Xarelto

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Jul 15, 2022

Warnings

Xarelto (rivaroxaban) Risks, Warnings, and Complications

Xarelto can cause serious health problems, especially in certain high-risk patients. Some of the risks of Xarelto therapy are described below.

RISK OF BLOOD CLOTS WITH EARLY DISCONTINUATION OF XARELTO: Patients treated with Xarelto should not stop taking this medicine before their doctor says so. Stopping Xarelto too early can increase the risk of blood clots and major thrombotic vascular events like heart attack or stroke, potentially leading to cardiovascular death. The risk is particularly high in patients with heart conditions like atrial fibrillation. If you are taking Xarelto to prevent stroke and systemic embolism (DVT or PE) and want to stop this medication, talk to your healthcare professional about switching to a different anticoagulant (blood thinner medicine).
RISKS ASSOCIATED WITH SPINAL PROCEDURES: Xarelto lowers blood clotting. Taking Xarelto can increase the risk of bleeding around the spine and the formation of epidural blood clots, which can lead to paralysis. The risk of an epidural blood clot is higher in people who receive spinal anesthesia or undergo procedures in the spinal and epidural areas, such as spinal punctures. Risk factors also include an indwelling epidural catheter, a history of spinal surgery, or difficult or repeated epidural or spinal punctures. People taking nonsteroidal anti-inflammatory drugs (NSAIDs) or other blood thinners are also at increased risk of bleeding complications. If you are undergoing a spinal puncture, your healthcare provider will tell you how to stop taking Xarelto safely before your procedure. Call your doctor immediately or go to the nearest hospital emergency room if you notice symptoms such as pain, tingling, numbness, burning, muscle weakness, or inability to urinate.
CHALLENGES WITH REVERSAL OF XARELTO: It can be more difficult to reverse the effects of Xarelto in an emergency compared to other blood thinners such as warfarin. Reversing the effects of Xarelto requires injectable or intravenous medicines. You should tell all your healthcare professionals that you are taking Xarelto. It might be a good idea to wear a medical bracelet that indicates you are on Xarelto.

Discuss the potential benefit versus risk of taking Xarelto with your healthcare provider. If you are at a high risk of complications from Xarelto use, your doctor or pharmacist can help you find other blood thinner medicines for your condition.

Precautions Before Starting Xarelto (rivaroxaban)

Tell your healthcare provider if you have ever had an allergic reaction to Xarelto (rivaroxaban) or any of the active or inactive ingredients in Xarelto tablets, other anticoagulants, or other drugs. Your pharmacy can give you a list of ingredients.

Give your healthcare provider a complete medical history. Xarelto may not be right for people with certain medical conditions. Tell your doctor if you have an artificial heart valve or have had bleeding problems in the past. Also, tell your doctor if you have kidney disease, liver disease, stomach ulcers, or a condition called antiphospholipid syndrome.

Give your doctor a complete list of your medications, including prescription drugs, over-the-counter medicines, vitamins, dietary supplements, and herbal products, especially St. John’s Wort. This can help avoid serious interactions between Xarelto and your other medicines.

Tell your doctor if you are pregnant, undertaking pregnancy planning, or breastfeeding.

Precautions During Use of Xarelto (rivaroxaban)

Keep all your appointments with your healthcare professional while on Xarelto. Your doctor may need to adjust your dose and keep an eye on signs or symptoms of unusual bleeding.

Contact your healthcare professional without delay if you experience any unusual bleeding. Call your doctor or seek emergency medical attention if you suffer any injuries, especially a head injury, while on Xarelto.

Call your doctor if you become pregnant while on Xarelto.

Tell all your healthcare professionals you are on Xarelto. This is especially important before undergoing any medical or dental procedure. Your doctor may ask you to stop taking Xarelto and put you on a different medication to prevent blood clots around your procedure or surgery. Follow your doctor’s directions carefully about stopping and restarting Xarelto.

Xarelto (rivaroxaban) Drug Interactions

Taking Xarelto with other medications can affect how much of the medication stays in your body and how it works. Some drug interactions can increase bleeding risk or the risk of other serious adverse effects, while others can make Xarelto less effective and increase the risk of blood clots. Your physician may choose a different medication for you, change the dose or frequency of one or both medicines, and/or closely monitor you for side effects if there are known interactions between Xarelto and your other medications.

Taking Xarelto and the following medications together may cause problems:

Anti-seizure medications such as carbamazepine (Carbatrol, Tegretol) and phenytoin (Phenytek, Dilantin).
Antibiotics such as erythromycin (Erythrocin, Eryc, Eryped, E.E.S.) and rifampin (Rifadin, Rimactane).
Antifungal agents like ketoconazole (Nizoral).
Antiviral drugs like ritonavir (Norvir, in Kaletra)
Antidepressants including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

This list may not describe all possible Xarelto interactions. Give your healthcare professionals a complete list of your medications, including prescription drugs, over-the-counter medicines, vitamins, dietary supplements, and herbal products, especially St. John’s Wort. Also, tell your health care provider if you smoke, drink alcohol, or use illegal drugs because some of these substances can cause serious health complications when used with prescription drugs.

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