Xarelto Side Effects: What You Should Know

Xarelto (Rivaroxaban) is a widely prescribed blood thinner used to prevent and treat blood clots. Like all anticoagulants, it comes with side effects — some minor and manageable, others that require immediate medical attention. This guide covers what to expect, who's at higher risk, and when to call your doctor.

What Is Xarelto?

Xarelto is a direct oral anticoagulant (DOAC) made by Janssen Pharmaceuticals. It works by blocking Factor Xa in the blood clotting cascade, which prevents clots from forming. It's FDA-approved for conditions including atrial fibrillation, DVT, pulmonary embolism, and more. For a deeper look at how it works, see our guide on Xarelto's mechanism of action.

Common Side Effects

The most frequently reported side effects of Xarelto from clinical trials and FDA labeling include:

• Bleeding — The most common side effect, reported in 5–28% of patients depending on the indication and dose. This includes nosebleeds, bleeding gums, heavier menstrual periods, and cuts that take longer to stop bleeding.
• Bruising — You may notice bruises appearing more easily or being larger than usual.
• Nausea — Some patients experience stomach upset, especially when first starting the medication.
• Back pain — Reported in clinical trials as a common side effect.
• Itching — Skin itchiness without a clear cause.
• Dizziness — Mild lightheadedness, particularly when standing up quickly.
• Stomach or abdominal pain — Discomfort in the belly area.
• Muscle spasms — Occasional cramping or muscle tightness.

Most of these side effects are mild and tend to improve as your body adjusts to the medication. However, you should mention any new or worsening symptoms to your doctor.

Serious Side Effects

Some side effects of Xarelto are serious and require immediate medical attention. Call your doctor or go to the emergency room right away if you experience any of the following:

• Major hemorrhage — Occurs in up to 4% of patients. Signs include blood in your urine (pink or brown), black or tarry stools, coughing up blood, vomiting blood or material that looks like coffee grounds, and severe or unexplained bruising.
• Intracranial bleeding — Sudden severe headache, confusion, vision changes, difficulty speaking, weakness on one side of the body, or loss of consciousness. This is a medical emergency.
• Gastrointestinal bleeding — Heavy GI bleeding can cause blood in stool, vomiting blood, dizziness, and weakness.
• Spinal or epidural hematoma — Xarelto carries a boxed warning about this risk in patients receiving spinal injections or epidural anesthesia. Symptoms include tingling, numbness, or weakness in the legs, or loss of bladder or bowel control. This can cause permanent paralysis if not treated immediately.
• Allergic reactions — Rare but serious. Symptoms include hives, swelling of the face or throat, difficulty breathing, and anaphylaxis.
• Stevens-Johnson syndrome — An extremely rare but life-threatening skin reaction.

Who's at Higher Risk for Side Effects?

Certain groups may experience more side effects or need closer monitoring while taking Xarelto:

• Patients with kidney impairment — Xarelto is partially cleared by the kidneys. Reduced kidney function (CrCl ≤50 mL/min) may require a dose adjustment. Patients with end-stage renal disease on dialysis should generally not take Xarelto.
• Patients with liver disease — Significant liver impairment (Child-Pugh B and C with coagulopathy) is a contraindication.
• Older adults — Higher bleeding risk due to age-related factors including kidney decline and more fragile blood vessels.
• People taking other blood-thinning medications — Combining Xarelto with other anticoagulants, antiplatelet drugs, or NSAIDs like ibuprofen significantly increases bleeding risk. See our full guide on Xarelto drug interactions.
• Patients with prosthetic heart valves — Xarelto is not recommended for this group.
• Patients with BMI over 40 or weight over 120 kg — Use with caution as effectiveness may vary.

How to Manage Side Effects

Here are practical steps to minimize and manage Xarelto side effects:

• Take it with food. The 15 mg and 20 mg doses should always be taken with food to ensure full absorption and may reduce stomach upset.
• Use a soft toothbrush. This helps prevent bleeding gums.
• Be careful with sharp objects. Use an electric razor instead of a blade. Be extra cautious when using knives or scissors.
• Avoid contact sports or activities with high injury risk. Even minor injuries can cause significant bleeding while on an anticoagulant.
• Limit alcohol. Alcohol can increase bleeding risk and interact with Xarelto.
• Wear a medical alert bracelet. In an emergency, medical professionals need to know you're on a blood thinner.
• Don't stop taking Xarelto suddenly. This is critical — Xarelto has a boxed warning that stopping abruptly increases the risk of blood clots, stroke, or pulmonary embolism. Always talk to your doctor first.

When to Call Your Doctor

Call your doctor if you experience:

• Any unusual or prolonged bleeding
• Frequent nosebleeds that don't stop easily
• Blood in your urine or stool
• Excessive bruising
• Persistent nausea or stomach pain
• Dizziness or fainting

Call 911 or go to the ER immediately if you have signs of major bleeding (coughing up blood, vomiting blood, sudden severe headache, confusion) or symptoms of spinal hematoma (leg numbness, weakness, or loss of bladder control).

Final Thoughts

Most people tolerate Xarelto well, and the benefits of preventing blood clots generally outweigh the risks of side effects. The key is knowing what to watch for and when to seek help. Stay in close communication with your doctor, report any new symptoms promptly, and never stop taking Xarelto without medical guidance.

Looking for Xarelto at a good price? Check out our guide on how to save money on Xarelto, or visit Medfinder to find it in stock near you.