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What anti-inflammatory can you take with Xarelto?

Xarelto can interact with many anti-inflammatories. Here's which ones are safest—and which to avoid.
Wendy Wisner
By | Jul. 2, 2025 Medically reviewed by Samantha Marr, DNP, APN, AGPCNP-BC, CCRN
Person holding their wrapped wrist: What anti-inflammatory drugs can you take with Xarelto?

Key takeaways

  • In general, anti-inflammatory medications like NSAIDs shouldn’t be combined with Xarelto because they increase your risk of bleeding, especially stomach bleeding.

  • There are other pain relievers that are safe to take with Xarelto, and there are some anti-inflammatory medications that can be used with healthcare provider approval.

  • If you need to take an anti-inflammatory medication while you’re on Xarelto, your healthcare provider can discuss safer options to consider, as well as alternative medications.

In this article:

Xarelto is the brand name for rivaroxaban, an anticoagulant (blood thinner). It’s a factor Xa inhibitor, which helps decrease blood clot production in the body. Xarelto is FDA-approved to prevent and treat clots in numerous conditions, such as stroke, nonvalvular atrial fibrillation, and deep vein thrombosis.  

Unfortunately, combining Xarelto with most common anti-inflammatory medications is not safe, because it can increase your risk of bleeding. That said, there are other pain medications you can take, and some anti-inflammatory medications that are safer than others.

Here, we’ll discuss which anti-inflammatory medications you can take with Xarelto and which ones you should avoid.

What anti-inflammatory drugs can you take with Xarelto? 

The most common anti-inflammatory medications are nonsteroidal anti-inflammatory drugs (NSAIDs), which are pain relievers that can also decrease inflammation in the body. Common NSAIDs include Advil, Motrin, and Aleve. It’s important to be very cautious when it comes to taking Xarelto and NSAIDs, as well as other anti-inflammatory medications. 

“The big concern when taking anti-inflammatory medications—like ibuprofen or naproxen—along with Xarelto is the risk of bleeding,” Sean Ormond, MD, dual board-certified in anesthesiology and interventional pain management physician at Atlas Pain Specialists, explains. “Xarelto already makes your blood less likely to clot (which is good if you’re at risk for strokes or clots), but NSAIDs can add to that risk by irritating your stomach lining and affecting how your platelets work.”

At the same time, some non-anti-inflammatory pain medications are safe to take with Xarelto. Additionally, some anti-inflammatory medications carry a lower risk of bleeding when combined with Xarelto. Still, these medications should be used cautiously and only under a healthcare provider’s supervision.

Over-the-counter medications that are safe to take with Tylenol

While you have to be cautious when it comes to most over-the-counter anti-inflammatory pain relievers like non-steroidal anti-inflammatory drugs (NSAIDs), other over-the-counter pain relievers are generally safe to take.  

Tylenol

Tylenol and Xarelto are typically a safe combination. “Acetaminophen (Tylenol) is generally considered the safest over-the-counter pain reliever to use with Xarelto and other anticoagulants since it does not impair platelet function or increase bleeding risk in the same way NSAIDs do,” Erika Gray, Pharm.D., founder and chief medical officer at MyToolBox Genomics, says. But even Tylenol should be used in moderation, she says, especially in patients with liver disease or who consume more than two alcoholic drinks per day.

Low-dose aspirin

Xarelto is indicated for use in combination with low-dose aspirin to decrease the risk of serious heart issues, heart attacks, and strokes in people with coronary artery disease. It’s also indicated to decrease the risk of reduced blood flow to your legs, amputation, heart issues, and stroke in people with peripheral artery disease. However, it’s vital that you seek medical advice from a healthcare provider before you take low-dose aspirin with Xarelto.

Prescription medications safe to take with Xarelto

There are certain prescription pain relievers, and even certain prescription anti-inflammatory medications, that may be safer to take with Xarelto. Again, it’s important to consult with a healthcare provider before combining any prescription medications with Xarelto.

Celebrex

Celebrex (celecoxib) is an NSAID. Nevertheless, as Matthew L. Holt, Pharm.D., assistant professor of pharmacology at PCOM (Philadelphia College of Osteopathic Medicine), notes it’s a newer NSAID, and is less likely to cause unwanted bleeding, such as stomach bleeding. Yet while the risk of stomach bleeding is lower with Celebrex than other NSAIDs, the risk still exists, Dr. Holt notes. 

As such, if Celebrex is combined with anticoagulants like Xarelto, caution should be taken. “It’s a bit gentler on the stomach than others, but still not something I’d recommend casually with Xarelto,” Dr. Ormond says. “If it’s absolutely needed, it should be used short-term and under close supervision.”

Voltaren gel

If you are looking for a safe anti-inflammatory to combine with Xarelto, Voltaren gel is a good option. “Diclofenac (Voltaren) gel ranks among the safest anti-inflammatory to take with anticoagulants such as Xarelto, as the medication is applied onto the skin, and absorption is often limited to the affected painful area,” Dr. Holt explains. “This aspect of diclofenac gel decreases the risk of bleeding that usually accompanies other NSAIDs taken by mouth.”

At the same time, some caution is advised. “There is some degree of absorption so prolonged use can potentially increase bleeding risk and should be used with caution under medical supervision,” Dr. Gray says.

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What anti-inflammatory medications should be avoided while on Xarelto?

Most oral NSAIDs should be avoided while taking Xarelto, unless they are strictly prescribed by your healthcare provider, Dr. Gray explains. These include:

  • Ibuprofen (Advil/Motrin)
  • Naproxen (Aleve)
  • Meloxicam (Mobic)
  • Ketorolac (Toradol)
  • Indomethacin (Indocin)
  • Piroxicam (Feldene)
  • Oral diclofenac

Additionally, according to the manufacturer’s guidelines, the following medications should also be avoided when taking Xarelto, as they can also increase your risk of bleeding:

  • Aspirin (regular doses)
  • Warfarin
  • Any medication containing heparin
  • Clopidogrel (Plavix)
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin norepinephrine reuptake inhibitors (SNRIs)
  • Other medications prescribed to prevent or manage blood clots

Of course, there are always exceptions, and some healthcare providers may prescribe these medications in certain circumstances or for limited periods of time.

“If you truly need an anti-inflammatory, your doctor can help you weigh the risks and find the safest route possible,” Dr. Ormond says. “It’s all about finding a balance between relieving your pain and keeping you safe—something we can definitely do with the right approach.”