Disclaimer: This article is for informational purposes only and does not constitute medical advice. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition.
Overview
Xarelto is the brand name of rivaroxaban, a prescription anticoagulant (blood thinner) made by Bayer. It makes it harder for blood to clot. It comes as 2.5 mg, 10 mg, 15 mg and 20 mg tablets.
Health Canada has authorized Xarelto for adults to lower the risk of stroke in atrial fibrillation (an irregular heartbeat), to treat deep vein thrombosis and pulmonary embolism and stop them from coming back, and to prevent blood clots after hip or knee replacement surgery. The 2.5 mg dose is used with aspirin in some people with coronary or peripheral artery disease. Xarelto is usually started after a diagnosis, and it needs follow-up.
Xarelto needs a prescription. BC residents can speak with a BC-licensed doctor by phone through Avee Health to ask whether it is appropriate for them. The doctor decides based on your health history. A prescription is not guaranteed. If you already take Xarelto, do not stop it without medical advice.
In Canada, Xarelto is authorized for:
- Preventing stroke and clots elsewhere in the body in people with atrial fibrillation
- Treating deep vein thrombosis (DVT) and pulmonary embolism (PE), and preventing them from coming back
- Preventing blood clots in the veins after planned hip or knee replacement surgery
- Lowering the risk of stroke, heart attack and cardiovascular death in people with coronary artery disease, with or without peripheral artery disease, and preventing clot-related events in people with symptomatic peripheral artery disease (2.5 mg twice a day, taken with aspirin)
- Treating blood clots in children and adolescents under 18 and preventing them from coming back, with doses based on weight and under specialist care
These conditions need a diagnosis first, and the doctor may need blood tests, heart tests or an in-person assessment.
Rivaroxaban
Anticoagulant (factor Xa inhibitor)
cardiovascular
Prescription required
Available
How Xarelto Works
Rivaroxaban blocks factor Xa, a protein the body needs to form blood clots. With less clotting, clots are less likely to form in the heart or the veins, or to travel to the brain or lungs. The same effect means you can bleed more easily. Routine blood tests to measure its effect are not needed, and the INR test cannot be used to judge it.
Dosage Instructions of Xarelto
Your doctor sets your dose. The usual adult doses in the Canadian product monograph are:
- Atrial fibrillation: 20 mg once a day with food. People with moderately reduced kidney function take 15 mg once a day with food.
- Treating DVT or PE: 15 mg twice a day with food for the first 3 weeks, then 20 mg once a day with food.
- Preventing another DVT or PE, after at least 6 months of treatment: 10 mg or 20 mg once a day, depending on your risk.
- After hip or knee replacement: 10 mg once a day, starting 6 to 10 hours after surgery. Treatment lasts 35 days after a hip replacement and 14 days after a knee replacement.
- Coronary or peripheral artery disease: 2.5 mg twice a day, together with 75 mg to 100 mg of aspirin once a day.
With food: always take the 15 mg and 20 mg tablets with food, because food helps your body absorb them. The 2.5 mg and 10 mg tablets can be taken with or without food. If you cannot swallow tablets whole, they can be crushed and mixed with applesauce just before you take them. Eat right after a crushed 15 mg or 20 mg dose.
Kidney or liver problems: tell your doctor about any kidney or liver disease. Xarelto is not recommended for people with very poor kidney function, and it must not be used with liver disease that affects blood clotting.
If you miss a dose:
- 10 mg, 15 mg or 20 mg once a day: take it as soon as you remember, then go back to one tablet a day the next day. Do not take a double dose to make up for a missed one.
- 15 mg twice a day (the first 3 weeks of clot treatment): take the missed tablet right away so that you get 30 mg that day. You may take two 15 mg tablets at the same time.
- 2.5 mg twice a day: skip the missed dose and take the next one at the usual time.
Surgery and dental procedures: when possible, the 10 mg, 15 mg and 20 mg doses are stopped at least 24 hours before a planned procedure, and the 2.5 mg dose at least 12 hours before. Before surgery with a high risk of bleeding, it may be stopped 2 to 4 days ahead. Your doctor decides when to stop and when to restart.
Do not stop Xarelto without medical advice. Stopping any blood thinner early raises the risk of clots and stroke.
Storage Instructions
Store Xarelto as directed on the pharmacy label and the package insert. Keep it out of the reach and sight of children.
Side Effects of Xarelto
Bleeding is the most important side effect. It can happen anywhere in the body, and it is not always easy to see. Other reported effects include anemia, nausea, stomach pain, indigestion, diarrhea, rash, and changes in liver or kidney blood tests.
In clinical trials, major bleeding happened in:
- Atrial fibrillation: 3.60% of people a year on Xarelto, compared with 3.45% on warfarin. Bleeding in the brain was less common with Xarelto (0.49% compared with 0.74% a year).
- Treatment of DVT or PE: 1.0% on Xarelto, compared with 1.7% on enoxaparin followed by a warfarin-type medicine.
- Hip or knee replacement: 0.3% on Xarelto, compared with 0.2% on enoxaparin.
- Coronary or peripheral artery disease: 3.1% on Xarelto plus aspirin, compared with 1.9% on aspirin alone.
Get medical help right away if you have:
- Bleeding that is heavy or will not stop
- Black or bloody stools, vomit that looks like coffee grounds, or blood in the urine
- A sudden bad headache, confusion, weakness or vision changes, which can be signs of bleeding in the brain
- After a spinal or epidural procedure: numbness or weakness in the legs, or loss of bladder or bowel control
- Signs of a serious allergic reaction, such as rash, swelling of the face or trouble breathing
Important Safety Information About Xarelto
- Stopping early: stopping Xarelto or any blood thinner too soon raises the risk of clots and stroke. Do not stop it unless your doctor tells you to.
- Spinal or epidural bleeding: a spinal or epidural anesthetic or a spinal puncture while you take a blood thinner can cause bleeding around the spine, which can lead to long-term or permanent paralysis. Tell every doctor and dentist that you take Xarelto.
- Do not take Xarelto if you have active serious bleeding, a condition with a high risk of bleeding (such as a recent stroke or an active stomach ulcer), liver disease that affects blood clotting, or an allergy to rivaroxaban or another ingredient.
- Pregnancy and breastfeeding: do not take Xarelto if you are pregnant or breastfeeding. Tell your doctor right away if you become pregnant.
- Do not combine it with other blood thinners, such as heparin, warfarin or another anticoagulant tablet, unless your doctor is switching you from one to another.
- Do not combine it with the antifungals ketoconazole, itraconazole or posaconazole, or with the HIV medicines ritonavir or cobicistat.
- Bleeding risk is higher if you have kidney problems, or if you take NSAIDs, aspirin, other antiplatelet drugs, or SSRI or SNRI antidepressants.
- Antiphospholipid syndrome: Xarelto is not recommended for people with this condition who have had a blood clot, because it has been linked to more repeat clots.
- Lactose: the tablets contain lactose. People with a rare inherited lactose or galactose intolerance should not take Xarelto.
Drug Interactions
Tell your doctor, dentist and pharmacist about everything you take, including non-prescription and herbal products. The main interactions are:
- Ketoconazole, itraconazole, posaconazole, ritonavir and cobicistat: must not be taken with Xarelto. They raise the amount of rivaroxaban in the blood.
- Dronedarone: should not be used with Xarelto, because it can raise rivaroxaban levels.
- Erythromycin: can raise rivaroxaban levels in people with reduced kidney function, so it is used with caution.
- Rifampin, phenytoin, carbamazepine and phenobarbital: lower rivaroxaban levels, so Xarelto may not work as well. They are generally avoided.
- Aspirin, NSAIDs (such as ibuprofen and naproxen) and clopidogrel: raise the risk of bleeding. Ask before you take any pain reliever.
- Prasugrel and ticagrelor: not recommended with Xarelto.
- SSRI and SNRI antidepressants: can add to the risk of bleeding.
- Warfarin: the INR blood test is not a reliable measure of Xarelto. If you are switching between the two, your doctor will give you specific instructions.
Brands & DIN Number of Xarelto
Brand Names
Xarelto
Key Takeaways
- 1Xarelto (rivaroxaban) is a blood thinner authorized in Canada to prevent stroke in atrial fibrillation, to treat and prevent DVT and PE, to prevent clots after hip or knee replacement, and for some heart and artery disease.
- 2The 15 mg and 20 mg tablets must be taken with food. The 2.5 mg and 10 mg tablets can be taken with or without food.
- 3If you miss a once-daily dose, take it as soon as you remember and never take a double dose.
- 4Do not stop Xarelto without medical advice, because stopping early raises the risk of clots and stroke.
- 5Bleeding is the main risk. Get medical help right away for heavy bleeding, black stools or a sudden bad headache.
- 6Do not take it if you are pregnant or breastfeeding. Ask your doctor or pharmacist before taking NSAIDs, aspirin or any new medicine.
- 7Xarelto needs a prescription. BC residents can ask a BC-licensed doctor by phone whether it is right for them.
Frequently Asked Questions
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Avee Editorial
Avee Editorial Team