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Main differences | Conditions treated | Efficacy | Side effects | Drug interactions | Warnings | Insurance & costs | FAQ
Eliquis and Xarelto are two brand-name medications used to prevent and treat various clotting disorders. Both drugs are oral anticoagulants classified in a group of medications called factor Xa inhibitors. They work by blocking factor Xa, which produces thrombin, a necessary ingredient in clot production. By blocking factor Xa, the medications decrease the production of clots.
Eliquis (apixaban) and Xarelto (rivaroxaban) are NOACs (novel oral anticoagulants), which are a group of newer blood thinners. They are also known as DOAC (direct oral anticoagulants). Unlike Coumadin (warfarin), a popular and older anticoagulant, patients taking Eliquis or Xarelto do not need regular blood tests to monitor levels.
Eliquis and Xarelto are both approved by the FDA for prescription use and are available in brand name only. No generic is available yet for either drug; however, a generic Eliquis is expected to be available in April 2028. Eliquis is made by Bristol-Myers Squibb. Xarelto is made by Janssen Pharmaceuticals. Both drugs are used by adults. Xarelto is also used in children. Dosages vary by indication.
RELATED: Are new blood thinners better than Coumadin (warfarin)?
Main differences between Xarelto vs. Eliquis |
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|---|---|---|
| Xarelto | Eliquis | |
| Drug class | Factor Xa inhibitor | |
| Brand/generic status | Brand | |
| What is the active ingredient? | Rivaroxaban | Apixaban |
| What form(s) does the drug come in? | Tablet, oral suspension | Tablet, starter pack |
| What is the standard dosage? | Adults: 10 mg to 20 mg once daily
Dosage varies by indication Children: Dosage varies by weight and indication |
2.5 mg or 5 mg twice a day
Dosage varies by indication |
| How long is the typical treatment? | Varies | |
| Who typically uses the medication? | Adults and children | Adults |
| More information | What is Xarelto? | What is Eliquis? |
Conditions treated by Xarelto and Eliquis
Eliquis and Xarelto have several indications that are the same—to reduce the risk of stroke and embolism in patients with nonvalvular atrial fibrillation (AFib, or irregular heartbeat), prevent deep vein thrombosis (DVT) in patients who have had hip or knee replacement, treat DVT, treat PE, and to reduce the risk of recurrent DVT or PE following initial therapy.
Additionally, Xarelto has several more indications, including FDA-approved indications in pediatric patients. See the chart below for more detailed information on uses of Eliqius and Xarelto.
When to use Xarelto vs. Eliquis |
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|---|---|---|
| Condition | Xarelto | Eliquis |
| Reduce the risk of stroke and embolism in patients with nonvalvular atrial fibrillation | Yes | |
| Prophylaxis of deep vein thrombosis (DVT), which could lead to pulmonary embolism (PE), in patients who have had hip or knee replacement surgery | Yes | |
| Treatment of DVT | Yes | |
| Treatment of PE | Yes | |
| Reduce risk of recurrent DVT and PE following initial therapy | Yes | |
| Prophylaxis of venous thromboembolism (VTE) and VTE-related death during hospitalization and post-hospital discharge in adult patients admitted for an acute medical illness who are at risk for thromboembolic complications due to restricted mobility/other risk factors and not at high risk of bleeding | Yes | No |
| In combination with aspirin, to reduce the risk of major cardiovascular events: cardiovascular death, myocardial infarction (MI; also known as a heart attack), and stroke in patients who have chronic coronary artery disease (CAD) or peripheral artery disease (PAD) | Yes | No |
| In combination with aspirin, to reduce the risk of major clotting events in patients with peripheral artery disease, including patients after lower extremity revascularization | Yes | No |
| Treatment of VTE and reduce the risk of recurrent VTE in children from birth to less than 18 years—after at least 5 days of initial parenteral (non-oral) anticoagulant treatment | Yes | No |
| Prevent VTE in children 2 years and older with congenital heart disease who have undergone a surgery called the Fontan procedure | Yes | No |
RELATED: How does Eliquis work for AFib?
Is Xarelto or Eliquis more effective?
Researchers published a review and meta-analysis of Eliquis and Xarelto for acute venous thromboembolism (VTE). They concluded that both drugs were similarly effective but that Eliquis may be safer. The patients treated with Xarelto experienced more bleeding—both major and minor.
A study in the Annals of Internal Medicine found that in addition to bleeding more, people who took Xarelto also had more ischemic (clots and strokes) events. Investigators in a study in JAMA on older adults also found similar results—people in the rivaroxaban group (those who took Xarelto) had more clotting and bleeding events than those in the apixaban group (those who took Eliquis).
Another study reviewed Eliquis and Xarelto, and also Pradaxa (another newer anticoagulant), and Coumadin (warfarin, an older anticoagulant). The authors concluded that Eliquis had the most favorable efficacy, safety, and patient compliance.
A 2022 trial from the University of Pennsylvania studied patients with atrial fibrillation and associated valvular heart disease. The study concluded that those who took Eliquis had the risk of blood clots decrease by almost half, compared with Xarelto.
Sometimes it can be stressful to think about what the best drug for you is, especially with so many advertisements as well as opinions from family and friends. However, it’s best to remember that the best drug for you can only be determined by your healthcare provider, who can take into account the full picture of your medical condition(s), medical history, and other medications you take that could interact with Eliquis or Xarelto.
RELATED: Eliquis vs. warfarin
Side effects of Xarelto vs. Eliquis
The most common side effects of Eliquis and Xarelto are related to bleeding, such as nosebleeds, contusions (bruising), blood in the urine, or bleeding gums. The incidence of bleeding side effects can vary. On rare occasions, bleeding can be serious or even life-threatening.
Other common side effects that may occur with Eliquis include nausea and anemia.
Other common side effects of Xarelto include abdominal or back pain, fatigue, dizziness, itching, anxiety, depression, and/or insomnia.
In rare cases, a serious allergic reaction to either medication may occur. If symptoms such as hives, difficulty breathing, or swelling of the face, lips, tongue, or throat, occur, get emergency medical help right away.
This is not a complete list of side effects. Consult your healthcare provider for more information on the adverse reactions of Eliquis and Xarelto.
| Xarelto side effects | Eliquis side effects | |
| Shared side effects of Xarelto and Eliquis |
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| Drug-specific side effects |
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Drug interactions of Xarelto vs. Eliquis
Before taking Eliquis or Xarelto, tell your healthcare provider about all the medications you take, including prescription and OTC drugs, vitamins, and supplements.
Eliquis and Xarelto interact with certain drugs that are metabolized by the same enzyme. When enzyme inhibitor drugs are used with Eliquis or Xarelto, the levels of Eliquis or Xarelto in your body would increase, which would put you at increased risk for bleeding. If you have to take this combination of drugs, it is likely that your doctor will decrease your dose of Eliquis or Xarelto while on both medications. Examples of these interacting drugs include Nizoral (ketoconazole), erythromycin, and ritonavir.
On the other hand, when enzyme inducers are taken with Eliquis or Xarelto, there is an interaction where those drugs make Eliquis or Xarelto metabolize faster, and you may not get enough of the Eliquis or Xarelto dose. Examples include rifampin, Tegretol (carbamazepine), Dilantin (phenytoin), and the supplement St. John’s wort.
Using Eliquis or Xarelto with other anticoagulants, antiplatelet drugs, NSAIDs (nonsteroidal anti-inflammatory drugs), or certain antidepressants may increase the risk of bleeding. However, for some indications, Xarelto should be taken with a low dose of aspirin. Your healthcare provider will tell you whether you should take aspirin.
This is not a full list of drug interactions. Consult your healthcare provider for more information about drug interactions and how they may affect you.
Warnings of Xarelto and Eliquis
Eliquis and Xarelto have a boxed warning, also known as a black box warning, which is the strongest warning required by the U.S. Food and Drug Administration (FDA). This warning states:
- Discontinuing Eliquis or Xarelto prematurely increases the risk of a clotting event.
- Epidural or spinal hematoma may occur in patients who are receiving neuraxial (between vertebrae) anesthesia or spinal puncture. The hematoma could result in long-term or permanent paralysis. The risk is higher in patients with epidural catheters, patients taking other medications that affect blood flow, patients with a history of traumatic/repeated punctures, and/or patients with a history of spinal deformity or surgery. Patients should be frequently monitored for signs/symptoms of neurological impairment (such as numbness/weakness of the legs, bowel/bladder problems), and if any issues occur, the patient should seek emergency medical attention.
Other warnings of both medications include:
- Bleeding may occur and could be serious (major bleeding) or potentially fatal. Using Eliquis or Xarelto with certain drugs (anticoagulants, antiplatelet drugs, NSAIDs, SSRI or SNRI antidepressants) increases the risk of bleeding. Patients with bleeding should seek emergency medical attention. The drug should be stopped in patients with active hemorrhage.
- A reversal agent is available, to reverse the effects of factor Xa inhibition.
- Eliquis or Xarelto are not recommended in patients with prosthetic heart valves.
- Eliquis or Xarelto are not recommended as an alternative to heparin for the initial treatment of PE patients who have hemodynamic instability (shock/heart failure).
- Eliquis or Xarelto should not be used in patients with triple-positive antiphospholipid syndrome (APS) due to an increased risk of clotting.
- If you have chronic liver problems or chronic kidney disease, talk to your healthcare provider before taking Eliquis or Xarelto.
Using Xarelto or Eliquis during pregnancy
There is limited data on the use of Eliquis or Xarelto in pregnancy. Treatment with Eliquis or Xarelto may increase the risk of bleeding during both pregnancy and delivery and increase the risk of bleeding in the fetus/newborn.
Using Eliquis or Xarelto during labor or delivery in individuals receiving an epidural may cause epidural or spinal hematoma.
A shorter-acting anticoagulant may be used if needed.
Consult your OB-GYN about the use of Eliquis or Xarelto during pregnancy. Generally, the drug is only used if the benefits outweigh the risks (for example, in certain high-risk pregnancies), and with careful monitoring. If you are already using Eliquis or Xarelto and find out that you are pregnant, consult your OB-GYN for guidance.
Coverage and cost comparison of Xarelto vs. Eliquis
Xarelto and Eliquis are typically covered by insurance and Medicare prescription plans, but the copays vary widely.
A one-month supply (60 tablets of 5 mg) of Eliquis costs about $780 without insurance. However, you can use a SingleCare card to purchase Eliquis for less than $475.
A one-month supply (30 tablets of 20 mg) of Xarelto costs about $700 without insurance. You can use a SingleCare coupon to purchase Xarelto for just over $400.
| Xarelto | Eliquis | |
| Typically covered by insurance? | Yes | Yes |
| Typically covered by Medicare? | Yes | Yes |
| Cost without insurance | $703 for 30, 20 mg tablets | $780 for 60, 5 mg tablets |
| Lowest SingleCare price | $407 for 30, 20 mg tablets | $473 for 60, 5 mg tablets |
| SingleCare coupons | Xarelto coupons | Eliquis coupons |
Prescription drug prices often change. These are the most accurate medication prices at the time of publishing. Click the coupon buttons to see updated drug prices.
RELATED: Get the SingleCare discount card
By signing up for SingleCare, you can save an extra $3 off your next prescription.
Frequently asked questions about Eliquis vs. Xarelto
Are Eliquis and Xarelto the same?
Eliquis and Xarelto are both known as direct factor Xa inhibitors. They are similar, but not exactly the same. One of the main differences is that Xarelto has several more indications, including some uses for children and adolescents, while Eliquis is not FDA-approved for use in this age group. Xarelto is typically taken once a day, while Eliquis is taken twice daily. Other similarities and differences are outlined above. Other factor Xa inhibitors include Pradaxa (dabigatran), Arixtra (fondaparinux), and Savaysa (edoxaban).
RELATED: Eliquis alternatives
What is the most significant difference between Xarelto and Eliquis side effects?
A clinical trial that studied Xarelto in older adults found that the risk of bleeding increases with age, which is a concern for older adults. On the other hand, Eliquis also can have a side effect of bleeding, but studies show that it is not age-related.
Is Eliquis or Xarelto better?
Studies (see above for details) have shown that Eliquis and Xarelto are similarly effective, or that Eliquis may be slightly more effective. Eliquis seems to have a lower risk of bleeding than Xarelto. For example, this was seen in a clinical study on gastrointestinal bleeding in patients with atrial fibrillation. Ask your doctor if Eliquis or Xarelto is appropriate for you.
Can I use Eliquis or Xarelto while pregnant?
Generally, Eliquis and Xarelto are not used in pregnancy. However, some exceptions may occur in certain patients who are at high risk for clots. Consult your healthcare provider.
Can I use Eliquis or Xarelto with alcohol?
Alcohol can thin the blood. If you take Eliquis or Xarelto and drink alcohol, this could increase the risk for bleeds. Also, alcohol can aggravate certain medical conditions. You can ask your healthcare provider if it is safe to drink, and how much, with the medication you take and the medical condition(s) you have.
Is Xarelto cheaper than Eliquis?
For a one-month supply, the price of Xarelto and the price of Eliquis are very similar. On average, Xarelto costs $703 without insurance; Eliquis costs $780 without insurance. The price of Xarelto with a SingleCare coupon is $407; the price of Eliquis with a SingleCare coupon is $473.
Can you switch between Eliquis and Xarelto?
While these drugs should not be taken together, in some cases, there may be a reason to switch from Eliquis to Xarelto, or Xarelto to Eliquis. This switch should only be done under the medical advice of the healthcare provider, who will also give dosing instructions on how to switch medications.
