
- Diclofenac
- Diflunisal
- Dipyridamole
- Dipyrone
- Drotrecogin Alfa
- Droxicam
- Duloxetine
- Edoxaban
- Enoxaparin
- Epoprostenol
- Eptifibatide
- Escitalopram
- Etodolac
- Etofenamate
- Etoricoxib
- Felbinac
- Fenoprofen
- Fepradinol
- Feprazone
- Floctafenine
- Flufenamic Acid
- Fluoxetine
- Flurbiprofen
- Fluvoxamine
- Fondaparinux
- Heparin
- Ibrutinib
- Ibuprofen
- Idelalisib
- Iloprost
- Indinavir
- Indomethacin
- Inotersen
- Itraconazole
- Ketoconazole
- Ketoprofen
- Ketorolac
- Lepirudin
- Levomilnacipran
- Lopinavir
- Lornoxicam
- Loxoprofen
- Lumacaftor
- Lumiracoxib
- Meclofenamate
- Mefenamic Acid
- Meloxicam
- Milnacipran
- Morniflumate
- Nabumetone
- Nadroparin
- Naproxen
- Nefazodone
- Nepafenac
- Nevirapine
- Niflumic Acid
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Nintedanib
- Omadacycline
- Orlistat
- Oxaliplatin
- Oxaprozin
- Oxcarbazepine
- Oxyphenbutazone
- Parecoxib
- Paroxetine
- Pentosan Polysulfate Sodium
- Phenindione
- Phenobarbital
- Phenprocoumon
- Phenylbutazone
- Phenytoin
- Piketoprofen
- Piracetam
- Piroxicam
- Pranoprofen
- Prasugrel
- Primidone
- Proglumetacin
- Propyphenazone
- Proquazone
- Protein C
- Reteplase, Recombinant
- Rifampin
- Ritonavir
- Rofecoxib
- Sarecycline
- Selexipag
- Sertraline
- Sibutramine
- Simeprevir
- St John's Wort
- Streptokinase
- Sulfinpyrazone
- Sulindac
- Telaprevir
- Tenecteplase
- Tenoxicam
- Tiaprofenic Acid
- Ticagrelor
- Ticlopidine
- Tinzaparin
- Tirofiban
- Tolfenamic Acid
- Tolmetin
- Trazodone
- Treprostinil
- Urokinase
- Valdecoxib
- Venlafaxine
- Vilazodone
- Vorapaxar
- Vortioxetine
- Warfarin
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
How much does Xarelto (rivaroxaban) cost?
Xarelto (rivaroxaban) contraindications
Active bleeding
What are alternatives to Xarelto (rivaroxaban)?
Adults:
Lower the risk of stroke and blood clots in people with atrial fibrillation (AFib) not caused by a heart valve problem
Treat blood clots in the legs (deep vein thrombosis (DVT)) or lungs (pulmonary embolism (PE))
Lower the risk of DVT or PE coming back after treatment
Prevent blood clots in people in the hospital or recently released who are at high risk
Lower the risk of serious heart problems, like heart attack or stroke, in people with coronary artery disease (CAD), taken with aspirin
Lower the risk of blood clots and related problems in people with peripheral artery disease (PAD), taken with aspirin
Children:
Treat blood clots and lower the risk of new clots in children from birth to under 18 years old
Prevent blood clots in children 2 years and older with congenital heart disease (CHD) after a Fontan procedure
Prevention and treatment blood clots in the veins
Prevention and treatment blood clots linked to atrial fibrillation (AFib) or heart valve replacement
Prevention of more blood clots and to lower risk of death after a heart attack
Lower the risk of stroke or blood clots in people with atrial fibrillation (AFib) not caused by a heart valve problem
Treat blood clots in the legs (deep vein thrombosis (DVT)) or lungs (pulmonary embolism (PE))
Lower the risk of DVT or PE coming back after treatment
Treat blood clots and lower the risk of new clots in children from birth and older
What is the latest news about Xarelto (rivaroxaban)?
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References
Best studies we foundBrown, M. A., et al. (2013). Coagulation factor Xa. Handbook of Proteolytic Enzymes.
Janssen Pharmaceuticals, Inc. (2025). Xarelto- rivaroxaban tablet, film coated; rivaroxaban tablet, film coated; rivaroxaban kit; rivaroxaban granule, for suspension [package insert]. DailyMed.
Khairat, A., et al. (2023). Epidural Hematoma. StatPearls.
Mathew, P., et al. (2023). Prosthetic Heart Valve. StatPearls.
National Organization for Rare Disorders. (2016). Antiphospholipid Syndrome.
Nemours KidsHealth. (2021). The Fontan procedure.
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