3 foods to avoid on Xarelto

In this article:

• How Xarelto works
• Xarelto diet
• Foods to avoid
• Foods to prioritize
• Other considerations
• Life with Xarelto

In this article

• How Xarelto works
• Xarelto diet
• Foods to avoid
• Foods to prioritize
• Other considerations
• Life with Xarelto

Many people rely on blood thinners to keep their cardiovascular systems functioning properly. These medications prevent blood clots from forming or stop existing ones from getting bigger for people with many different heart or circulatory issues. One of the most popular blood thinners is Xarelto, the brand name for rivaroxaban.

Xarelto is an anticoagulant medication that prevents deep vein thrombosis (DVT) and pulmonary embolism (blood clot in the lungs) for people with heart rhythm problems or those at risk of stroke or heart attack. It may be prescribed alone or with aspirin. Xarelto has fewer food interactions than older blood thinners, namely warfarin. However, there are a few things to avoid, such as grapefruit juice, plus foods that are bad for your heart health, like red meat and sugary drinks. Keep reading to learn more.

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How Xarelto works

Blood clots form through a chain reaction of clotting factors. Xarelto works by blocking factor Xa, one of the key proteins in that chain, so blood is less likely to clot. 

This action is more precise than older blood thinners, such as warfarin. “Warfarin blocks several vitamin K-dependent clotting factors, which is why we tend to see more bleeding problems with warfarin,” explains Tracy Paeschke, MD, preventive cardiologist at Heart Health Prevention and Wellness in Monument, Colorado.

Because Xarelto targets a single clotting factor, it works quickly. “Xarelto starts thinning the blood within one to two hours of the first dose, reaching full effect in two to four hours,” Dr. Paeschke adds.

The “why” behind dietary restrictions with Xarelto

Traditional blood thinners work by blocking vitamin K, a crucial part of the body’s clotting process. People on those medications had to avoid vitamin-K-rich foods to avoid counteracting their efficacy. Xarelto works differently and is processed differently by the body.

“Many people think that you have to avoid leafy greens that are rich in vitamin K because Xarelto is a blood thinner, but that is inaccurate,” explains Michelle Routhenstein, MS, registered cardiology dietitian at Entirely Nourished. “Xarelto is not a vitamin K antagonist like warfarin, and therefore does not have that interaction.” 

Instead, the focus should be on maintaining a heart-healthy diet, which can help reduce the incidence of cardiovascular events. “I tell patients to think of Xarelto like any other drug where they take it and blood levels will be good, not impacted by diet, and levels don’t have to be checked like on warfarin,” Dr. Paeschke says. In short, it’s about nourishing your heart, not avoiding food-drug interactions.

3 foods to avoid with Xarelto

Only one food directly interacts with Xarelto. That said, it’s smart to avoid some foods that are proven to be damaging to the cardiovascular system. When taking this blood thinner, avoid:

1. Grapefruit and grapefruit juice

“Grapefruit and grapefruit juice can potentially affect the metabolism of Xarelto and should be consumed in limited quantities if someone is taking Xarelto,” Dr. Paeschke says. According to the U.S. Food and Drug Administration (FDA), grapefruit and grapefruit juice block the action of an enzyme in the intestines that assists with the breakdown of medications. As a result, more of the drug enters your bloodstream, which can increase your risk of bleeding and other side effects of Xarelto. 

2. Red meat

While Xarelto will work just fine if you eat red meat while taking it, doing so may work against you. According to one study that looked at the diets of nearly 150,000 people, red meat consumption is associated with an increased risk of cardiovascular disease, a risk that is even higher for intake of processed red meat. The study also found that replacing just half a serving per day of red meat with half a serving per day of nuts or whole grains was associated with a 14% lower cardiovascular disease risk.

Researchers credit the high amounts of saturated fat in red meat and added sodium in processed meat with increasing instances of high blood pressure, high cholesterol, and inflammation, all of which contribute to a higher risk of developing heart disease. 

3. Sugary drinks

Regularly drinking sugary beverages, like soda or juices, has been shown to significantly increase the risk of multiple cardiovascular diseases, including stroke and atrial fibrillation, both of which Xarelto is used to prevent. Sugary drinks increased these risks even more than sweet treats like cookies and pastries, according to research. 

Why? The researchers note that liquid sugars make you feel less full, which can lead to overconsumption. Plus, they might be consumed more regularly than high-sugar treats like cake, which are often reserved for social settings or special occasions.

What should you eat while taking Xarelto?

“If you’re on a blood thinner, your diet should support healthy blood flow, reduce inflammation, and maintain optimal blood viscosity,” Routhenstein says. That means following an eating pattern that includes:

• Complex carbohydrates, such as brown rice
• Lean proteins, including chicken, salmon, or quinoa
• Heart-healthy fats, such as olive oil
• Fruits and vegetables

You should take higher doses of Xarelto with food. “Research shows that taking higher doses, such as 15 or 20 milligrams, with a full meal that includes carbohydrates, fats, and protein can help your body absorb it better,” Routhenstein explains. “This is probably because the drug dissolves well in fat, so eating fat helps your body take it in more effectively.”

Medications and supplements to avoid on Xarelto

Certain prescription drugs, over-the-counter (OTC) medications, and herbal supplements don’t mix with Xarelto. “While on any blood-thinner, including Xarelto, patients should avoid taking any other blood thinners unless prescribed by their provider,” Dr. Paeschke says. That includes medications such as Eliquis (apixaban), Coumadin (warfarin), and Plavix (clopidogrel). Additionally, the following interact with Xarelto:

• Selective serotonin reuptake inhibitors (SSRIs), such as  Zoloft and Prozac
• Selective norepinephrine reuptake inhibitors (SNRIs),  like Effexor and Cymbalta
• Certain antifungal drugs, such as ketoconazole
• Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and Aleve (naproxen)
• Supplements containing vitamin E
• Omega-3 fatty acids
• St. John’s Wort

They may increase the risk of side effects or add to the blood-thinning effects of Xarelto. 

The bottom line: Living well on Xarelto

Grapefruit and grapefruit juice affect how your body metabolizes Xarelto. While no other foods directly affect its efficacy, it’s smart to follow a heart-healthy diet and avoid red meat and sugary drinks. “Your dietary needs should be personalized based on your medical history, lab results, and the specific medication you’re taking,” Routhenstein says. That’s why it’s important to always discuss your diet with a healthcare professional when you start a new drug, like Xarelto.

Since Xarelto prevents your blood from clotting normally,  it may take longer than usual for you to stop bleeding if you get a cut or an injury. However, if you experience unusual bleeding or bruising, bleeding from your gums, or heavy menstrual bleeding, seek medical advice from a healthcare provider right away. It is also important to know that Xarelto can increase the risk of bleeding in the brain. If you fall and hit your head on Xarelto, it is important to seek emergency medical care to determine if a CT scan is necessary.