Rivaroxaban (Xarelto)

What is this medication?

RIVAROXABAN (ri va ROX a ban) prevents or treats blood clots. It is also used to lower the risk of stroke in people with AFib (atrial fibrillation). It can be used to lower the risk of heart attack or stroke in people with heart or peripheral artery disease. It belongs to a group of medications called blood thinners.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Xarelto, Xarelto Starter Pack

What should I tell my care team before I take this medication?

They need to know if you have any of these conditions:

• Antiphospholipid antibody syndrome
• Bleeding disorders
• Bleeding in the brain
• Blood clots
• Kidney disease
• Liver disease
• Prosthetic heart valve
• Recent or planned spinal or epidural procedure
• Stomach bleeding
• Take medications that treat or prevent blood clots
• An unusual or allergic reaction to rivaroxaban, other medications, foods, dyes, or preservatives
• Pregnant or trying to get pregnant
• Breast-feeding

How should I use this medication?

Take this medication by mouth. For your therapy to work as well as possible, take each dose exactly as prescribed on the prescription label. Do not skip doses. Skipping doses or stopping this medication can increase your risk of a blood clot or stroke. Keep taking this medication unless your care team tells you to stop.

If you are taking this medication after hip or knee replacement surgery, take it with or without food. If you are taking this medication for atrial fibrillation, take it with your evening meal. If you are taking this medication to treat blood clots, take it with food at the same time each day. If you are taking this medication for coronary artery disease or peripheral artery disease, take it with or without food at the same time every day. If you are unable to swallow your tablet, you may crush the tablet and mix it in applesauce. Then, immediately eat the applesauce. You should eat more food right after you eat the applesauce containing the crushed tablet.

A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time.

Talk to your care team about the use of this medication in children. While it may be prescribed for children as young as newborns for selected conditions, precautions do apply.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you take your medication once a day and miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

If you are taking this medication twice a day to treat blood clots and miss a dose, take the missed dose as soon as you remember. In this instance, 2 tablets may be taken at the same time. The next day you should take 1 tablet twice a day.

If you are taking this medication twice a day for coronary artery disease or peripheral artery disease and miss a dose, skip it. Take your next dose at the normal time. Do not take extra or 2 doses at the same time to make up for the missed dose.

What may interact with this medication?

Do not take this medication with any of the following:

• Defibrotide

This medication may also interact with the following:

• Aspirin and aspirin-like medications
• Certain antibiotics like erythromycin and clarithromycin
• Certain medications for fungal infections like ketoconazole and itraconazole
• Certain medications for seizures like carbamazepine, phenytoin
• Certain medications that treat or prevent blood clots like warfarin, enoxaparin, dalteparin, apixaban, dabigatran, and edoxaban
• Conivaptan
• Indinavir
• Lopinavir; ritonavir
• NSAIDS, medications for pain and inflammation, like ibuprofen or naproxen
• Rifampin
• Ritonavir
• SNRIs, medications for depression, like desvenlafaxine, duloxetine, levomilnacipran, venlafaxine
• SSRIs, medications for depression, like citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
• St. John's wort

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medication?

Visit your care team for regular checks on your progress. You may need blood work done while you are taking this medication. Your condition will be monitored carefully while you are receiving this medication. It is important not to miss any appointments.

Avoid sports and activities that might cause injury while you are using this medication. Severe falls or injuries can cause unseen bleeding. Be careful when using sharp tools or knives. Consider using an electric razor. Take special care brushing or flossing your teeth. Report any injuries, bruising, or red spots on the skin to your care team.

Wear a medical ID bracelet or chain. Carry a card that describes your condition. List the medications and doses you take on the card.

Tell your dentist and dental surgeon that you are taking this medication. You should not have major dental surgery while on this medication. See your dentist to have a dental exam and fix any dental problems before starting this medication. Take good care of your teeth while on this medication. Make sure you see your dentist for regular follow-up appointments.

If you are going to need surgery or other procedure, tell your care team that you are using this medication.

Do not become pregnant while taking this medication. Women should inform their care team if they wish to become pregnant or think they might be pregnant. There is potential for serious harm to an unborn child. Talk to your care team for more information.

What side effects may I notice from receiving this medication?

Side effects that you should report to your care team as soon as possible:

• Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
• Bleeding—bloody or black, tar-like stools, vomiting blood or brown material that looks like coffee grounds, red or dark brown urine, small red or purple spots on skin, unusual bruising or bleeding
• Bleeding in the brain—severe headache, stiff neck, confusion, dizziness, change in vision, numbness or weakness of the face, arm, or leg, trouble speaking, trouble walking, vomiting
• Heavy periods

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medication?

Keep out of the reach of children and pets.

Store at room temperature between 20 and 25 degrees C (68 and 77 degrees F). Get rid of any unused medication after the expiration date.

To get rid of medications that are no longer needed or have expired:

• Take the medication to a medication take-back program. Check your pharmacy or law enforcement to find a location.
• If you cannot return the medication, check the label or package insert to see if the medication should be thrown out in the garbage or flushed down the toilet. If you are not sure, ask your care team. If it is safe to put it in the trash, empty the medication out of the container. Mix the medication with cat litter, dirt, coffee grounds, or other unwanted substance. Seal the mixture in a bag or container. Put it in the trash.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

How long does Xarelto stay in your system?

After you take Xarelto®, 50% of the dose will still be in your system after five to nine hours. Some of the drug stays in your system for one to two days. The amount in your system decreases over time until you take another dose.

If you’re older than 75, Xarelto may stay in your body longer than these estimates. It may not come out in your pee (urine) as quickly as it does in a younger person.

Is Xarelto a blood thinner?

Yes. Xarelto is a blood thinner, or anticoagulant. It helps keep blood clots from forming by holding back factor Xa. This factor plays a role in making clots.

What happens if you miss a dose of Xarelto?

If you miss a dose of Xarelto, you won’t have the right amount in your body to prevent blood clots. You’ll be at risk of forming a clot if you miss a dose. Don’t stop taking Xarelto unless your healthcare provider tells you to stop.

Does Xarelto make you tired?

Yes, Xarelto can make you tired. If it does, contact your healthcare provider right away. Feeling tired can be a sign of a serious side effect.

A note from Cleveland Clinic

Newer blood thinners like Xarelto have some advantages over traditional ones. But they’re powerful medicines and you need to take them with care. Be sure to follow instructions from your healthcare provider and talk to them if you have questions.