What is Xarelto: Uses, Warnings & Interactions

How to take Xarelto

Xarelto is available in tablet form and dosages vary depending on treatment and severity of the clotting risk. Depending on need, Xarelto tablets come in four strengths: 

• 2.5 mg

• 10 mg

• 15 mg

• 20 mg

The medication will begin thinning blood within a few hours after taking the first dose. If a patient stops taking it, Xarelto will wear off within 24 hours. Follow doctor orders and the instructions given with Xarelto on how to take the medication. 

The following list outlines standard dosages prescribed for various conditions: 

• AFib: 15-20 mg once a day with food

• DVT/PE treatment: 15 mg twice a day with food for 21 days, and then 20 mg once a day with food

• DVT/PE risk reduction: 10 mg once a day

• Coronary/pulmonary artery disease: 2.5 mg twice a day combined with aspirin

Since Xarelto is usually taken once or twice a day, it is safe to take it every day unless told otherwise by the healthcare provider prescribing the pill. 

If you have trouble swallowing pills, you can crush Xarelto tablets and mix them with soft foods to eat, like applesauce, immediately prior to use. However, it would be best if you only did this as necessary. If possible, swallow the pill whole. 

Lower dosages (2.5 and 10 mg) of Xarelto can be taken without regard to food, but it is often recommended to take them with meals if possible. If the prescription is for one pill each day, it's recommended to take it with dinner. If taken twice a day, doctors recommend taking it with breakfast and the evening meal. 

It's crucial never to stop taking Xarelto without a doctor's permission. Xarelto can cause complications if stopped suddenly, so doctors must help wean patients off the drug. 

There may be some withdrawal symptoms after stopping Xarelto. Symptoms may occur within 12 to 24 hours but will stop within a week. Withdrawal symptoms from Xarelto can include: 

• Headache

• Dizziness and nausea

• Fatigue

• Heart palpitations

• High blood pressure

It is possible to overdose on Xarelto, and the consequences can be fatal. If a patient ingests more rivaroxaban than prescribed, they can develop excessive bleeding. This is a possibly deadly complication. 

Xarelto doesn't come with specific instructions for storing the medication. Patients should store the pills at room temperature and away from moisture and high heat. The medication should also be kept out of reach of young children, as well as separated from other medications (preferably in its own bottle) to avoid accidental excess ingestion. 

What to do if you miss a dose of Xarelto

If you miss a dose of Xarelto and are taking the 15 mg twice daily regimen, take the dose as soon as you remember on the same day to ensure 30 mg is consumed. If you miss a dose and are taking 2.5 mg twice daily, skip the missed dose and resume doses at the next scheduled time. For other regimens of once daily Xarelto, take the missed dose as soon as remembered and then resume doses normally the following day. If you forget to take it for more than 24 hours, contact your healthcare provider or pharmacist for instructions. 

Xarelto contraindications

• Xarelto should only be taken by those who need to reduce blood clot risks from a cardiovascular or blood vessel condition. 

• While there aren't sufficient clinical studies regarding Xarelto used by pregnant women, it may cause bleeding in the fetus or the mother. Patients who are pregnant or plan to become pregnant should talk with their healthcare professional before starting Xarelto and likely will be prescribed alternative anticoagulants with more information available in this population. Breastfeeding might also not be safe while taking this anticoagulant.

Xarelto warnings

There are two significant warnings surrounding the use of Xarelto. 

• Stopping the use of the medication too early could increase the risk of a severe blood clot. 

• The also warns that epidural and spinal hematomas have occurred in patients who took Xarelto while undergoing a spinal puncture and receiving neuraxial anesthesia. The result can be permanent paralysis. 

If you're scheduled for surgery, stop taking Xarelto at least two to three days before major procedures and one day before minor procedures. Patients can resume the medication after surgery. There is a reversal agent for life-threatening bleeding due to Xarelto available as an IV infusion, which is used in conjunction with standard supportive measures. 

In a March 2019 settlement between Johnson & Johnson and Bayer, Xarelto users resolved more than 25,000 lawsuits. The suit claimed that manufacturers did not warn users of serious side effects, including uncontrollable bleeding and hemorrhaging. The severe side effects are now listed on the medication's warning label. 

Xarelto interactions

There are no dietary restrictions required when using Xarelto so you can continue your diet as usual. However, drinking alcohol while taking Xarelto can increase your risk of bleeding. Drinking alcohol thins the blood. On top of that, the liver's metabolic changes caused by drinking can also alter Xarelto's effectiveness. 

It is recommended to abstain from alcohol while being treated for clotting risks with a blood thinner. 

There are a few potential drug interactions with the blood-thinning medication. 

• Anticoagulants and Xarelto: Taking another blood-thinning medication with Xarelto can significantly increase your risk of uncontrolled bleeding.

• Aspirin and Xarelto: Unless your doctor prescribes it, avoid taking aspirin while on Xarelto. Aspirin thins the blood, which significantly increases the risk of bleeding when added to Xarelto. However, doctors may prescribe a low-dose aspirin regimen with a low dose of Xarelto.

Xarelto interacts with various drugs that thin the blood. If your doctor wants to prescribe Xarelto, it's essential to let them know if you take any of the following medicines, as they may cause severe interactions: 

• Clarithromycin

• Defibrotide

• Eliquis

• Nizoral

• Ritonavir

• Savaysa

• Warfarin (coumadin)

• Zydelig

What should you not take with Xarelto? 

Avoid most pain relievers or nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, naproxen, Excedrin, and ibuprofen. If you need a pain-relieving medication, acetaminophen (Tylenol) does not have known interactions with Xarelto. 

Avoid taking Pepto-Bismol with Xarelto, as it can also increase the risk of bleeding. Certain heartburn medicines are also not safe to ingest with Xarelto, including cimetidine. However, the following heartburn and acid reflux medications are safe: 

• Famotidine (Tums, Pepcid)

• Omeprazole (Prilosec)