People treated with Xarelto who receive neuraxial anesthesia (such as an epidural) or undergo spinal puncture may develop epidural or spinal hematomas that can lead to long-term or permanent paralysis. These individuals should be monitored for signs of neurological impairment.
Rivaroxaban is also referred to as a “blood thinner,” although it does not actually thin your blood. Xarelto works by inhibiting free factor Xa and prothrombinase activity, which play a role in blood clotting, to help prevent and treat certain blood clots.
Xarelto increases the risk of bleeding, so you have to be careful to avoid injuries while taking it. If you are taking Xarelto, you should stop only under the direction of your healthcare provider.
What Is Xarelto Used For?
Xarelto helps prevent serious health problems that can result from impaired blood flow due to blood clots. It is also used to treat some types of blood clots that have already formed.
Brand Name(s): Xarelto
Drug Availability: Prescription
Therapeutic Classification: Anticoagulant
Available Generically: No
Controlled Substance: N/A
Administration Route: Oral
Active Ingredient: Rivaroxaban
Dosage Form(s): Tablet
The Food and Drug Administration (FDA) has approved Xarelto for the following indications:
Treatment of nonvalvular atrial fibrillation (a type of heart rhythm problem) to reduce the risk of stroke or blood clots in the body Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) To reduce the risk of DVT and/or PE in people who have had one or more of these events and have a risk of recurrent DVT and/or PE after completing initial treatment lasting at least six months To prevent DVT or PE after knee or hip replacement surgery
A combination of symptoms, physical examination, and diagnostic tests can help determine your risk of these types of blood clots––whether you have already experienced a blood clot or not.
How to Take Xarelto
Xarelto is prescribed to be taken once or twice per day, depending on the indication. The 2.5-milligram (mg) and 10-mg tablets can be taken with or without food, and the 15- or 20-mg tablets should be taken with food.
Storage
This medication should be stored at a room temperature of 77 degrees F However, it is OK to expose Xarelto to temperatures between 59 and 86 degrees F.
Off-Label Uses
Healthcare providers may prescribe Xarelto off-label for medical conditions other than those approved by the FDA.
Some of the most common off-label uses are:
After heart surgery After a heart valve or other vascular valve placement To treat blood clots in the heart For children with heart disease or blood clotting disease, or who have undergone heart or vascular surgery At a different dose than recommended
Off-label doses prescribed by your health provider may be beneficial in some instances, but inappropriate dosing can lead to health risks for certain patients.
What Are the Side Effects of Xarelto?
This is not a complete list of side effects, and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 1-800-FDA-1088.
Bleeding is the most common side effect of Xarelto. The extent and effects of bleeding can vary when taking Xarelto.
Minor bleeding without adverse health effects is common. Extensive bleeding can be dangerous.
Common Side Effects
Mild bleeding can manifest with bruising, with or without a known injury. Additionally, prolonged bleeding after a cut can occur while taking Xarelto.
Severe Side Effects
Serious side effects due to taking Xarelto include:
Gastrointestinal (GI) bleeding, which can cause dark stools or vomiting blood Intracranial bleeding, which can cause headaches, seizures, and neurological problems Organ bleeding, which can cause pain, diminished consciousness, or death
These issues require medical treatment. For example, severe GI bleeding can cause blood loss that may necessitate treatment with a blood transfusion.
Long-Term Side Effects
Long-term side effects of taking Xarelto are not common but can occur due to organ damage caused by bleeding.
Dosage: How Much Xarelto Should I Take?
Modifications
If you are pregnant, use Xarelto with caution only when it is needed due to the potential for pregnancy-related hemorrhage and/or emergent delivery. Talk to your healthcare provider to weigh the benefits and risks of treatment while pregnant.
If you experience a serious side effect, you or your provider may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting Program or by phone (800-332-1088).
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
For oral dosage form (tablets): For prevention of deep venous thrombosis (hip replacement surgery): Adults—10 milligrams (mg) once a day for 35 days. The starting dose should be taken at least 6 to 10 hours after surgery. Children—Use and dose must be determined by your doctor. For prevention of deep venous thrombosis (knee replacement surgery): Adults—10 milligrams (mg) once a day for 12 days. The starting dose should be taken at least 6 to 10 hours after surgery. Children—Use and dose must be determined by your doctor. For prevention of reoccurring deep venous thrombosis and pulmonary embolism: Adults—10 milligrams (mg) once a day with or without food after at least 6 months of treatment with a blood thinner medicine. Children—Use and dose must be determined by your doctor. For prevention of heart attack, stroke, and serious heart problems in patients with coronary artery disease: Adults—2. 5 milligrams (mg) 2 times a day together with aspirin (75 to 100 mg once a day), taken with or without food. Children—Use and dose must be determined by your doctor. For prevention of sudden decrease in blood flow to the legs, major amputation, heart attack, and stroke in patients with peripheral artery disease: Adults—2. 5 milligrams (mg) 2 times a day together with aspirin (75 to 100 mg once a day), taken with or without food. Children—Use and dose must be determined by your doctor. For prevention of stroke and blood clots in patients with nonvalvular atrial fibrillation: Adults—15 or 20 milligrams (mg) once a day, taken with the evening meal. Children—Use and dose must be determined by your doctor. For prevention of blood clots in people who are hospitalized for an acute illness: Adults—10 milligrams (mg) once a day in hospital and after hospital discharge for a total recommended duration of 31 to 39 days, taken with or without food. Children—Use and dose must be determined by your doctor. For treatment of deep venous thrombosis and pulmonary embolism: Adults—At first, 15 milligrams (mg) 2 times a day, taken with food for the first 21 days. Then, your doctor may give you 20 mg once a day, taken at the same time each day with food. Children—Use and dose must be determined by your doctor. For treatment and prevention of venous thromboembolism: Children 6 months of age and older weighing 30 kilograms (kg) or more—Dose is base on weight and must be determined by your doctor. Weighing 50 kilograms (kg) or more—20 milligrams (mg) once a day, taken with food. Weighing 30 kg to 49. 9 kg—15 mg once a day, taken with food. Children 6 months of age and older weighing less than 30 kg—Use the oral suspension. Children younger than 6 months of age—Use and dose must be determined by your doctor. For prevention of blood clots in patients with congenital heart disease after Fontan procedure: Children 2 years of age and older weighing 50 kilograms (kg) or more—Dose is base on weight and must be determined by your doctor. The dose usually 10 milligrams (mg) once a day, taken with or without food. Children 2 years of age and older weighing less than 50 kg—Use the oral suspension. Children younger than 2 years of age—Use and dose must be determined by your doctor.
For oral dosage form (suspension): For treatment and prevention of venous thromboembolism: Children 6 months of age and older—Dose is base on weight and must be determined by your doctor. Weighing 50 kilograms (kg) or more—20 milligrams (mg) once a day, taken with food. Weighing 30 kg to 49. 9 kg—15 mg once a day, taken with food. Weighing 12 kg to 29. 9 kg—5 mg 2 times a day, taken with food. Weighing 10 kg to 11. 9 kg—3 mg 3 times a day, taken with food. Weighing 9 kg to 9. 9 kg—2. 8 mg 3 times a day, taken with food. Weighing 8 kg to 8. 9 kg—2. 4 mg 3 times a day, taken with food. Weighing 7 kg to 7. 9 kg—1. 8 mg 3 times a day, taken with food. Weighing 5 kg to 6. 9 kg—1. 6 mg 3 times a day, taken with food. Weighing 4 kg to 4. 9 kg—1. 4 mg 3 times a day, taken with food. Weighing 3 kg to 3. 9 kg—0. 9 mg 3 times a day, taken with food. Weighing 2. 6 kg to 2. 9 kg—0. 8 mg 3 times a day, taken with food. Children younger than 6 months of age and weighing less than 2. 6 kg—Use and dose must be determined by your doctor. For prevention of blood clots in patients with congenital heart disease after Fontan procedure: Children 2 years of age and older—Dose is base on weight and must be determined by your doctor. Weighing 50 kilograms (kg) or more—10 milligrams (mg) once a day, taken with or without food. Weighing 30 kg to 49. 9 kg—7. 5 mg once a day, taken with or without food. Weighing 20 kg to 29. 9 kg—2. 5 mg 2 times a day, taken with or without food. Weighing 12 kg to 19. 9 kg—2 mg 2 times a day, taken with or without food. Weighing 10 kg to 11. 9 kg—1. 7 mg 2 times a day, taken with or without food. Weighing 8 kg to 9. 9 kg—1. 6 mg 2 times a day, taken with or without food. Weighing 7 kg to 7. 9 kg—1. 1 mg 2 times a day, taken with or without food. Children younger than 2 years of age of age and weighing less than 7 kg—Use and dose must be determined by your doctor.
Additionally, this medication may pass into breast milk. Consult with your healthcare provider if you plan on breastfeeding.
Older adults are at higher risk of bleeding events, and so they may be more sensitive to the effects of rivaroxaban.
Missed Dose
If you miss a dose, take the dose as soon as possible on the same day.
If you take 15 mg twice a day and you miss a dose, take the missed dose immediately. In this case, you can take two 15-mg tablets at once if needed to ensure you take 30 mg of Xarelto that day. Continue with your recommended regimen on the following day.
If you take 2.5 mg twice a day and you miss a dose, take a single 2.5-mg dose at the next scheduled time; then resume therapy as usual.
If you take 20 mg, 15 mg, or 10 mg once a day and you miss a dose, take the missed dose as soon as you remember.
Overdose: What Happens If I Take Too Much Xarelto?
Taking too much Xarelto can cause dangerous bleeding complications. The medication is absorbed in the body and binds to the clotting factors rapidly. Andexanet alfa is an FDA-approved reversal agent specifically for life-threatening bleeding associated with rivaroxaban and apixaban, another anticoagulant.
Treatment of a Xarelto overdose involves close medical observation. A healthcare professional may need to treat any bleeding complications. Plasma products might be considered to reduce the risk of bleeding in some instances.
Precautions
What Are Reasons I Shouldn’t Take Xarelto?
You should not take Xarelto if you have active pathological bleeding or have had a severe hypersensitivity reaction (e.g., anaphylactic reaction) to the treatment.
If someone collapses or isn’t breathing after taking rivaroxaban, call 911 immediately.
You may bleed or bruise more easily while you are using this medicine. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Be careful when using sharp objects, including razors and fingernail clippers. Avoid nose picking and forceful nose blowing.
Make sure any doctor or dentist who treats you knows that you are using this medicine.
This medicine may cause bleeding problems. This risk is higher if you have a catheter in your back for pain medicine or anesthesia (sometimes called an “epidural”), or if you have kidney problems. The risk of bleeding increases if your kidney problems get worse. Check with your doctor right away if you have any unusual bleeding or bruising, black, tarry stools, bleeding gums, blood in the urine or stools, tingling, numbness, or weakness of the lower legs, or pinpoint red spots on your skin.
Check with your doctor right away if you have a decreased urine output, confusion, dizziness, nausea, rapid weight gain, swelling of the face, ankles, or hands, or unusual tiredness or weakness after receiving the medicine. These may be symptoms of a serious kidney problem.
Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
Do not suddenly stop taking this medicine without first checking with your doctor. Doing so, may increase your risk of having a stroke.
Make sure your doctor knows if you are pregnant or planning to become pregnant during treatment with this medicine.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John’s wort) or vitamin supplements.
What Other Medications Interact With Xarelto?
Other medications that can prevent blood clots or cause bleeding may increase the risk of harmful side effects if taken with Xarelto. However, in some instances, your healthcare provider might recommend that you continue to take them if necessary.
Additionally, certain medications can affect the action of or be affected by Xarelto due to their chemical interactions.
Medications that can interact with Xarelto include:
Ketoconazole HIV protease inhibitors (e. g. , ritonavir, indinavir) Erythromycin Carbamazepine Phenytoin Rifampin St. John’s wort
Other medications that can add to the risk of bleeding if taken with Xarelto include:
Chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) Aspirin Warfarin Clopidogrel Enoxaparin
Dosing changes may be necessary if you need to take any of these medications along with Xarelto.
What Medications Are Similar?
Several medications can help to prevent blood clots, each with its own mechanism of action.
Medications similar to Xarelto include:
Anticoagulants: Apixaban, edoxaban, warfarin, heparin, enoxaparin Antiplatelet agents: Clopidogrel, aspirin, ticlopidine
These medications all have their own approved indications, but they might be used off-label as well.
Antiplatelet medications use different mechanisms than anticoagulants to prevent blood clots. While anticoagulants work by inhibiting blood clotting proteins, antiplatelet agents prevent platelets from clumping together. Both anticoagulants and antiplatelet medications are often referred to as blood thinners.
Because anticoagulants and antiplatelet medications work differently, your healthcare provider may consider one to be better for your situation than the other. Various aspects of blood clotting tests may also guide or contraindicate the use of a specific blood thinner.
How Can I Stay Healthy While Taking Xarelto?
If you are taking Xarelto, it is important that you reduce your risk of side effects and get medical attention if you develop symptoms of bleeding.
These medications include:
Ketoconazole Ritonavir Erythromycin Carbamazepine Phenytoin RifampinSt. John’s wort
Things you can do to reduce your risk:
Avoid activities with a high risk of falling. Reduce your risk of trauma or injuries, such as in contact sports. Use a cane or walker if you have balance problems. Tell anyone who will perform a procedure on you—such as a medical or surgical procedure, acupuncture, piercing, or tattoo—that you are taking Xarelto.
Also, be sure to follow instructions regarding care for your underlying condition that puts you at risk of blood clots.
