Xarelto (Rivaroxaban)
Xarelto
Rivaroxaban
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Rivaroxaban (Generic)
Rivaroxaban
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Prescription Required.
Product of Canada.
Express Ships from Canada.

Xarelto (Rivaroxaban)

What is Xarelto (Rivaroxaban)?

Xarelto (rivaroxaban) is an anticoagulant medication that is used to treat blood clots in individuals with pulmonary embolism or deep vein thrombosis. It is also used to prevent blood clot formation in those who have recently experienced DVT or PE, as well as in those who have recently had a knee replacement or total hip replacement. This medication may also be prescribed for blood clot and stroke prevention in patients with atrial fibrillation, among other conditions.

How is Xarelto Used?

This medication is available in tablet form and is taken orally for the treatment of a variety of conditions associated with blood clots and to prevent clotting-related issues in those with certain cardiovascular conditions or that have recently had knee or hip replacements.

Typically, this medication is taken once or twice per day as instructed by the patient’s physician. Low doses of the medication may be used alongside an aspirin regimen in the prevention of blood clots, heart attack, stroke, and death in those with CAD.

Storage

This medication should be stored at room temperature, ranging between 68°F (20°C) and 77°F (25°C). If needed, due to travel or other such conditions, this medication may be temporarily exposed to temperatures as low as 59°F (15°C) or as high as 86°F (30°C).

Keep this medication out of the reach of children and pets at all times.

Uses

Xarelto is prescribed for the following purposes in adults:

  • to reduce the risk of blood clots and strokes in patients with non-valvular atrial fibrillation
  • treatment of deep vein thrombosis
  • treatment of pulmonary embolism
  • to reduce the risk of pulmonary embolism or deep vein thrombosis re-occurring after a patient has already been treated for these conditions
  • prevention of deep vein thrombosis or pulmonary embolism in patients that have had a knee or hip replacement
  • prevention of venous thromboembolism and death associated with this condition in those that have recently been or are currently hospitalized with acute illness
  • to reduce the risk of serious heart-related issues occurring in those with coronary artery disease
  • to reduce the risk of both blood clots and clot-related issues in those with peripheral artery disease

It may also be prescribed for the following uses in pediatric patients:

  • the prevention of blood clots in pediatric patients with congenital heart disease that have had a certain type of open-heart surgery known as “the Fontan procedure”
  • treatment of venous thromboembolism and to prevent its reoccurrence after the patient has already received another blood thinning medication for five days

Dosage

Xarelto is available in tablet form in the following strengths:

  • 5 mg
  • 10 mg
  • 15 mg
  • 20 mg

Patients using this medication to treat pulmonary embolism or deep vein thrombosis will most commonly take a twice-daily dose of 15 mg for a 21-day period and then change to a once-daily dose of 20 mg for a period of six months. It is recommended that patients on this particular dosing schedule take their daily doses with food and keep the twice-daily doses scheduled 12 hours apart.

Individuals with nonvalvular atrial fibrillation that are using this medication to reduce their risk of systemic embolism or stroke will typically be prescribed a once-daily dose of 20 mg to be taken in the evenings with a meal.

Patients that are having orthopedic surgery performed and that are administered Xarelto for the prevention of DVT and PE will take their first dose of the medication within six to ten hours after surgery. Those who had a hip replacement performed will most commonly take a once-daily dose of 10 mg for a period of 35 days. Those who had knee replacement surgery will also take a once-daily dose of 10 mg but only for a period of 12 days after surgery.

When used in the prevention of PE or DVT in those who have just recently had one of these conditions occur, these patients will commonly take a once-daily dose of 20 mg after their initial 6-month treatment period.

Overdose

If an overdose has occurred or is suspected, the patient should be sure to contact their local Poison Control Center or prescribing physician for guidance. Although an overdose of this medication may not be immediately life-threatening, too much of this medication may result in excessive bleeding and become fatal if an injury were to occur.

If someone has overdosed on this medication and stops breathing or loses consciousness, emergency medical attention should be sought immediately.

Side Effects

The most common side effects are as follows and should be discussed with your doctor if they remain persistent or increase in severity:

  • bleeding
  • bruising
  • constipation
  • decreased levels of energy
  • diarrhea
  • headaches
  • heartburn
  • menstrual bleeding that becomes heavier
  • nausea
  • stomach cramps
  • vomiting
  • weakness

Some of the following side effects may also occur while using this medication and require immediate medical attention due to the potential health risks such symptoms may indicate:

  • anemia symptoms
    • breathing difficulties
    • dizziness
    • fatigue
    • pale skin
    • unusual weakness
  • bleeding symptoms
    • bleeding gums after brushing your teeth
    • blood in the urine
    • coughing up blood
    • excessive menstrual bleeding
    • nose bleeds that last longer than usual
    • rectal bleeding or hemorrhoids that bleed
  • bleeding from a surgical wound
  • bruising or bleeding after a surgery that is not typical or expected
  • decreased urine production
  • fever
  • infection symptoms
    • chills
    • diarrhea (severe)
    • dizziness
    • fever
    • listlessness
    • neck stiffness
    • shortness of breath
    • weight loss
  • joints that are painful, sore, hot, or stiff
  • loss of consciousness
  • low blood pressure
  • numbness, swelling, or pain in the arms or legs
  • itchy skin
  • rapid heart rate
  • reddish tint in one’s urine
  • skin rash
  • symptoms of liver problems
    • appetite loss
    • dark-colored urine
    • diarrhea
    • jaundice (yellowing of the eyes or skin)
    • nausea
    • pale-colored stools
    • vomiting
    • weight loss
  • symptoms that would indicate unidentified or internal bleeding
    • dizziness
    • headache
    • paleness
    • unexplained swelling
    • weakness
  • vaginal bleeding in those who are post-menopausal

Please seek out immediate medical assistance if you experience any of the following symptoms, and stop using Xarelto immediately:

  • severe allergic reaction symptoms
    • breathing difficulties
    • hives
    • swelling of the throat and face
  • severe skin reactions
    • blistering
    • peeling
    • rash accompanied by pain or fever
    • rash that covers a significant amount of the body
    • rash that rapidly spreads
  • seizures
  • stomach bleeding symptoms
    • stools that are tarry, black, or bloody
    • spitting up blood
    • vomiting blood or what looks like coffee grounds
  • stroke symptoms
    • changes in vision
    • severe or sudden headache
    • sudden loss of coordination
    • sudden slurring of speech
    • unexplained pain, numbness, or weakness in one’s leg or arm

Warnings & Precautions

Bleeding Risk

This medication is associated with an increased risk of bleeding. Patients with a history of other health conditions that increase their bleeding risk should exercise caution when using this medication and be sure to inform their prescribing physician of all relevant health history related to these conditions as this may affect their treatment plan, any special monitoring requirements, and the safety and efficacy of using this medication. The following conditions are examples of those that include a high risk of bleeding: uncontrolled hypertension, retinopathy, recent stroke, bleeding conditions, currently having or having a history of intestinal or stomach ulcers, or recent surgery involving the eye, brain, or spinal column.

Epidural or Spinal Catheters and Injections

Any patients requiring epidural or spinal catheters or injections should inform their physician of any use of Xarelto, as this medication may impact the conditions and medications associated with such procedures.

Geriatric Patients

Senior patients have an increased likelihood of experiencing side effects when using this medication. Patients that are above the age of 65 years should be sure to discuss the potential risks of using this medication with their physician, as well as determine if any special monitoring may be required.

Heart Valve Disease

Individuals that have had artificial aortic valve replacement or that have artificial heart valves should not use Xarelto. If you have either of these factors, please discuss these aspects of your health history with your physician before beginning treatment with this medication.

Kidney Disease

Renal impairment or any type of kidney disease can contribute to a buildup of Xarelto within a patient’s body, leading to an increase in the frequency and severity of side effects associated with using the medication. Patients with current kidney-related health conditions or a history of renal impairment should be sure to discuss this with their doctor before beginning treatment with this medication, as special monitoring or changes in the patient’s dosage may be required.

Lactose-Related Conditions

Patients with conditions such as glucose-galactose malabsorption, Lapp lactase deficiency, or any other conditions related to galactose or lactose intolerance should avoid using Xarelto, as this medication contains lactose.

Liver Disease

Individuals with hepatic impairment or liver disease should be sure to inform their prescribing physician of these conditions before beginning treatment with Xarelto. This medication may impact liver function or have impaired hepatic function impact the safety and efficacy of the medication, and special monitoring may be required in some cases. Any symptoms of liver-related issues that occur or worsen while using this medication should be reported to the patient’s prescribing physician immediately.

Pediatric Patients

In patients below the age of 18 years, this medication has been shown to be both safe and effective for the treatment of blood clots that have developed in the legs or lungs, as well as the prevention of blood clots re-occurring in those areas within the body. However, Xarelto has not been approved for any other uses in this particular age group.

Pregnancy and Breastfeeding

This medication is not safe for use during pregnancy, and any patients using this medication for treatment that become pregnant should notify their prescribing physician immediately.

There is also a risk of this medication passing into a patient’s breast milk, which may pose health risks to a breastfed child. Patients that choose to breastfeed a child should not use this medication or should stop using this medication under the guidance of their physician if they would like to breastfeed their baby.

Surgeries

Due to the increased bleeding risk associated with this medication, any patient requiring surgery should inform all relevant members of their healthcare team about using Xarelto, as they will likely be required to temporarily stop using the medication before undergoing any necessary surgical or dental procedures to prevent serious bleeding events from occurring.

Drug Interactions

Speak to your doctor about any medications or herbal supplements you are currently taking before beginning treatment with this medication. Discuss any concerns you may have with your doctor or a trusted pharmacist.

The following medication, foods, and substances are known to cause interactions with Xarelto:

  • acetylsalicylic acid (ASA)
  • alemtuzumab
  • alteplase
  • anagrelide
  • anticoagulant medications
  • apalutamide
  • apixaban
  • aprepitant
  • “-azole” antifungal medications
  • carbamazepine
  • celecoxib
  • ceritinib
  • citalopram
  • clarithromycin
  • clopidogrel
  • cobicistat
  • conivaptan
  • crizotinib
  • dabrafenib
  • dabigatran
  • darunavir
  • dasatinib
  • dalteparin
  • deferasirox
  • defibrotide
  • desvenlafaxine
  • diclofenac
  • diltiazem
  • dipyridamole
  • dronedarone
  • duloxetine
  • edoxaban
  • enoxaparin
  • erythromycin
  • escitalopram
  • fluoxetine
  • fondaparinux
  • garlic
  • ginger
  • ginkgo biloba
  • ginseng
  • grapefruit juice
  • heparin
  • HIV protease inhibitors
  • Ibuprofen
  • imatinib
  • indinavir
  • itraconazole
  • ketoconazole
  • lapatinib
  • levetiracetam
  • low-molecular-weight heparins
  • macrolides
  • medications that break blood clots down
  • mifepristone
  • naproxen
  • nevirapine
  • non-steroidal anti-inflammatory medications (NSAIDs)
  • obinutuzumab
  • omega-3 fatty acids
  • oxcarbazepine
  • paroxetine
  • phenobarbital
  • phenytoin
  • prasugrel
  • primidone
  • protein kinase inhibitors
  • red clover
  • rifampin
  • ritonavir
  • selective serotonin reuptake inhibitors (SSRIs)
  • serotonin-norepinephrine reuptakes inhibitors (SNRIs)
  • John’s wort
  • streptokinase
  • sunitinib
  • ticagrelor
  • tipranavir
  • urokinase
  • valproate
  • venlafaxine
  • verapamil
  • vitamin E
  • voriconazole
  • warfarin

Alternative Medications

For patients who are unable to take Xarelto or experiencing significant adverse side effects, alternative medications may be used to treat some of the associated conditions for which this medication is commonly prescribed:

  • apixaban (Eliquis)
  • argatroban
  • aspirin
  • betrixaban (Bevyxxa)
  • bivalirudin (Angiomax)
  • clopidogrel (Plavix)
  • dabigatran (Pradaxa)
  • dalteparin (Fragmin)
  • desirudin (Iprivask)
  • edoxaban (Savaysa)
  • enoxaparin (Lovenox)
  • fondaparinux (Arixtra)
  • prasugrel (Effient)
  • ticagrelor (Brilinta)
  • unfractionated heparin
  • warfarin (Jantoven)

Frequently Asked Questions

Xarelto is an anticoagulant medication that is used in the treatment and prevention of various blood clot-related conditions in both adults and children.

Xarelto is an anticoagulant medication that functions by targeting the Factor Xa enzyme that contributes to blood clotting within a patient’s body. By blocking this particular enzyme, this medication is able to reduce a patient’s risk of developing blood clots.

The most important information a patient should be aware of regarding this medication are that it causes an increased risk of bleeding that may potentially be serious or life-threatening and that those who use the medication and then stop are at an increased risk of developing blood clots afterward. Additionally, many medications may increase a patient’s bleeding risk if used alongside Xarelto, and those who require spinal or epidural injections or catheters have a notably high risk of developing blood clots in those areas that may result in paralysis.

This medication should be taken exactly as instructed by the patient’s physician. The dosage and frequency with which this medication will need to be administered will vary based on the condition for which it has been prescribed as well as any additional health conditions that may apply to the patient using this medication. Typically, it will be taken once or twice per day.

The most common side effects one might experience when using this medication are inflammation in the gut and stomach, bleeding, a cough, and vomiting.

The following medications may increase a patient’s risk of bleeding if taken alongside Xarelto: aspirin, warfarin, heparin, SNRIs, SSRIs, other medications used to treat or prevent blood clots, Plavix (clopidogrel), and non-steroidal anti-inflammatory drugs (NSAIDs).

This medication may be prescribed for any of the following conditions: atrial fibrillation, pulmonary impairment, pulmonary embolism, coronary artery disease, deep vein thrombosis, cardiovascular disease, heart disease, the prevention of DVT after hip or knee replacement, pulmonary thromboembolism, venous thromboembolism, congenital heart disease, intestinal arterial insufficiency, renal artery atherosclerosis, peripheral arterial disease, and thromboangiitis obliterans.

This medication should not be used by pregnant or breastfeeding individuals due to the bleeding risks associated with the use of Xarelto.

Patients using this medication should exercise caution or simply avoid engaging in activities that may result in injury or bleeding occurring, such as shaving, certain sports activities, and tooth brushing.

Patients that only take this medication once per day should take their missed dose once they remember to do so and then resume their regular dosing schedule. These individuals should not take two doses in the span of one day. Patients taking a twice-daily dose of 2.5 mg should simply skip and disregard their missed dose and take their next upcoming dose. Those taking a twice-daily dose of 15 mg should take their missed dose as soon as they remember it, may do so at any point during the same day in which the dose was missed, and are perfectly safe to consume two doses of the medication at once to compensate for a missed dose.

If an overdose of Xarelto is suspected or has occurred, the individual should contact their local Poison Control Center or prescribing physician for further guidance. Although an overdose of this medication may not be immediately life-threatening, too much of this medication may result in excessive bleeding occurring.

If someone has overdosed on this medication and stops breathing or loses consciousness, emergency medical attention should be sought immediately.

This medication may sometimes be used “off-label” for the following conditions: preventing blood clots in a patient’s lower limbs after an orthopedic surgical procedure, treating heparin-induced thrombocytopenia, treating acute coronary syndrome, or treating superficial vein thrombosis.

Severe adverse reactions may occur if Xarelto is mixed with prothrombin complex concentrate or defibrotide. The following medications are also known to result in serious interaction in those using Xarelto: apixaban, cobicistat, clarithromycin, edoxaban, conivaptan, idelalisib, ketoconazole, factor X, indinavir, and ritonavir. There are also additional medications that are known to have interactions when used with Xarelto, so please be sure to discuss any current medications you are using with your prescribing physician before beginning treatment.

The active ingredient in Xarelto is rivaroxaban. The inactive ingredients in these tablets are as follows: sodium lauryl sulfate, microcrystalline cellulose, magnesium stearate, lactose monohydrate, hypromellose, and croscarmellose sodium. The coating of the 2.5 mg tablets also contains titanium dioxide, polyethylene glycol 3350, hypromellose, and ferric oxide yellow. The 10 mg tablets contain Opadry Pink, ferric oxide red, polyethylene glycol 3350, hypromellose, and titanium dioxide. The 15 mg tablets contain Opadry Red, titanium dioxide, ferric oxide red, polyethylene glycol 3350, and hypromellose. The 20 mg tablets contain titanium dioxide, talc, polyethylene glycol 3350, polyvinyl alcohol (partially hydrolyzed), Opadry II Dark Red, and ferric oxide red.

Patients with any of the following conditions should not use this medication: spinal operations, internal bleeding inside of the skull, acute kidney failure, current bleeding, clotting disorders that increase the patient’s risk of bleeding, antiphospholipid antibody syndrome, chronic kidney disease (stage 4 or 5), deep plexus block, deep peripheral nerve block, neuraxial anesthesia, cerebral amyloid angiopathy, bioprosthetic heart valve, mechanical heart valve, or Child-Pugh liver impairment (class B or C).

This medication is available in tablet form in the following strengths: 2.5 mg, 10 mg, 15 mg, and 20 mg.