Xarelto, made simple.
Xarelto is a common blood thinner. Taking it the right way means knowing one thing many patients are never told: with the most common doses, food is part of the medicine. This guide explains what Xarelto does, how to take it safely, and what to watch for. A Mississippi pharmacist who fills Xarelto every day wrote it for you.
This guide is here to teach you. It is not medical advice, and it does not replace your doctor or pharmacist. Always do what your doctor tells you, and ask a pharmacist before you change how you take any medicine.
Print this guide for your fridgeWhat Xarelto is and why your doctor gave it to you
Xarelto is a blood thinner. Its other name is rivaroxaban. It is the same medicine.
Doctors give it for a few different reasons.
- An irregular heartbeat, called AFib. When the heart beats in an uneven way, blood can sit still and form a clot. That clot can travel to the brain and cause a stroke. Xarelto lowers that risk.
- A blood clot, or the risk of one. If you had a clot in your leg or your lung, Xarelto treats it and helps stop another one. It is also used after some hip or knee surgeries.
- Heart or leg artery disease. For some people with heart disease or poor blood flow in the legs, a low dose of Xarelto is used along with aspirin to lower the risk of a heart attack or stroke.
The simple version: Xarelto makes your blood less likely to form a dangerous clot. That protects you. It also means a cut takes a little longer to stop bleeding. So it asks you to be a little careful. This guide shows you how.
How Xarelto works
Your body uses a tiny part of your blood, called Factor Xa, to start a clot. Think of it like a key that starts the clotting.
Xarelto blocks that key.
When the key is blocked, your blood does not start a clot as easily. That is good. It stops dangerous clots. It also means that when you get a cut, the bleeding takes a little longer to stop. That is the medicine doing its job, not the medicine going wrong.
Your dose, and why food matters
Xarelto comes in a few sizes. Your doctor picks your size and your pharmacist checks it. They choose based on what they are treating, your age, and how well your kidneys work.
Here is the part many patients are never told, and it matters a lot. The two larger sizes of Xarelto, the 15 mg and the 20 mg, must be taken with food. Not a snack on the side. A real meal. Without food, your body cannot absorb the medicine well, and you may not get the protection you need. The smaller sizes do not have this food rule. If you are not sure which size you take or whether yours needs food, ask your pharmacist. This is one of the most important questions you can ask.
Many people with AFib take Xarelto once a day, with their evening meal. Other people take it twice a day. Your doctor and your pharmacist decide your dose and your schedule. This page will not tell you what dose to take. If you are switching to Xarelto from another blood thinner like Eliquis, know that the rules are not the same. Eliquis does not have the food rule. Xarelto does. Ask your pharmacist to walk you through the difference.
Timing, and what to do if you miss a dose
Take Xarelto at the same time every day. If you take it once a day for AFib, take it with your evening meal, the same meal each day. If you take it twice a day, pick two times that are easy to remember and stay with them.
What to do about a missed dose depends on your dose and your schedule, and the rules are not the same for everyone. That is why the safest answer is the one below.
If you miss a dose:
- If you miss a dose, do not guess. Call your pharmacist and ask what to do for your specific dose.
- For many once-a-day patients: take the missed dose as soon as you remember on the same day, then take the next dose at the normal time.
- Never take two doses at once to catch up, unless your pharmacist or doctor has told you that your specific dose allows it.
- If a lot of time has passed, or you are not sure, call Fairview. We will tell you exactly what to do.
Side effects, what is normal and what is not
Normal. This is the medicine working.
- You bruise more easily than before.
- Small cuts take a little longer to stop bleeding.
- You may have an occasional nosebleed, or bleed a little longer after the dentist.
- Feeling a little more tired than usual.
Call your doctor if you see:
- Bleeding that is unusual, or that does not stop.
- Pink, red, or dark brown pee.
- Red, black, or tar colored stool.
- Coughing up or throwing up blood.
- Feeling dizzy, weak, or faint.
- A rash or signs of an allergic reaction.
Go to the emergency room right away if:
- You fall or hit your head, even if you feel fine. Xarelto can cause bleeding around the brain that you cannot feel at first.
- Bleeding will not stop, or is severe.
- You have a sudden bad headache, trouble seeing, slurred speech, or weakness on one side. These can be signs of a stroke.
- After a spinal procedure or epidural, you have numbness, weakness, or trouble controlling your bladder or bowels. Tell the staff you take Xarelto.
What to be careful with
This part is the one patients are told about the least. It is one of the most important.
Some medicines make you bleed more easily when you take them with Xarelto. The most common ones are over the counter pain pills like ibuprofen (Advil, Motrin) and naproxen (Aleve). Aspirin too, unless your doctor told you to take it. Some prescription medicines and some supplements can also change how Xarelto works, either raising your bleeding risk or making the medicine weaker.
One supplement to know by name is St. John's Wort. It can make Xarelto weaker. Some antifungal medicines, some HIV medicines, and some seizure medicines can also change how Xarelto works. This is not a list to memorize. It is a reason to do one simple thing.
The simple rule: before you start any new medicine, a prescription, an over the counter pill, or a supplement, tell your pharmacist you take Xarelto. Every single time.
For pain, acetaminophen (the medicine in Tylenol) is usually a safer choice than Advil or Aleve when you are on Xarelto. Ask your pharmacist what is right for you. At Fairview, every Xarelto patient has these warnings saved in their file, and we check every new prescription against them.
What it costs
The cost is different for every person, because every insurance plan is different.
Here is the honest way to find your price. If you pay cash, call Fairview and we will give you a price for your situation. If you have private insurance, there may be a coupon or a savings program from the maker of the drug that helps lower your cost, and we will check if one is available for you. The best step is to let a pharmacist look at your plan. We do this for every patient.
Do not let cost make you skip doses. Call us first. There is almost always something we can do.
There is also a generic version of many medicines. The generic is the same medicine. Ask your pharmacist if a generic is a good fit for you.
What should be checked
Xarelto does not need the regular blood test that the older blood thinner warfarin needs. That is one good thing about it. But it still needs some checking.
Your doctor should check, now and then:
- How well your kidneys work. This matters more as you get older.
- Signs of any bleeding, at every visit.
- Whether your other medicines still mix safely with Xarelto.
Your pharmacist should, now and then:
- Make sure your dose strength matches what you are being treated for.
- Make sure you know the food rule if you take the 15 mg or 20 mg size.
- Check every refill for any new medicine that does not mix well with Xarelto.
- Make sure you have not stopped Xarelto on your own.
At Fairview, we keep an eye on our Xarelto patients. If a refill is late, we call you. If a new medicine is added that does not mix well with Xarelto, we call you before you take it.
Special situations
Before surgery or the dentist.
Tell the surgeon or dentist that you take Xarelto. Then call the doctor who gave it to you. They will usually have you stop Xarelto for a short time before the procedure, often a day or two, and tell you when to start again. Never stop Xarelto on your own with no plan. Stopping with no plan opens a window of clot and stroke risk. You can also call Fairview and we will make sure the plan makes sense.
If you fall or hit your head.
If you take Xarelto and you hit your head, get checked by a doctor or the emergency room, even if you feel fine. Xarelto can cause slow bleeding around the brain. You might feel okay for hours. A quick scan can check for it. Tell the staff: I take Xarelto, also called rivaroxaban. That changes how they help you right away.
Spinal procedures and epidurals.
If you are having a spinal injection, an epidural, or a spinal tap, the team must know you take Xarelto well ahead of time. A blood thinner during these procedures carries a rare but serious risk of bleeding around the spine. This is one reason you should never hide that you take Xarelto from any member of your care team.
There is a way to reverse it.
If there is a serious bleeding emergency, hospitals have a treatment that can reverse the blood-thinning effect of Xarelto. It is a hospital treatment, not something you keep at home, but it is good to know it exists. It is one more reason to get to an emergency room quickly if bleeding will not stop.
Travel.
Keep Xarelto in your carry on bag, never in a checked bag. Bring extra in case of delays. If you take the 15 mg or 20 mg size, plan your dose around a real meal even while traveling. Carry a card that lists your medicines, your doctor, and Fairview's phone number.
Older adults.
People over 75 on Xarelto need a little extra care. Kidneys change with age, and that changes how the body handles the medicine. More medicines mean more chances for a bad mix. Falls are more likely. Taking Advil or Aleve for arthritis is common and risky with Xarelto. A weekly pill pack, regular check ins, and family who understand the medicine all help. At Fairview, our older Xarelto patients are some of the patients we watch most closely.
How Fairview helps Xarelto patients
When you fill Xarelto at Fairview, here is what you get. This is normal care for us, not something extra.
At your first fill:
- We check all your medicines, every prescription, supplement, and over the counter pill, against Xarelto.
- We make sure you know the food rule if your size needs it.
- We give you a simple list of what to avoid.
- We tell you what to do if you fall, bleed, or need surgery.
At every refill:
- We check your file for any new medicines.
- We check that you are refilling on time.
- We answer any new questions before you leave.
On our own, without being asked:
- If a refill is late, we call you.
- If we see a problem, we call your doctor.
- If there is important news about Xarelto, we tell you.
- We check your cost at every fill to make sure you are paying the best price for your plan.
Questions people ask about Xarelto
It depends on your size. The 15 mg and 20 mg sizes must be taken with a real meal, or your body will not absorb the medicine well. The smaller sizes do not have this rule. If you are not sure which size you take, ask your pharmacist. It is one of the most important things to get right.
Related guides
Have a question about your Xarelto? Ask a pharmacist who knows it well.
You just learned more about Xarelto than most patients are ever told, including the food rule that keeps the medicine working. If something made you wonder, ask us. And if you want a pharmacy that gives every Xarelto patient this kind of care, Fairview is here. Moving your prescription to us takes one phone call.