What is Xarelto? Uses, warnings & side effects

Take this medication as instructed.

Please read the Medication Guide that comes with this medicine.

Be sure you understand the dosing instructions:

• Dose: the dose may vary by condition and may change during treatment.

• Schedule: doses will taken once per day, once in the evening, or twice per day, depending on the condition being treated.

• Timing: Xarelto 15 mg and 20 mg tablets must be taken at the same time every day. The 2.5 mg and 10 mg tablets can be taken at any time of day.

• Food: The 15 mg and 20 mg tablets of Xarelto must always be taken with a meal. The 2.5 mg and 10 mg tablets can be taken with or without food.

• Other drugs: Xarelto 2.5 mg tablets must be taken along with a single daily dose of low-dose aspirin.

• Missed dose: the rules for taking a missed dose will vary depending on the condition being treated.

How to take Xarelto tablets:

• Swallow the tablet whole with a drink of water.

• If swallowing the tablet is too difficult, ask the prescriber for advice.

• Store Xarelto tablets at room temperature in a closed container securely out of the reach of children.

How to administer Xarelto oral suspension:

• Parents or other caregivers should measure and give doses to children.

• Read the Instructions for Use before giving doses.

• Precise dosing is critical. Ask the prescriber or a pharmacist how to use the Xarelto calibrated syringe correctly when measuring a dose, particularly if doses are going to be measured by the colored bands on the syringe.

• Gently shake the bottle slowly for ten seconds before measuring a dose.

• After shaking the bottle, check the bottle. If there are lumps or granules remaining at the bottom, shake the bottle slowly for another 10 seconds.

• Use only the calibrated oral syringe packaged with this medicine to measure out a dose. The syringe has color bands that allow for high-precision dosing.

• Do not use any other calibrated oral syringe or measuring device. If the syringe is missing, visit a pharmacist to get another.

• If the dose is higher than 5 mL, then use the oral syringe twice to give the proper dose. The Instructions for Use include a table for measuring out two separate doses to equal a single dose larger than 5 mL. 

• Before measuring a dose, push all the air out of the syringe first by pushing the plunger all the way to the bottom.

• With the syringe inserted fully into the adapter and the bottle turned upside down, fill the syringe to a point beyond the prescribed dose.

• With the syringe still in the adapter, tap the syringe to get all the air bubbles to the top of the syringe.

• When all the air bubbles are at the top of the syringe, push the plunger in until the medicine in the syringe aligns with the prescribed dose.

• If using the color bands for measuring a dose, the medicine in the syringe should align with the top of the color band.

• Turn the bottle back upright, remove the syringe, and give the dose.

• Store Xarelto oral suspension at room temperature in a closed container. Store both the bottle and the oral syringe in the original carton.

• Do not freeze.

Managing a missed dose will depend on the circumstances.

For doses given once per day (2.5 mg, 10 mg, 20 mg):

• If a dose is missed, give the missed dose if it’s the same day.

• Skip the missed dose if it’s the next day. Give that day’s dose as scheduled.

• Do not take two doses to make up for a missed dose.

For doses given twice per day (15 mg only):

• If a dose is missed, take the missed dose when remembered.

• It’s okay to take two doses at the same time to make up for a missed dose.

For doses given twice per day to a child:

• If a morning dose is missed, give it when remembered.

• A missed morning dose can be given at the same time as the evening dose if that’s necessary.

• If an evening dose is missed, give it only on the same evening it’s due. Skip the evening dose if it’s the next day.

For doses given three times per day to a child:

• If a dose is missed, skip the missed dose.

• Give the next dose as scheduled.

• Do not give two doses to make up for a missed dose.

If a child vomits or spits up a dose:

• Give the child another full dose if the child vomits up the dose within 30 minutes of taking the dose.

• Skip the dose if the child vomits up the dose more than 30 minutes after taking the dose.

• If a child is persistently vomiting or spitting up doses, talk to the prescribing healthcare provider.

This medicine is not right for everyone.

Xarelto should never be taken by people with:

• Known allergies to rivaroxaban

• Active bleeding

Xarelto is not for use in people with:

• Artificial heart valves

• Antiphospholipid syndrome (APS)

Tell any doctor or other healthcare provider who treats you that you are taking Xarelto. 

Because Xarelto is prescribed for severe conditions and can cause serious complications, the prescriber will need to schedule regular visits and blood tests for critical monitoring. Do not miss any follow-up appointments.

Because Xarelto increases the risk of bleeding, do not fail to tell all other healthcare providers and dentists that you are taking this medicine. 

• Xarelto can cause permanent paralysis in anyone receiving an epidural or spinal puncture.

• Xarelto will need to be discontinued two or three days before surgery.

Tell the doctor if you are pregnant, breastfeeding, or have:

• A history of bleeding problems

• Kidney problems

• Liver problems

Xarelto can cause bleeding, hemorrhage, or severe blood loss. Immediately contact a doctor or get immediate medical care if you experience:

• Unexpected or prolonged bleeding

• Severe bleeding

• Red or black stools

• Bloody or “coffee grounds” vomit

• Coughing up blood

• Dizziness

• Weakness

• Headache

Xarelto can cause bleeding in an unborn fetus. 

• Women taking Xarelto should immediately tell the doctor if they become pregnant.

• Women who can become pregnant should discuss pregnancy planning with the prescribing doctor.

• Women who are pregnant should immediately contact the doctor if they have bleeding or blood loss symptoms.

Do not stop taking Xarelto or reduce the dose until talking to the prescriber. Discontinuing treatment raises the risk of serious blood clots.

Before taking Xarelto, tell the prescribing healthcare professional about all prescription drugs, over-the-counter medications, and supplements you use, particularly:

• Other blood thinners, particularly Defitelio (defibrotide)

• Aspirin

• Salicylates like Pepto-Bismol (bismuth subsalicylate)

• NSAIDs like ibuprofen or naproxen

• SSRIs like Prozac (fluoxetine) or Paxil (paroxetine)

• Macrolide antibiotics like erythromycin 

• Azole antifungals like ketoconazole

• The anti-seizure drugs carbamazepine or phenytoin

• The antiviral drug ritonavir

• The COVID treatment Paxlovid

• St. John’s Wort

Avoid drinking alcohol when taking Xarelto. Alcohol increases the risk of bleeding problems.

Tell other healthcare providers you are using this medicine before they prescribe new medications.