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What are the side effects of Xarelto in the elderly?

Xarelto is the brand name version of rivaroxaban. It’s a blood thinner that treats and reduces the risk of blood clots for people with certain cardiovascular conditions, and it can also reduce the risk of strokes. Xarelto is commonly prescribed to seniors but may cause more side effects in older adults than in younger adults. Let’s take a more in-depth look at why this blood thinner is prescribed and the side effects of Xarelto in the elderly.  

Why are blood thinners prescribed to seniors? 

Blood thinners, also called anticoagulants, are medications that prolong the amount of time it takes the body to form a blood clot. Xarelto is a factor Xa inhibitor, which is a type of anticoagulant that prevents the enzyme thrombin from forming, which plays an important role in the formation of blood clots. Seniors often have a higher risk of getting blood clots, and blood thinners have a strong anticoagulation effect.  

There are many different health conditions seniors can have that may require them to take a blood thinner. Here are some conditions that would justify a blood thinner prescription: 

  • Nonvalvular atrial fibrillation: This type of atrial fibrillation is not caused by a heart valve problem, but it causes a fast and irregular heartbeat. Because this condition disrupts blood flow and increases the risk of getting a blood clot, many people who have it will need to take a blood thinner, and clinical trials have shown that Xarelto is safe and effective for people with atrial fibrillation.  
  • Deep vein thrombosis (DVT): DVT is a condition where a blood clot develops deep within a vein, usually in a lower leg or thigh. This condition can become life-threatening if it causes a pulmonary embolism. People with symptoms or a diagnosis of DVT may take a blood thinner to keep the blood clot from worsening and to prevent any new ones from forming.
  • Pulmonary embolism: A pulmonary embolism is what happens when a DVT blood clot loosens from where it formed and moves into one of the pulmonary arteries in the lungs. This can cause chest pain, shortness of breath, and can be life-threatening if it isn’t treated with blood thinners or procedures. 
  • Coronary artery disease (CAD): CAD is marked by the narrowing or blockage of the arteries in the heart. People with CAD have an increased risk of getting blood clots that can cause a stroke or heart attack. 
  • Peripheral artery disease (PAD): Just like with CAD, people with peripheral artery disease have an increased risk of getting blood clots and experiencing heart attacks or strokes because of them. PAD is characterized by a narrowing of the arteries in the legs, arms, and head. 
  • Knee or hip replacement surgery: Older adults often need a knee or hip replacement surgery later in life, and these kinds of surgeries can increase the risk of getting a blood clot. Sometimes doctors will prescribe a blood thinner like Xarelto after a knee or hip replacement surgery. 

What are the side effects of Xarelto in the elderly?

Blood thinners like Xarelto are great for treating and preventing blood clots but they also come with an increased risk of experiencing certain side effects. Because blood thinners affect the thickness of the blood, they’re often associated with bleeding-related side effects. They also affect blood cell counts, which can cause a unique set of symptoms.

Common side effects

Here are the most common side effects of Xarelto that seniors might experience: 

  • Increased risk of bleeding
  • Bruising easily 
  • Prolonged bleeding from cuts
  • Bleeding gums
  • Back pain
  • Dizziness
  • Headache
  • Nosebleeds
  • Numbness
  • Bowel or bladder dysfunction
  • Weakness

Drug-drug interactions

This risk of experiencing bleeding as a side effect of Xarelto will increase if it’s taken at the same time as certain other medications. Here’s a list of medications that can cause negative drug interactions: 

  • Other injectable or oral anticoagulants 
  • Aspirin
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Medications containing heparin
  • Warfarin 
  • Clopidogrel
  • Platelet inhibitors 
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin norepinephrine reuptake inhibitors (SNRIs)

Serious side effects

Taking Xarelto can also cause more serious side effects, especially for seniors. You should seek immediate medical care if you experience any of the following side effects while taking Xarelto: 

  • Uncontrollable or unusual bleeding 
  • Red, pink, or brown urine
  • Bloody stools
  • Black stools
  • Coughing up blood
  • Coughing up blood clots
  • Vomit that looks like coffee grounds 

It’s important that people who are taking Xarelto seek immediate medical attention if they’re having any of these side effects because they may indicate that there’s internal bleeding, gastrointestinal bleeding, or brain bleeding (intracranial hemorrhage) going on. These types of bleeding incidences are more common among seniors taking Xarelto and can be life-threatening if they’re not addressed right away. Older patients who fall while taking Xarelto should let their doctor know what’s happened and look for any signs of internal bleeding that may indicate it’s time to seek medical advice.   

Other warnings

In addition to these side effects, Xarelto comes with a boxed warning that cautions against prematurely stopping the medication because this can increase the risk of a blood clot blocking a vein or artery. The manufacturer’s instructions suggest that a different blood thinner should be taken instead of Xarelto if the medication needs to be stopped for any reason other than major bleeding events. This will help ensure that the person who’s been taking Xarelto doesn’t experience unnecessary and potentially life-threatening blood clots. 

Xarelto comes with a second boxed warning for an increased risk of spinal/epidural hematomas. People with spinal punctures or people who receive injections into their spine or epidural area have a high risk of getting a blood clot that can cause long-term or permanent paralysis. Doctors will closely monitor their patients for signs of a blood clot, which may include tingling, numbness, back pain, incontinence, and muscle weakness. If you have a spinal puncture, epidural catheter, or receive injections into your spine and have any of these symptoms, you should seek medical care right away.  

How to take Xarelto

Taking Xarelto properly is important to make sure it works as effectively as possible and that it causes the least amount of side effects. Xarelto tablets come in four dosage strengths: 2.5mg, 10mg, 15mg, and 20mg. Here are the standard doses of Xarelto for different medical conditions:

  • Atrial fibrillation not caused by a heart valve problem: 15-20 mg taken once per day with an evening meal.
  • Deep vein thrombosis (DVT): 15 mg taken twice per day with a meal, at the same times each day.  
  • Pulmonary embolism: 15 mg taken twice per day with a meal, at the same times each day.
  • Coronary artery disease (CAD): 2.5 mg taken twice per day with or without food.
  • Peripheral artery disease (PAD): 2.5 mg taken twice per day with or without food.
  • Knee replacement surgery or hip replacement surgery: 10 mg taken once per day with or without food. 

It takes about two to four hours for Xarelto to reach its maximum blood-thinning effect, but the exact amount of Xarelto that someone needs to take will vary based on their medical condition, medical history, and age, so it’s always best to talk with your doctor about how much Xarelto you should be taking. 

Once you’ve talked with your doctor and know how much Xarelto you should be taking, you can start taking it as long as you follow any guidelines your doctor gave you. Many doctors recommend that patients take Xarelto at night with an evening meal. This is because the Food and Drug Administration (FDA) released information saying that Xarelto may be less effective if it’s not taken that way. 

Drug-food interactions

Most foods and beverages are safe to take with Xarelto, with the exception of alcohol, grapefruits, and grapefruit juice. Studies have shown that consuming alcohol while taking Xarelto can increase the risk of experiencing bleeding, bruising, and headaches. For some patients, moderate alcohol consumption while taking Xarelto may be okay, but it’s always a good idea to check with your doctor to be on the safe side. 

People who take blood thinners like Xarelto shouldn’t eat grapefruits or drink grapefruit juice because they contain compounds that can interact with the medication and cause complications. Switching to another citrus fruit like oranges can help curb any cravings you might have for citrus fruit and help you stay safe while taking Xarelto. 

Missed dose

If you end up missing a dose of Xarelto, it’s best to take the missed dose as soon as you remember on the same day. If you remember that you missed a dose a day later, then it’s best just to take the next dose you’re scheduled to take. Xarelto has a half-life of about 11 to 13 hours for older patients, which means that it takes this long for the body to process half of a dose. Do not take an extra dose of Xarelto in the event that you miss a dose. Having extra medication in your system can cause serious side effects. Xarelto doses may need to be decreased in older patients with decreased renal function.  

How to avoid Xarelto side effects

Taking Xarelto at the same time each day will help your body get used to the medication and will help you remember when to take it. This will also help reduce your chance of experiencing any side effects. If you do start to have side effects after starting Xarelto, you should continue to take the medication but let your doctor know. Stopping Xarelto abruptly can increase your risk of getting a stroke or experiencing other serious side effects. 

You’ll have to be tapered off of Xarelto in order to safely discontinue using it. Your doctor will come up with a plan for you where you’ll take lower doses of Xarelto over a certain period of time. This will help reduce your chance of experiencing withdrawal symptoms, adverse events, and blood clotting problems.

What is the safest blood thinner? 

Xarelto isn’t the only blood thinner for seniors. Here are some other common blood thinners: 

Best blood thinners for seniors

Drug name Drug class Standard dosage in seniors (65+)* Common side effects in seniors SingleCare savings Learn more
Xarelto (rivaroxaban) Anticoagulant  2.5 mg-10 mg per day Increased risk of bleeding, back pain, and weakness Get coupon Xarelto details
Eliquis (apixaban) Anticoagulant  2.5 mg-10 mg taken twice daily depending Chest pain, bruising, and dizziness  Get coupon Eliquis details
Coumadin (warfarin) Anticoagulant  < 5 mg per day Bruising, bleeding, and weakness  Get coupon Warfarin details
Lovenox (enoxaparin) Anticoagulant  1 mg-40 mg injected subcutaneously Bleeding, injection site reactions, and bruising Get coupon Lovenox details
Pradaxa (dabigatran) Anticoagulant  75 mg-150 mg taken twice per day Bruising and minor bleeding, nausea, and heartburn  Get coupon Pradaxa details
Arixtra (fondaparinux) Anticoagulant  2.5 mg-10 mg injected once per day Bleeding problems, anemia, and low red blood cell counts Get coupon  Arixtra details 

* Dosage depends on the medical condition being treated