High-Alert Medications

Xarelto (rivaroxaban)

Safety Sheet

Take extra care! Xarelto is a high-alert medicine.

This means that Xarelto has been proven to be safe and effective, but serious harm, such as severe bleeding or a stroke, can occur if it is not taken exactly as directed.

When Your Doctor Prescribes Xarelto (a blood thinner)

1. Tell your doctor about all your diseases and conditions. Xarelto may not be right for you if you have any of the following: bleeding disorders, kidney or liver disease, stomach ulcers, problems with your heart valves, artificial heart valves, open wounds, if you tend to fall, or if you are at risk for falls.

2. Tell the doctor what else you take. Certain medicines increase the risk of bleeding when taken with Xarelto. Provide the doctor with a list of all the prescription, over-the-counter, and herbal medicines, vitamins, and other dietary supplements you take. While taking Xarelto, tell your doctor if you start or stop any medicines or dietary supplements. Common over-the-counter and herbal medicines to avoid can be found on the other side of this page in the Fast Facts table.

3. Know why you take Xarelto and how to take it. Check that you understand how to take Xarelto by telling the doctor why you are taking the medicine, what time of the day you will take it, what strength pills you will take (10 mg, 15 mg, or 20 mg), and how many pills you will take each time. If you take Xarelto to treat a blood clot in your legs or lung, the dose will be reduced after a few weeks (typically 21 days). In this case, your doctor may prescribe a Xarelto Starter Pack for the first 30 days with directions for taking the correct dose each day.

4. Talk about costs. Let your doctor know if you might have trouble paying for Xarelto. The doctor may be able to help you get a discount or switch you to a less expensive medicine.

5. Take exactly as directed. Take your Xarelto at the same time or times each day and do not skip any doses. If you take Xarelto once daily and forget to take a dose, do NOT take more than one dose at the same time. Take it as soon as you remember unless it is close to the time of your next dose. If you take Xarelto twice daily and forget to take a dose, take the missed dose as soon as you remember. If it is close to the time of the next dose, you may take two doses at the same time to make up for the missed dose.

6. Do not stop the medicine. Do not stop taking Xarelto unless your doctor tells you to stop. Refill your prescription before you run out. Stopping the medicine may increase your risk of forming blood clots or having a stroke.

7. Tell all your healthcare providers. Tell all your doctors, dentists, and pharmacists that you are taking Xarelto.

8. Take precautions to prevent bleeding. Avoid sharp objects, rough sports, and fall risks (climbing a ladder, for example) that can lead to bruising, cuts, or injuries. Use a soft toothbrush and electric razor, and blow your nose gently.

When You Should Call Your Doctor

9. Call immediately if you fall or injure yourself, especially if you hit your head, or if you experience any signs of bleeding, a blood clot, a stroke, or an allergic reaction, which are listed on the other side of this page. If you can’t reach your doctor right away, seek immediate treatment in an emergency room.

10. Call before you have any dental work, surgery, a spinal or epidural injection, or any other type of medical procedure that may cause you to bleed. Your doctor may tell you to stop taking Xarelto for a while. Ask your doctor to tell you when to start taking Xarelto again after the procedure.

Xarelto tablets come in three strengths (10 mg, 15 mg, and 20 mg). The front of each tablet is marked with a number that corresponds to the strength. The back of each tablet is marked with the letters Xa. Be sure the number on the front of the tablet matches the strength you need for your prescribed dose.

  • Unusual pain, swelling, discomfort (may also be a sign of a clot)
  • Unusual or easy bruising
  • Pink, red, or brown urine
  • Prolonged bleeding of gums or cuts
  • Persistent, frequent nosebleeds
  • Unusually heavy/long menstrual flow
  • Coughing up blood clots
  • Vomit that is bloody or looks like “coffee grounds”
  • Severe dizziness, weakness, headache,
  • fainting, unusual or persistent tiredness
  • Bloody red or black tarry stools (poop)
  • Joint pain

  • In the lung: chest pain, fast heart rate, coughing, trouble breathing, fever
  • In the arm or leg: sudden pain, swelling, redness, warmth, tenderness
  • In the brain (stroke): headache; dizziness; seizure; vision changes; slurred speech or trouble speaking; weakness or tingling in the face, arm, or leg, especially on one side of body
  • Skin rash or hives
  • Itching
  • Trouble breathing
  • Wheezing
  • Chest tightness
  • Swollen face or tongue