Xarelto Dosage, forms & strengths
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Xarelto (rivaroxaban) is a prescription drug approved by the U.S. Food and Drug Administration (FDA) to stop blood clots from forming. A blood clot is formed when some of your blood thickens and forms a gel-like plug in your body. It can block the flow of your blood, and in some cases lead to life-threatening conditions. Xarelto can cause adverse reactions like any other drug. Learn more about Xarelto’s side effects and how to avoid them.
Xarelto is a brand name FDA-approved prescription blood thinner used to treat venous thromboembolism (VTE), which includes both deep vein thrombosis (DVT) and pulmonary embolism (PE). Deep vein thrombosis is when a blood clot forms in your leg, pelvis, or arm. This blood clot can break and travel to your lungs, causing a pulmonary embolism. Xarelto is also used to stop DVT and PE recurring.
Xarelto belongs to a class of medications called Factor Xa inhibitors which reduce the risk of blood clots and also reduce the risk of coronary heart disease and peripheral artery disease. Xarelto is not recommended if you have an artificial heart valve.
Xarelto forms and strengths
The active ingredient in Xarelto, rivaroxaban, is classed as an orally taken anticoagulant drug, sometimes called a blood thinner. It reduces the risk of clots forming in your blood.
When your blood clots, it goes through a chemical process that turns it from a liquid to a thick gel. This chemical process is complex and has a number of steps that happen in sequence. Rivaroxaban works by interrupting one of these steps.
When you take Xarelto, rivaroxaban is absorbed into your blood. It attaches itself to and blocks an enzyme in your blood, called Factor Xa. This enzyme controls a step in the clotting process, and by blocking it, rivaroxaban makes it less likely your blood will clot.
Xarelto comes as a tablet that you swallow. Your dose, and how often you take your Xarelto, will be decided upon by the doctor who prescribes it to you. Xarelto is available in different oral tablet strengths:
- Xarelto 2.5 mg tablets
- Xarelto 10 mg tablets
- Xarelto 15 mg tablets
- Xarelto 20 mg tablets
Always speak with a healthcare professional about any changes to your dose so they can monitor and evaluate your condition. There is a higher risk of blood clots if Xarelto is stopped too soon. If you miss a dose, take it as soon as you remember. However, if it is near the time of your next dose, skip the missed dose. For additional safety information, read the full prescribing information and medication guide.
Xarelto dosage chart
|Venous thromboembolism (VTE), including DVT and PE||15 mg twice daily for 21 days, 20 mg thereafter|
|Prophylaxis of VTE, including DVT and PE, in patients with risk factors||10 mg once daily 6 months after initial anticoagulant treatment|
|Prophylaxis of DVT after hip replacement surgery||10 mg once daily for 35 days starting 6-10 hours after surgery|
|Prophylaxis of DVT after knee replacement surgery||10 mg once daily for 12 days 6-10 hours after surgery|
|Prophylaxis of VTE due to hospitalization for acute illness||10 mg once daily for days 31 to 39|
|Prophylaxis of stroke in people with nonvalvular atrial fibrillation||20 mg once daily|
|Prophylaxis of stroke, heart attack, and death in people with coronary artery disease||2.5 mg twice daily, taken with a daily 75-100 mg dose of aspirin|
|Prophylaxis of stroke, heart attack, and other cardiovascular events in people with peripheral artery disease||2.5 mg twice daily, taken with a daily 75-100 mg dose of aspirin|
Xarelto dosage for venous thromboembolism (VTE)
The recommended initial daily dose for the treatment of VTE in adults is 15 mg with food twice per day. After 21 days the dose of Xarelto is altered to 20 mg with food once per day.
Xarelto dosage for the prophylaxis of venous thromboembolism
Xarelto can also be used to reduce the risk of DVT and PE in people at higher risk of a blood clot. Risk factors include a previous DVT, PE, hip replacement or knee replacement surgery, or previous hospitalization with an acute illness.
The recommended dosage is 10 mg once daily, the length of treatment will vary based on the risk factor:
- Continuing risk factors – six months following the initial anticoagulant therapy
- Hip replacement surgery – for thirty-five days, starting six to ten hours after surgery
- Knee replacement surgery – for twelve days starting six to ten hours after surgery
- Prevention of VTE due to hospitalization for acute illness – for 31 to 39 days
Xarelto prophylaxis dosage used for nonvalvular atrial fibrillation, coronary artery disease, and peripheral artery disease
You may be more likely to develop blood clots if you have nonvalvular atrial fibrillation, coronary artery disease, or peripheral artery disease. Xarelto may be prescribed to you to prevent dangerous blood clotting and to reduce the risk of cardiovascular events such as stroke or heart attack.
- The recommended dose to reduce the risk of stroke and blood clots if you have nonvalvular atrial fibrillation is 20 mg once per day with your evening meal
- The recommended dose to prevent cardiovascular events in coronary artery disease is 2.5 mg with or without food twice daily, with a 75-100 mg dose of aspirin daily
- The recommended dose to prevent complications from blood clots if you have peripheral artery disease is 2.5 mg with or without food twice daily, with a daily 75-100 mg dose of aspirin
Xarelto dosage for children
Treatment of venous thromboembolism and risk reduction of recurrent VTE in pediatric patients from birth to 18 years after at least 5 days of initial parenteral anticoagulant treatment is based on the child’s body weight.
Xarelto is recommended for thromboprophylaxis in pediatric patients aged 2 years or above with congenital heart disease who have undergone the Fontan procedure (a type of open-heart surgery).
Xarelto dosage restrictions
If you have a hepatic impairment or kidney problems Xarelto levels in your blood can get excessively high and increase your risk of bleeding as well as other possible side effects. To prevent this from happening you may be given Xarelto at a lower dose.
You may not be recommended Xarelto if you have a severe renal impairment (CrCl less than15 mL per minute) unless you are being treated for atrial fibrillation, coronary artery disease, or peripheral artery disease. If you have mild to normal renal function or moderate renal impairment, you can take standard Xarelto doses unless you are being treated for atrial fibrillation.
If you have nonvalvular atrial fibrillation you will be given 15 mg of Xarelto once daily if your creatinine clearance is lower than 50 mL/min.
If you have liver disease you may also have a condition known as coagulopathy. If you have moderate to severe hepatic impairment or coagulopathy-associated liver disease, you are recommended to avoid the use of Xarelto due to an increased risk of bleeding.
Xarelto is contraindicated if you have active major bleeding, have had a recent spinal puncture or epidural catheter placement, have a history of spinal surgery, prosthetic heart valves, or triple positive antiphospholipid syndrome. You should also avoid Xarelto if you have PE and have poor circulation or unstable blood pressure.
How to take Xarelto
Xarelto is typically taken once a day, at the same time each day. It can be taken with food or without food. Sticking to this timing and taking your medication consistently will make a big difference in how well Xarelto works for you.
If you miss a dose of this medicine, skip the missed dose and go back to your next scheduled time. Do not double your doses. Refer to your medication guide for more detailed drug information.
Xarelto dosage FAQs
How long will it take for Xarelto to work?
Xarelto will start to work after an hour of you taking a dose, with the greatest effect seen within 2 to 4 hours. Food will not affect the body’s ability to absorb Xarelto doses 2.5 mg or 10 mg, but will affect absorption at 15 mg and 20 mg doses. You are advised to take higher doses of Xarelto with food.
How do I stop taking Xarelto?
Based on clinical trials the FDA has issued a warning, known as a boxed warning for the risk of blood clots if you suddenly stop taking Xarelto and for the risk of blood clots forming near the spine or brain.
You are advised to not stop taking Xarelto without speaking to your doctor first. Your doctor may prescribe you another treatment for preventing blood clots if they think it is safe.
What is the maximum dosage for Xarelto?
The maximum recommended dosage of Xarelto in adults is 30 mg per day.
Can you overdose on Xarelto medication?
Yes, you can. Xarelto can potentially cause bleeding problems if you take too much. Speak with your healthcare provider for medical advice if you think you have taken an overdose so they can monitor and evaluate your condition.
What drug interactions are there with Xarelto?
Coadministration with certain other medications is not recommended. These include:
- Any other anticoagulant medications, such as clopidogrel
- Aspirin or products containing aspirin
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen
- Any other medications or supplements that can put you at a high risk of bleeding, including any medications that contain warfarin, enoxaparin, or heparin
- Any selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressants
- Other antiplatelet agents, e.g. prasugrel or ticagrelor
- Any medications taken to treat fungal infections, particularly ketoconazole
- Any antibiotics taken to treat a bacterial infection, such as erythromycin or rifampicin
- Any HIV/AIDS medications, such as ritonavir
- Any medications taken to treat seizures, particularly phenytoin or carbamazepine
- A herbal supplement called St John’s Wort
What happens when you mix Xarelto and alcohol?
Research shows that small quantities of alcohol may have anticoagulant properties, working almost like blood thinners. Ethanol the scientific name for alcohol has been found to reduce levels of fibrinogen, another protein involved in blood clotting. A study published in 2015 found that drinking 2-3 alcoholic drinks a day reduced the amount of fibrinogen in the blood by 14%. So if we combine both Xarelto and alcohol it may result in an intensified anticoagulant activity in your blood.
Why is this dangerous? Alcohol and Xarelto are blood thinners and when both are combined the risk of side effects increases, in particular, a higher risk of minor to major bleeding problems.
Minor bleeding such as nosebleeds, bruising and bleeding gums may occur. Major bleeding events such as menstrual bleeding that is heavier than normal, coughing up blood, and severe headaches are possible too. Internal bleeding is the most dangerous because it is more difficult to detect and life-threatening.
You may have a higher risk of bleeding if you also take some of these drugs:
- NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen
- Aspirin or aspirin-containing products
- Warfarin (Coumadin)
- Drugs containing heparin
- Other blood-thinning drugs
What are the side effects of Xarelto?
The most common side effects of Xarelto are:
- Muscle pain
- Stomach pain or discomfort
Xarelto can cause more serious side effects, including:
- Severe allergic reactions to the medication
- An increased risk of serious bleeding that won’t stop, like a hemorrhage (bleeding from a ruptured blood vessel)
- An increased risk of spinal or epidural hematoma (bleeding and blood clots in your spine) in patients who take Xarelto and who receive a spinal puncture or local anesthetic injection around their spine – this could result in paralysis
- Spinal blood clot, symptoms include back pain, numbness or muscle weakness in your lower body, or loss of bladder or bowel control
- Vomiting blood that looks like coffee grounds
- Tarry stools
Is it safe to take Xarelto during pregnancy or when breastfeeding?
Xarelto is not recommended if you are pregnant or planning to become pregnant, or if you are breastfeeding or planning to breastfeed.