When Your Pharmacy Says "No" — What Are Your Options?

If you've been told your pharmacy doesn't have Xarelto in stock, or if cost is making it impossible to fill your prescription, the first thing to know is: don't panic, and don't stop taking your blood thinner without talking to your doctor.

Xarelto (Rivaroxaban) is a critical medication for preventing strokes, blood clots, and other serious cardiovascular events. But it's not the only option. Several other medications work in similar ways, and your doctor can help you find the right alternative if Xarelto isn't available or affordable.

In this article, we'll explain what Xarelto is, how it works, and walk you through the most common alternatives — with real details about each one.

What Is Xarelto?

Xarelto is the brand name for Rivaroxaban, a prescription blood thinner (anticoagulant) made by Janssen Pharmaceuticals. It belongs to a class of drugs called direct oral anticoagulants (DOACs), which are newer alternatives to older blood thinners like Warfarin.

Xarelto is FDA-approved to:

• Reduce the risk of stroke in people with nonvalvular atrial fibrillation (AFib)
• Treat and prevent deep vein thrombosis (DVT) and pulmonary embolism (PE)
• Prevent blood clots after hip or knee replacement surgery
• Reduce cardiovascular risk in people with coronary artery disease (CAD) or peripheral artery disease (PAD)

For more details, see our complete guide: What Is Xarelto? Uses, Dosage, and What You Need to Know.

How Does Xarelto Work?

Xarelto works by directly blocking Factor Xa, a protein that plays a critical role in the blood clotting process. By inhibiting Factor Xa, Xarelto prevents the formation of thrombin — the enzyme that turns blood into a clot.

Unlike older anticoagulants like Warfarin, Xarelto:

• Doesn't require routine blood monitoring (no INR tests)
• Has fewer dietary restrictions
• Works at a predictable, fixed dose for most patients
• Starts working within 2-4 hours

To learn more about the science, read How Does Xarelto Work? Mechanism of Action Explained.

Alternatives to Xarelto

If you can't get Xarelto — whether it's out of stock, too expensive, or causing side effects — your doctor has several well-studied alternatives to consider. Here are the four most common:

1. Eliquis (Apixaban)

Drug class: Direct Factor Xa Inhibitor (DOAC)

How it works: Like Xarelto, Eliquis blocks Factor Xa to prevent blood clots. It's the most commonly prescribed DOAC in the United States, used by over 50% of DOAC patients.

Key differences from Xarelto:

• Taken twice daily instead of once daily
• Some studies suggest a slightly lower risk of major bleeding compared to Rivaroxaban
• Also FDA-approved for AFib stroke prevention, DVT/PE treatment and prevention
• Medicare negotiated price of $231 per month in 2026

Who it's good for: Patients who need an anticoagulant similar to Xarelto, especially those at higher bleeding risk. Available in 2.5 mg and 5 mg tablets.

2. Pradaxa (Dabigatran)

Drug class: Direct Thrombin Inhibitor (DOAC)

How it works: Instead of blocking Factor Xa, Pradaxa directly blocks thrombin — the enzyme that converts fibrinogen into fibrin clots. It's a different mechanism but achieves the same goal of preventing blood clots.

Key differences from Xarelto:

• Taken twice daily
• Has a specific reversal agent called Praxbind (Idarucizumab), which can rapidly reverse its effects in emergencies
• Must be stored in the original bottle (capsules are moisture-sensitive)
• May cause more GI side effects (stomach upset, heartburn) than Xarelto

Who it's good for: Patients who want the reassurance of having a specific reversal agent available, or those who haven't responded well to Factor Xa inhibitors.

3. Savaysa (Edoxaban)

Drug class: Direct Factor Xa Inhibitor (DOAC)

How it works: Like Xarelto and Eliquis, Savaysa blocks Factor Xa. It's the least commonly prescribed DOAC in the U.S. but is a solid option for the right patient.

Key differences from Xarelto:

• Taken once daily
• For DVT/PE treatment, requires 5-10 days of an injectable anticoagulant first (like Heparin or Enoxaparin) before switching to oral Savaysa
• Not recommended for patients with CrCl greater than 95 mL/min (high kidney function) for AFib — a unique restriction
• Generally less expensive than Xarelto

Who it's good for: Patients who prefer once-daily dosing and are willing to start with a short course of injections for DVT/PE treatment.

4. Warfarin (Coumadin)

Drug class: Vitamin K Antagonist

How it works: Warfarin blocks the action of Vitamin K, which your liver needs to make certain clotting factors. It's been used for over 60 years and remains one of the most widely prescribed anticoagulants worldwide.

Key differences from Xarelto:

• Requires regular blood tests (INR monitoring) — usually every 2-4 weeks
• Has significant dietary restrictions (must maintain consistent Vitamin K intake)
• Many more drug interactions than DOACs
• Extremely inexpensive — as low as $4-$10 per month for generic Warfarin
• Has well-established reversal with Vitamin K and fresh frozen plasma

Who it's good for: Patients who can't afford DOACs, those with mechanical heart valves (where DOACs are not recommended), and patients who are comfortable with regular monitoring.

Important: Never Switch Medications on Your Own

All blood thinners are serious medications with real risks. Never switch from Xarelto to another anticoagulant without your doctor's guidance. Your doctor will consider:

• Your specific medical condition and diagnosis
• Your kidney and liver function
• Other medications you're taking (drug interactions matter)
• Your bleeding risk and history
• Cost and insurance coverage

Still Looking for Xarelto?

Before switching to an alternative, it's worth trying to find Xarelto first. Use Medfinder to check real-time availability at pharmacies near you. Many availability issues are temporary and pharmacy-specific.

Final Thoughts

If you can't fill your Xarelto prescription, you have real, effective alternatives. Eliquis, Pradaxa, Savaysa, and Warfarin all prevent blood clots through slightly different mechanisms, and each has its own pros and cons.

The most important thing is to stay on anticoagulation therapy. Talk to your doctor about which alternative is right for you, and use Medfinder to help locate whatever medication you need. For cost concerns, our guide on saving money on Xarelto may also help.