What they are and how to manage them

Xarelto (rivaroxaban) is a prescription brand-name medication. It’s approved by the Food and Drug Administration (FDA) to prevent and treat certain blood clots. Depending on the condition it’s used for, Xarelto may be prescribed for either short-term or long-term use.

Xarelto is specifically approved for use in adults to:

• reduce the risk of blood clots and stroke related to atrial fibrillation that isn’t caused by a heart valve problem
• treat deep vein thrombosis (DVT) or pulmonary embolism (PE), which are types of blood clots
• reduce the risk of developing another DVT or PE in certain people who have already had at least 6 months of initial treatment for DVT or PE
• prevent DVT and PE from developing after knee replacement or hip replacement surgery
• reduce the risk of major heart and blood vessel problems (including heart attack, stroke, or death) in people who have coronary artery disease
• reduce the risk of complications related to blood clots in people with peripheral artery disease
• prevent blood clots in certain people who are hospitalized with an acute (sudden or short-term) medical illness and are at risk for developing blood clots

Xarelto is also approved for use in children to:

• treat venous thromboembolism (VTE) and lower the risk of additional VTEs in children of all ages who have already had at least 5 days of initial blood thinner treatment
• prevent blood clots in children ages 2 years and older who have congenital heart disease and have had the Fontan procedure (a type of open-heart surgery)

Here are some fast facts on Xarelto:

• Active ingredient: rivaroxaban
• Drug class: anticoagulant (blood thinner) that inhibits factor Xa
• Drug forms: oral tablet, oral liquid suspension

Like other drugs, Xarelto can cause side effects. Read on to learn about potential common, mild, and serious side effects. For a general overview of Xarelto, including details about its uses, see this article.

Xarelto can cause certain side effects, some of which are more common than others. These side effects may be temporary, lasting for a few days or weeks. But if the side effects last for longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

These are just a few of the more common side effects reported by people who took Xarelto in clinical trials:

• abdominal (belly) pain
• back pain
• dizziness
• itching
• bleeding (see “Side effect specifics” below)

Mild side effects can occur with Xarelto use. This list doesn’t include all possible mild side effects reported with the drug. For more information, you can refer to Xarelto’s prescribing information.

Mild side effects of Xarelto can include:

• abdominal (belly) pain
• back pain
• itching
• dizziness
• muscle spasms (involuntary muscle tightening)
• trouble sleeping
• anxiety
• depression
• fatigue*
• bleeding*

These side effects may be temporary, lasting for a few days or weeks. But if the side effects last for longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you develop a side effect while taking Xarelto and want to tell the FDA about it, visit MedWatch.

* For more information on this side effect, see “Side effect specifics” below.

Xarelto may cause serious side effects, although these weren’t common in clinical trials. The list below may not include all possible reported serious side effects of the drug. For more information, you can refer to Xarelto’s prescribing information.

If you develop bad or serious side effects while taking Xarelto, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Serious side effects, which are explained in more detail in the “Side effect specifics” section below, include:

• serious or fatal bleeding
• blood clots after stopping Xarelto too soon*
• a spinal or epidural hematoma*
• allergic reaction†

* Xarelto has a boxed warning for this side effect. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Side effect specifics” section below.
† An allergic reaction is possible after using Xarelto. Although this side effect wasn’t reported in clinical trials, allergic reaction has been reported in people taking Xarelto since the drug was approved.

Some side effects were more common in children in Xarelto’s clinical trials. These side effects include bleeding, which was also a common side effect in adults. And the following side effects were not reported in adults, but were reported in children:

• coughing
• vomiting
• inflammation of the stomach and intestines

However, it’s possible for any of Xarelto’s side effects in adults to also occur in children.

In clinical trials of Xarelto, researchers specifically looked at whether side effects in older adults were different from those in younger adults.

In these trials, people 65 years and older were more likely to experience bleeding as a side effect of Xarelto. No other age-related differences in side effects were seen.

If you have questions about Xarelto’s side effects given your age, talk with your doctor or pharmacist. And for more information about bleeding as a side effect of Xarelto, see the “Side effect specifics” section below.

Xarelto may cause several side effects. Here are some frequently asked questions about the drug’s side effects and their answers.

Can Xarelto affect the liver?

It’s not likely. Liver-related side effects weren’t seen in people taking Xarelto in clinical trials.

Since the drug was approved, there have been reports of liver-related side effects in people taking Xarelto. These side effects include liver damage and hepatitis (inflammation in your liver). But it’s unclear how often these side effects may occur and if Xarelto may be the cause.

If you have questions about how Xarelto may affect your liver, talk with your doctor.

What are the side effects of the 20-milligram strength of Xarelto?

In a clinical trial, people who took the 20-milligram (mg) strength of Xarelto reported side effects such as:

• abdominal (belly) pain
• fatigue
• back pain
• muscle spasms (involuntary muscle tightening)
• dizziness
• anxiety
• depression
• trouble sleeping
• itching

In this trial, people took Xarelto to treat either deep vein thrombosis or pulmonary embolism, which are types of blood clots.

If you’re experiencing side effects from taking Xarelto, including the 20-mg strength, talk with your doctor about treatment options.

Is hair loss a side effect of Xarelto?

No, hair loss wasn’t reported as a side effect in people taking Xarelto in clinical trials.

If you have questions about potential hair loss while taking Xarelto, talk with your doctor.

Can Xarelto cause weight gain?

It’s unlikely. In clinical trials, people taking Xarelto didn’t report weight gain as a side effect.

If you have questions or concerns about weight gain while you’re taking Xarelto, talk with your doctor. They can recommend ways to help you maintain a body weight that’s healthy for you.

Are there any side effects of stopping Xarelto treatment?

Yes, it’s possible to experience side effects from stopping Xarelto. In fact, Xarelto has a boxed warning for the risk of blood clots if you stop taking the drug before the recommended duration of treatment. See the “Side effect specifics” section just below for more information about this.

If you have questions about side effects after you stop taking Xarelto, talk with your doctor or pharmacist.

Learn more about some of the side effects that Xarelto may cause.

Fatigue

Fatigue (lack of energy) is a possible side effect of Xarelto.

This side effect was somewhat common in people taking Xarelto in clinical trials. But no one reported severe fatigue or stopped taking Xarelto due to fatigue.

What you can do

If you have fatigue while taking Xarelto, talk with your doctor. They may suggest ways to treat this side effect. If fatigue is affecting your daily life, your doctor may suggest a drug other than Xarelto for you.

Bleeding

Bleeding was the most common side effect reported in people taking Xarelto in clinical trials.

Xarelto is an anticoagulant (blood thinner), which is a drug that makes it harder for your body to form blood clots. So it’s not unusual that the drug increases your risk for bleeding. But it’s important to be aware that Xarelto can cause bleeding anywhere in your body, including internal bleeding. Internal bleeding can affect your organs, such as your stomach, lungs, brain, and eyes.

Xarelto may cause both mild and severe bleeding. In very rare cases, severe bleeding from Xarelto can be fatal. Most people who reported bleeding in clinical trials experienced mild bleeding. This may cause you to bleed or bruise more easily than usual. It may also cause bleeding to take longer than usual to stop.

The following symptoms may indicate more severe bleeding:

• bleeding that lasts for a long time or is heavier than usual
• unexpected bleeding, such as unusual bleeding from the gums
• severe bleeding, or bleeding that you can’t control
• vomiting blood (which may look similar to coffee grounds, in some cases)
• stool that’s red or black and tarry
• brown, red, or pink urine
• coughing up blood or blood clots
• unusual vaginal bleeding or heavy periods
• headache, dizziness, or weakness (which could be symptoms of bleeding in your head or brain)
• new or worsening symptoms at wound sites after you’ve had surgery, such as pain, swelling, or fluid drainage

If you develop severe bleeding, your doctor may treat it with an injection of a drug called Andexxa. This drug works to reverse the effects of Xarelto (specifically, to stop Xarelto from preventing blood clot formation in your body). It’s used to treat severe, uncontrolled, or life threatening bleeding in people taking drugs such as Xarelto.

Note: Xarelto has a boxed warning for bleeding around the brain or spine. A boxed warning is a serious warning from the FDA. See “Risk of spinal or epidural hematoma” below for details.

What you can do

Talk with your doctor about your risk for bleeding while taking Xarelto. It’s also important to monitor yourself for any unusual bleeding or bruising while taking Xarelto. Make sure that you (and any caregivers) know what symptoms to watch for.

If you experience any of the symptoms of severe bleeding listed above, call 911 (or your local emergency number) immediately. Or, go to your nearest emergency room.

Abdominal pain

Xarelto may cause abdominal (belly) pain. This was a somewhat common side effect in people taking Xarelto in clinical trials. But no one reported severe abdominal pain or stopped taking Xarelto due to abdominal pain in these trials.

What you can do

Abdominal pain can be a side effect of Xarelto. But it can also be a symptom of internal bleeding, such as bleeding in your stomach or intestines.*

For this reason, if you have abdominal pain while taking Xarelto, call your doctor. They’ll likely want to examine you to help determine if your pain is a symptom of a more serious side effect. If your abdominal pain is mild and likely not a symptom of bleeding, your doctor may suggest treatments to relieve this side effect.

* For more information on bleeding with Xarelto, see “Bleeding” just above.

Risk of blood clots if you stop taking Xarelto too soon

Xarelto has a boxed warning for the risk of blood clots if you stop taking the drug too soon. A boxed warning is a serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.

If you stop taking Xarelto before the recommended length of treatment, your risk for having a blood clot increases. If you have a condition that affects your arteries or heart, stopping Xarelto also increases your risk for heart attack and stroke. Examples of these conditions include peripheral artery disease and coronary artery disease.

Symptoms of a blood clot vary depending on the location of the clot and may include:

• pain and swelling, which can affect a specific area of the body, such as the calf
• trouble breathing
• nausea
• lightheadedness

For more information about this warning, see Xarelto’s drug label information. You can also talk with your doctor.

What you can do

You should not stop taking Xarelto unless your doctor instructs you to do so.

Sometimes, you may need to temporarily stop taking Xarelto, with your doctor’s approval. This may be recommended before certain dental, medical, or surgical procedures. Your doctor will give you specific dates for when to stop taking Xarelto and when to start taking it again after your procedure. And, in the time leading up to your procedure, your doctor may prescribe a medication other than Xarelto for your condition.

Risk of spinal or epidural hematoma

Xarelto has a boxed warning for risk of spinal or epidural hematoma. A boxed warning is a serious warning from the FDA. It alerts doctors and patients about drug effects that may be dangerous.

If you receive certain injections while taking Xarelto, there’s a risk of bleeding around your spine or brain. These injections include spinal and epidural injections, such as lumbar punctures.

It’s possible that this bleeding around your spine or brain could cause a spinal or epidural hematoma. A spinal hematoma is a buildup of blood around your spine. And an epidural hematoma is a buildup of blood around your brain. These hematomas can cause brain damage or paralysis (an inability to move parts of the body), either of which can be long lasting or permanent.

You may be at higher risk for a spinal or epidural hematoma if you:

• take other medications that affect your body’s ability to form blood clots, including:
  • other blood thinners,* such as aspirin or clopidogrel (Plavix)
  • nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil) or naproxen (Aleve)
• have a history of repeated or difficult spinal or epidural injections
• have a history of spinal surgery or problems with your spine

For more information about this warning, see Xarelto’s drug label information. You can also talk with your doctor.

* Xarelto is also a blood thinner. Blood thinners are also called anticoagulants.

What you can do

If your doctor determines that it’s necessary for you to receive a spinal or epidural injection while you’re taking Xarelto, they’ll monitor you for symptoms of bleeding around your brain or spine. These symptoms may include:

• loss of control over your bladder or bowels
• back pain
• numbness
• tingling
• muscle weakness

Numbness, tingling, and muscle weakness are particularly likely to affect your feet and legs.

If you have any of the above symptoms while taking Xarelto, talk with your doctor immediately.

Allergic reaction

As with most drugs, Xarelto can cause an allergic reaction in some people. This side effect wasn’t reported in clinical trials, but it has been reported since the drug was approved.

Symptoms can be mild or serious and can include:

• rash
• itching
• flushing
• swelling under your skin, typically in your lips, eyelids, feet, or hands
• swelling of your mouth, tongue, or throat, which can make it hard to breathe

What you can do

For mild symptoms of an allergic reaction, call your doctor right away. They may recommend ways to ease your symptoms and determine whether you should keep taking Xarelto. But if your symptoms are serious and you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Below are precautions to be aware of before you begin taking Xarelto.

Boxed warnings

This drug has boxed warnings. These are serious warnings from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

• Risk of blood clots if you stop taking Xarelto too soon. Stopping treatment with Xarelto increases your risk for having a blood clot.
• Risk of spinal or epidural hematoma. Getting a spinal or epidural injection while you’re taking Xarelto could cause bleeding around your spine or brain. This could result in either a spinal or epidural hematoma. This refers to a buildup of blood around your spine or brain.

For details, see the “Side effect specifics” section above.

Other precautions

Be sure to talk with your doctor about your health history before you take Xarelto. This drug may not be the right treatment for you if you have certain medical conditions or other factors that affect your health. The conditions and factors to consider include:

• Bleeding problems. You should not take Xarelto if you have any active abnormal bleeding or an increased risk for bleeding. This may apply if you’re having cancer treatment or you have a stomach ulcer. Taking Xarelto increases your risk for bleeding. So if you have a history of bleeding problems, talk with your doctor about whether Xarelto is right for you.
• An artificial heart valve. You should not take Xarelto if you have an artificial heart valve. In a clinical trial, Xarelto increased the risk of side effects when used in people with a specific type of artificial heart valve. And Xarelto hasn’t been studied with most other types of artificial heart valves. Talk with your doctor about treatments other than Xarelto that may be safer for you.
• Kidney problems. Xarelto may build up in your body if your kidneys aren’t working well. If you have kidney problems, you may need to take a lower dosage of Xarelto than usual. Or, your doctor may recommend a different medication that’s safer for you. Talk with your doctor about whether Xarelto is safe for you to take if you have kidney problems. Xarelto usually won’t be prescribed for use in children who have kidney problems.
• Liver problems. If you have moderate to severe liver problems, you should not take Xarelto. And you should avoid taking Xarelto if you have a blood clotting condition that’s related to a liver problem. Before taking Xarelto, talk with your doctor about your history of liver problems. Xarelto typically is not prescribed for use in children who have liver problems.
• Pulmonary embolism (PE) requiring treatment to dissolve the clot. Xarelto shouldn’t be used to treat PE that needs surgery or medication to dissolve the clot. But the drug may be used to treat PE in other cases (see this article for details). If you’re taking Xarelto to treat PE, be sure to talk with your doctor about whether Xarelto is right for your specific type of PE.
• Triple-positive antiphospholipid syndrome (APS). If you have APS, taking Xarelto increases your risk for developing blood clots. Make sure that your doctor knows about your condition. They can recommend a medication other than Xarelto for you.
• Allergic reaction. You shouldn’t take Xarelto if you’ve ever had an allergic reaction to the drug or any of its ingredients. Talk with your doctor about which other treatments are better choices for you.

Alcohol use with Xarelto

Alcohol isn’t known to interact with Xarelto. However, drinking large amounts of alcohol while taking Xarelto can increase your risk for bleeding, especially in your stomach or digestive tract.

If you drink alcohol, talk with your doctor about how much is safe for you to drink while you’re taking Xarelto.

Pregnancy and breastfeeding while taking Xarelto

Pregnancy. Taking Xarelto during pregnancy can increase the risk of bleeding in both the pregnant person and the fetus. The drug can also increase the risk of pregnancy-related hemorrhage (excessive bleeding) and complications with labor and delivery.

For these reasons, blood thinners other than Xarelto are usually prescribed for use during pregnancy. But Xarelto may be prescribed during pregnancy if your doctor determines that the drug’s benefits outweigh its risks. Talk with your doctor if you become pregnant or plan to become pregnant while taking Xarelto.

Breastfeeding. Xarelto has been shown to pass into breast milk. But the drug’s potential effects on a breastfed child aren’t known. If you’re breastfeeding, be sure to talk with your doctor before you take Xarelto. They can help determine whether this is safe for you and your child.

Xarelto is approved to help prevent and treat certain blood clots. If you’d like to learn more about Xarelto, talk with your doctor or pharmacist. They can help answer any questions you have about side effects from taking the drug.

Besides talking with your doctor, you can do some research on your own. These articles might help:

• More information about Xarelto. For details about other aspects of Xarelto, refer to this article.
• Drug comparison. To learn how Xarelto compares with Eliquis, you can see this article.
• Dosage. For information about the dosage of Xarelto, view this article.
• Interactions. To find out about Xarelto’s interactions, see this article.
• Cost. For information about the cost of Xarelto treatment, you can refer to this article.
• A look at cardiovascular health. For details about the conditions Xarelto is used for, our cardiovascular health hub may be helpful.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Xarelto oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Warnings:

Do not stop taking rivaroxaban unless directed by your doctor. If you stop taking this medication early, you have a higher risk of forming a serious blood clot (such as a stroke, blood clot in the legs/lungs). Your doctor may direct you to take a different “blood thinning” or antiplatelet medication to reduce your risk. Get medical help right away if you have weakness on one side of the body, trouble speaking, sudden vision changes, confusion, chest pain, trouble breathing, or pain/warmth/swelling in the legs.

People taking this medication may bleed near the spinal cord after certain spinal procedures. Bleeding in this area can cause paralysis that lasts a long time or could become permanent. Before any spinal procedure, ask your doctor about the benefits and risks. The risk of bleeding may be higher if you have a deformed spine, or have had spinal procedures/surgery before (such as epidural catheter placement, difficult epidural/spinal puncture), or are taking other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, “blood thinners” such as warfarin/enoxaparin, nonsteroidal anti-inflammatory drugs-NSAIDs such as ibuprofen). Tell your doctor right away if you notice symptoms such as back pain, leg numbness/tingling/weakness, loss of control of the bowels or bladder (incontinence).

How to use Xarelto

Read the Medication Guide provided by your pharmacist before you start taking rivaroxaban and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth as directed by your doctor. If you are taking this drug to prevent strokes and blood clots that may form due to an irregular heartbeat, the dose is usually taken once a day with the evening meal. If you are taking this medication to prevent blood clots due to other conditions (such as after knee or hip replacement surgery, during a hospital stay and after discharge, after Fontan procedure), the dose is usually taken once a day. For adults taking rivaroxaban to treat blood clots, the dose is usually taken twice a day for the first 3 weeks, and then once a day. For children taking rivaroxaban to treat blood clots, the dose is usually taken once a day. If you are taking this medication to lower the risk of blood clots from forming again, the dose is usually taken once a day. Carefully follow your doctor’s directions. Do not increase your dose, take it more often, or stop taking it unless you are told to do so by your doctor.

The 10 milligrams tablet may be taken with or without food. The 15 milligrams and 20 milligrams tablet should be taken with food. If you have any questions about how to take rivaroxaban, ask your doctor or pharmacist.

If you are unable to swallow whole tablets, you may crush the tablet and mix it with applesauce. Eat the entire mixture right away. Do not prepare a supply for future use.

If you are giving this medication through a tube into the stomach (nasogastric or gastric tube), ask your health care professional for detailed instructions on how to properly mix and give it.

The dosage and length of treatment is based on your medical condition and response to treatment. For children, the dosage is also based on weight.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.

Side Effects

See also Warning section.

Easy bruising or minor bleeding (such as nosebleed, bleeding from cuts) may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This medication can cause serious bleeding if it affects your blood clotting proteins too much. Tell your doctor right away if you have any signs of serious bleeding, including: nosebleeds that happen often or don’t stop, unusual tiredness/weakness, unusual pain/swelling/discomfort, unusual bruising, prolonged bleeding from cuts or gums, unusually heavy/prolonged menstrual flow, pink/dark urine, coughing up blood, vomit that is bloody or looks like coffee grounds, severe headache, dizziness/fainting, bloody/black/tarry stools, difficulty swallowing.

Get medical help right away if you have any signs of very serious bleeding, including: vision changes, confusion, trouble speaking, weakness on one side of the body.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US – Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before taking rivaroxaban, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: cancer, liver disease, kidney disease, bleeding problems (such as bleeding of the stomach/intestines, bleeding in the brain), stroke, artificial heart valves, recent major injury/surgery, blood disorders (such as anemia, hemophilia, thrombocytopenia), frequent falls/injuries, certain eye problem (retinopathy), a certain clotting disorder (antiphospholipid syndrome), certain hereditary enzyme problems (such as galactose intolerance, Lapp lactase deficiency, glucose-galactose malabsorption).

Before having surgery or any medical/dental procedures (especially spinal puncture or spinal/epidural anesthesia), tell your doctor or dentist that you are taking this medication and about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). Your doctor or dentist may tell you to stop taking rivaroxaban before your surgery. Ask for specific instructions about stopping or starting this medication.

This medication may cause stomach bleeding. Daily use of alcohol while using this medicine will increase your risk for stomach bleeding. Limit alcoholic beverages. Ask your doctor or pharmacist about how much alcohol you may safely drink.

This medication can cause heavy bleeding. To lower the chance of getting cut, bruised, or injured, use caution with sharp objects like razors and nail cutters, and avoid activities such as contact sports. Use an electric razor when shaving and a soft toothbrush when brushing your teeth. If you fall or injure yourself, especially if you hit your head, call your doctor right away. Your doctor may need to check you.

Older adults may be more sensitive to the side effects of this drug, especially bleeding.

Tell your doctor if you are pregnant or if you plan to become pregnant. During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor before using this medication.

This medication may pass into breast milk. Consult your doctor before breast-feeding.

Consult your pharmacist or physician.

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Some products that may interact with this drug include: mifepristone, other drugs that can cause bleeding/bruising (including antiplatelet drugs such as clopidogrel, NSAIDs such as ibuprofen/naproxen, “blood thinners” such as warfarin/enoxaparin), certain antidepressants (including SSRIs such as fluoxetine, SNRIs such as desvenlafaxine/venlafaxine).

Other medications can affect the removal of rivaroxaban from your body, which may affect how rivaroxaban works. Examples include cobicistat, conivaptan, dronedarone, ritonavir, certain azole antifungals (itraconazole, ketoconazole, posaconazole), HIV protease inhibitors (such as lopinavir), rifamycins (such as rifampin), St. John’s wort, drugs used to treat seizures (such as carbamazepine, phenytoin, phenobarbital), among others.

Aspirin can increase the risk of bleeding when used with this medication. However, if your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually 81-162 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.

Does Xarelto interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: bloody/black/tarry stools, pink/dark urine, unusual/prolonged bleeding.

Do not share this medication with others.

Lab and/or medical tests (such as hematocrit/hemoglobin, red blood cell count) may be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

If you are taking this medication once a day and miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

If you are taking this medication twice a day and miss a dose, take it as soon as you remember. If you missed the morning dose and it is near the time of the evening dose, you may take both doses together. Then take your next dose at the regular time.

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Use/discard the crushed tablet mixture within 4 hours. (See also How to Use section.)

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Images

Xarelto 20 mg tablet

Color: dark redShape: triangularImprint: logo and 20 Xa

This medicine is a dark red, triangular, film-coated, tablet imprinted with “logo and 20” and “Xa”.

Xarelto 10 mg tablet

Color: light redShape: roundImprint: logo and 10 Xa

This medicine is a dark red, triangular, film-coated, tablet imprinted with “logo and 20” and “Xa”.

Xarelto 15 mg tablet

Color: redShape: roundImprint: logo and 15 Xa

This medicine is a dark red, triangular, film-coated, tablet imprinted with “logo and 20” and “Xa”.

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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

Do blood thinners (anticoagulants) prevent blood clots in people hospitalized with COVID-19?

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Key messages

– High doses of “blood thinning” drugs have little or no effect on death rates and increase minor bleeding rates compared to low doses in people hospitalized with COVID-19. The use of blood thinners (anticoagulants) compared to no use may reduce the rate of death.

– It is likely that new studies will not change the evidence for the effects of different doses of “blood thinning” drugs on death rates and minor bleeding. High-quality studies are still needed to analyze the need for additional respiratory support, the use of “blood thinner” drugs versus no use, the comparison of different “blood thinner” drugs, and their long-term use.

What is COVID-19?

COVID-19 usually affects the lungs and airways, however, in addition to respiratory problems, about 16% of people hospitalized with COVID-19 have problems with the blood and blood vessels, leading to the formation of blood clots (thrombi) in the arteries, veins and lungs. Nearly half of people with severe COVID-19 in intensive care units may develop blood clots in their veins or arteries.

What are blood thinners?

Blood thinners are medicines that prevent dangerous blood clots (deep vein thrombosis) from forming. However, they can cause unwanted effects such as bleeding. Some guidelines recommend giving blood thinners the first time people with COVID-19 are admitted to the hospital to prevent clots from forming, rather than waiting for clots (blood clots) to form and then treating them with blood thinners.

What did we want to find out?

We wanted to know if the prophylactic use of blood thinners in people hospitalized with COVID-19 reduces the number of deaths compared to people who did not receive them or received a placebo (an identical treatment but without the active substance). We also wanted to know if these people needed less breathing support, if they did develop blood clots, if they were bleeding, and if they had other adverse events.

What have we done?

We searched for studies that evaluated blood thinners used in people hospitalized with COVID-19 to prevent blood clots. The studies could be of any design, as long as they compared one blood thinner to another blood thinner, or to no treatment or to a placebo (dummy). Studies could be conducted anywhere in the world, and participants could be of any age, as long as they were in a hospital with a confirmed COVID-19 disease. We have combined the results where appropriate.

What did we find?

We included seven studies involving 16,185 people admitted to intensive care units, hospital wards, or emergency departments with COVID-19. The studies were conducted in Brazil (2), Iran (1), Italy (1) and the USA (1), and two studies included participants from more than one country. The age of the people participating in the studies ranged from 55 to 68 years. The studies lasted from 15 to 90 days, their results presented data on death, bleeding, blood clots, length of hospital stay, and adverse effects. There was little or no data on the need for respiratory support (help with breathing), COVID-19 related deaths and quality of life.

Higher dose of “blood thinning” drugs than lower dose (4 studies, 4647 people)

In people who received higher doses of blood thinners compared to lower doses, there was virtually no difference in the frequency of death. However, people who took higher doses were more likely to experience minor bleeding compared to those who took lower doses. People who received higher doses of blood thinners may have had fewer cases of pulmonary embolism (a blood clot in the lungs or in a blood vessel leading to the lungs), slightly more major (more severe) bleeding, and probably had little or no there was no difference in length of stay in the hospital compared to those who received lower doses of blood thinners. People who received higher doses of blood thinners had little or no difference in the incidence of deep vein thrombosis and other adverse events compared to those who received lower doses of blood thinners.

Blood thinners versus no treatment (3 studies, 11,538 people)

Those who received blood thinners had a lower rate of death compared to those who did not, but the evidence is highly uncertain.

What are the limitations of this evidence?

We strongly believe that higher doses of blood thinners do not change the risk of death but increase the risk of bleeding in people hospitalized with COVID-19.

Although our certainty in the evidence is very limited, people who receive blood thinners may have a lower rate of death than those who do not.

What’s next?

The search identified 62 ongoing studies with 35,470 participants. We plan to add the results of these studies to our review when they are published.

How relevant is this evidence?

Evidence is current to 14 April 2021.

If you found this evidence helpful, please consider donating to Cochrane. We are a charity that produces accessible evidence to help people make health and care decisions.

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Translation notes:

Translation: Airat Usmanovich Ziganshin. Editing: Ziganshina Lilia Evgenievna. Project coordination for translation into Russian: Cochrane Russia – Cochrane Russia on the basis of the Russian Medical Academy of Continuing Professional Education (RMANPE). For questions related to this transfer, please contact: [email protected]

top 5 list according to the KP version with instructions for use, doctors’ reviews, prices

The active ingredient of Xarelto is rivaroxaban. It reduces the production of the protein thrombin, with the participation of which platelets “stick together” and blood clots form. Xarelto is used to treat and prevent diseases that are accompanied by increased blood viscosity: thrombosis, thromboembolism, stroke, myocardial infarction.

List of top 5 Xarelto analogues according to KP version

Our list contains Xarelto analogues with different mechanism of action and dosage, so only a doctor can recommend a medicine that will not harm your health and provide the desired result.

Eliquis

Its active ingredient is the anticoagulant apixaban. Like rivaroxaban, it helps to “slow down” the production of the thrombin protein and prevent the formation of blood clots. Available in tablets with a dosage of 2.5 and 5 mg.

Contraindications for use: active bleeding and a tendency to them, hypersensitivity to the components of the drug, impaired renal function, pregnancy, lactation, age up to 18 years.

Pradaxa

Pradaxa contains dabigatran etexilate, a direct anticoagulant that reduces the activity of the thrombin protein and prevents the formation of blood clots. According to the mechanism of action, Pradaxa is slightly different from Xarelto, but is indicated for the same diseases. The drug is prescribed for the treatment and prevention of strokes, heart attacks, venous and systemic thromboembolism, deep vein thrombosis. Release form – capsules with a dosage of 150 mg.

Pradaxa should not be taken by pregnant and lactating women, children and adolescents under 18 years of age, people with kidney failure, liver dysfunction, active bleeding.

Warfarin

Warfarin helps block the production of proteins in the liver that increase blood clotting. As a result, the concentration of these proteins in the body decreases, and the formation of blood clots slows down. Release form – tablets 2.5 mg.

Warfarin is contraindicated in people with or with a tendency to bleed, severe liver and kidney problems, severe DIC and thrombocytopenia, and pregnant women.

Warfarex

The active ingredient of the drug is warfarin sodium, an indirect anticoagulant. Warfarex acts in the liver and helps slow down the synthesis of proteins that increase blood clotting. The drug is prescribed for the prevention and treatment of deep vein thrombosis, pulmonary embolism and myocardial infarction. Varfarex release form – tablets with a dosage of 5 mg.

The drug is contraindicated in cases of bleeding and the threat of their development, severe renal and hepatic insufficiency, hemorrhagic diathesis, thrombocytopenia, severe DIC, stroke, exacerbation of gastric and duodenal ulcers, pregnancy and age up to 18 years.

Phenylin

The mechanism of action of Phenylin is similar to that of Warfarin. The active substance phenindione reduces the production of proteins that are formed in the liver and are further involved in the formation of blood clots. It is used for the prevention and treatment of thromboembolism, thrombophlebitis, thrombosis, myocardial infarction. Available in tablets with a dosage of 30 mg.

Contraindications: should not be taken with hemorrhagic diathesis, anemia, severe kidney and liver diseases, anemia, stomach and duodenal ulcers, during pregnancy and lactation.

How to choose a Xarelto analogue

Xarelto analogue must be selected by a doctor. First of all, the doctor will take into account the reason why Xarelto was prescribed, as well as the patient’s state of health, what medications he is already taking. In most cases, before prescribing an analogue, blood tests are studied to assess the state of the coagulation system.

Frequently Asked Questions

Blood clotting is a very common problem, especially among people over 40 years of age. Therefore, the issues of taking and replacing drugs for blood thinning are of interest to many people. Our expert answers popular questions — PhD, endocrinologist, nutritionist, therapist Tatyana Gudozhnikova.

When Xarelto analogs can be used

– Xarelto analogs are used:

• for the prevention and treatment of venous thrombosis and pulmonary embolism;
• to prevent blockage of blood vessels by blood clots in hypertension, stroke, diabetes, heart failure;
• to prevent thrombosis after replacement of joints of the lower extremities and heart valves;
• in the complex therapy of patients with coronavirus infection.