Xarelto’s Side Effects: What to Know

Medically Reviewed By Patricia Weiser, PharmD

This drug has a boxed warning about the risk of blood clots from stopping Xarelto treatment too soon.

It also has a boxed warning for the risk of blood clots around the spine or brain that may occur after certain procedures, such as an epidural. These blood clots may lead to long-term paralysis.

Boxed warnings are serious warnings from the Food and Drug Administration (FDA). For details, see the “ Xarelto: Side effects explained” section below.

Xarelto: Overview

Xarelto is a brand-name prescription drug. It’s a type of drug called a Xa inhibitor and is an anticoagulant (blood thinner). It contains the active drug rivaroxaban. Xarelto comes as tablets and a suspension that are taken orally.

Xarelto is approved by the Food and Drug Administration (FDA) to:

  • treat pulmonary embolism (PE) in adults
  • treat deep vein thrombosis (DVT) in adults
  • help prevent PE and DVT in adults having hip or knee replacement surgery
  • reduce the risk of stroke and blood clots in adults with atrial fibrillation (a type of irregular, rapid heartbeat) that does not involve the heart valves
  • reduce the risk of a PE or DVT in adults who have experienced one in the past and who are still at risk of having one, after at least 6 months of initial treatment
  • help prevent blood clots in adults during and after hospitalization for an acute (short-term) illness
  • reduce the risk of serious heart problems in adults with coronary artery disease
  • reduce the risk of blood clots in adults with peripheral artery disease
  • help prevent blood clots after the Fontan procedure (a type of open-heart surgery) in children ages 2 years and older who have congenital heart disease (heart disease that started at birth)
  • treat and reduce the risk of venous thromboembolism (blood clots that form in veins) in children of all ages, after at least 5 days of initial treatment

Similar to other drugs, Xarelto may cause side effects. Read below for information about possible side effects, including common, mild, and serious ones.


For a general overview of Xarelto, including details about its uses, see this article.

If you’d like to take Xarelto, search here to find a healthcare professional who might prescribe it.

Xarelto: More common side effects

Some of Xarelto’s side effects may be more common than others. These side effects may last only a few days to weeks. However, some side effects may last longer or become severe or bothersome. Tell your doctor or pharmacist if you have concerns about any side effects with Xarelto.

In Xarelto’s clinical studies, these were some side effects that occurred more often in adults:

  • dizziness
  • abdominal pain
  • back pain
  • itching
  • bleeding, which may cause various symptoms, including headache*

To learn about Xarelto’s side effects that were more commonly reported in children, see “Xarelto: Side effects in children” below.

* For more information about this side effect, see “ Xarelto: Side effects explained” below.

Xarelto: Mild side effects

Xarelto can cause mild side effects, which are listed below. However, this list doesn’t include all possible mild side effects. To learn more about Xarelto’s side effects, view the drug’s prescribing information.

Xarelto’s mild side effects include:

  • dizziness
  • back pain
  • muscle spasm
  • abdominal pain
  • itching
  • fainting
  • anxiety
  • trouble sleeping
  • depression
  • itching
  • fatigue*

The side effects listed above may last only a few days to weeks. However, some side effects may last longer or become severe or bothersome. Tell your doctor or pharmacist if you have concerns about side effects of Xarelto.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you develop a side effect while taking Xarelto and want to tell the FDA about it, visit MedWatch.

* For more information about this side effect, see “ Xarelto: Side effects explained” below.

Xarelto: Serious side effects

It’s possible to have serious side effects with Xarelto. Serious side effects are listed below, but this list may not include all possibilities. To learn more about Xarelto’s side effects, view the drug’s prescribing information.

Call your doctor right away if you have serious side effects with Xarelto. However, if you think you’re having a medical emergency or have life threatening side effects, call 911 or your local emergency number.

Serious side effects of Xarelto and their possible symptoms include:

  • bleeding, which could be life threatening in rare cases*
  • risk of blood clots from stopping Xarelto treatment too soon†
  • risk of blood clots in people having certain procedures, such as an epidural injection†
  • allergic reaction*

* For more information about this side effect, see “ Xarelto: Side effects explained” below.
† Xarelto has a boxed warning for this side effect. This is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Xarelto: Side effects explained” section below.

Xarelto: Side effects in children

In clinical studies of Xarelto, the most common side effects in children ages 18 and under were:

  • bleeding
  • vomiting
  • cough
  • inflammation of the stomach and intestines

Bleeding was a common side effect of Xarelto in both adults and children in clinical studies. Vomiting, cough, and inflammation of the stomach and intestines were common in children but were not reported in adults. However, it is possible that any of Xarelto’s side effects that have occurred in adults may also occur in children.

To find out how often these side effects occurred in clinical studies of the drug, see Xarelto’s prescribing information.

Talk with your doctor if you have concerns about side effects of Xarelto in children.

Xarelto: Side effects in older adults

People ages 65 and older generally have a higher risk of bleeding problems with Xarelto than younger people. However, Xarelto treatment is considered just as effective for elderly people as it is for younger people.

Be sure that you know the symptoms of bleeding to watch for while you’re taking Xarelto. Some examples include blood in your urine or stool, bruising easily, unusual nosebleeds, and bleeding gums. You can see “Bleeding” under “Xarelto: Side effects explained” below for more symptoms and details about this side effect.

If you have any questions about the risks of Xarelto treatment at your age, talk with your doctor. They can discuss the risks and benefits of Xarelto treatment.

Xarelto: Common questions about side effects

Here are some common questions about the drug’s side effects and answers to them. Talk with your doctor if you have other questions about this drug.

Does Xarelto cause weight gain or weight loss as a side effect?

Weight gain wasn’t seen in clinical studies of Xarelto. It is not likely that weight gain is a side effect of the drug.

Different factors may contribute to weight loss while you’re taking Xarelto. For example, if you are taking Xarelto to help prevent a blood clot after a hip or knee replacement, your level of physical activity may increase once you recover from the surgery. Your new joint could allow you to exercise more than you did before the replacement. This may lead to weight loss in some people.

If you are concerned about weight loss or weight gain while taking Xarelto, talk with your doctor.

Is hair loss a side effect of Xarelto?

It’s possible. Hair loss did not occur as a side effect in Xarelto’s clinical studies. However, after the drug was approved for use, there were reports of hair loss in people taking Xarelto. It’s unclear how often hair loss happened and whether Xarelto was its cause.

Xarelto is a type of anticoagulant (blood thinner) that reduces blood clotting. Certain other anticoagulant drugs can cause hair loss. Talk with your doctor for more information on how certain drugs can cause hair loss.

Will Xarelto cause certain side effects due to it being a blood thinner?

Yes. Xarelto is an anticoagulant (blood thinner), and it can increase your risk of bleeding.* This can include internal or external bleeding. (With internal bleeding, blood leaks out of a damaged blood vessel but stays inside the body. With external bleeding, blood leaks out of your body through injured skin, such as a cut.)

In rare cases, bleeding with Xarelto can be serious and life threatening.

Taking other drugs that increase bleeding in combination with Xarelto may further increase your risk of bleeding.

Before starting Xarelto treatment, tell your doctor about any other drugs you take. Talk with your doctor about your risk of bleeding with this medication.

* For more information about this side effect, see “ Xarelto: Side effects explained” below.

What should I know about side effects after stopping Xarelto?

You may have life threatening side effects if you stop taking Xarelto too soon. In fact, this drug has a boxed warning for the risk of blood clots from stopping Xarelto treatment too soon.

This is a serious warning from the Food and Drug Administration (FDA). For more information about this boxed warning, see “Xarelto: Side effects explained” below.

Xarelto is a blood thinner that works to treat and help prevent blood clots. Serious side effects such as blood clotting and stroke can occur if you stop taking Xarelto. You should not stop Xarelto without first talking with your doctor. They’ll likely prescribe a different blood thinner to replace it.

During treatment, side effects typically last only a few days to weeks. However, some side effects may continue after you stop treatment. If you continue to have side effects after your doctor recommends you stop taking Xarelto, talk with your doctor.

Do 20-mg doses of Xarelto cause different side effects than other doses?

It is not likely that 20-milligram (mg) doses of Xarelto cause different side effects than other doses. Xarelto comes in different strengths, but its active ingredient is the same in all strengths.

However, in some people, the risk of side effects may increase with higher doses. In clinical studies, the most common side effect of Xarelto was bleeding.* This side effect occurred more often in people taking a 20-mg dose of the drug than those taking a 10-mg dose.

It’s important to note that several clinical studies of Xarelto were conducted before it was approved for use. Some studies used different doses and reported different side effects. The drug’s manufacturer cautions that the results aren’t directly comparable with each other. This is because the studies that gathered the results were conducted under different conditions.

For more information about the risk of side effects from different doses of Xarelto, talk with your doctor or pharmacist.

* For more information about this side effect, see “ Xarelto: Side effects explained” below.

Are there long-term side effects of Xarelto?

Long-term side effects were not reported in clinical studies of Xarelto. However, one serious side effect of Xarelto may cause long-term effects.

Taking Xarelto may increase the risk of blood clots around the spine or brain if you have certain procedures, such as an epidural injection. These blood clots may lead to long-term or permanent paralysis (inability to move body muscles).

Xarelto has a boxed warning for this risk. A boxed warning is a serious warning from the Food and Drug Administration (FDA). To learn more about this risk, see “Xarelto: Side effects explained” below.

Xarelto: Side effects explained

Here’s detailed information about some of Xarelto’s side effects.

Risk of blood clots if Xarelto is stopped too soon

Xarelto has a boxed warning about the risk of blood clots if Xarelto is stopped too soon during treatment. This is a serious warning from the Food and Drug Administration (FDA).

Xarelto works to treat or help prevent blood clots. You may have a blood clot or stroke if you stop taking Xarelto without your doctor’s recommendation.

Possible symptoms of blood clots can include:

  • swelling and pain in your arm or leg
  • warmth in an area of your arm or leg
  • chest pain or tightness
  • sudden cough or shortness of breath

What to do

It is important to take Xarelto exactly as your doctor prescribes. Continue taking the drug as prescribed unless your doctor recommends otherwise. Avoid missing doses, and be sure to refill your prescription before you run out of Xarelto.

Try using a medication reminder to help you remember to take your dose on time. You can also ask your pharmacy to auto-fill your medication so that it is ready for you when you need it.

If you have any symptoms of blood clots, call your doctor right away. However, if your symptoms feel life threatening, call 911 or your local emergency number instead.

Risk of blood clots around the spine or brain

Xarelto has a boxed warning for the risk of blood clots around the spine or brain. This may occur if you take Xarelto and have certain procedures, such as an epidural injection or spinal tap.

Doctors may refer to these types of blood clots as epidural hematomas or spinal hematomas. They may cause paralysis that is long term or permanent. (With paralysis, you’re unable to move your muscles.)

Symptoms of blood clots in the spine or brain include:

  • back pain
  • numbness or tingling in the body
  • muscle weakness, especially in the feet and legs
  • loss of bowel or bladder control
  • confusion

This risk increases if you have a history of spine problems, past surgery on your spine, or past spinal injections. Taking Xarelto with certain other medications that also cause bleeding may also increase the risk of bleeding around the spine.

What to do

While you’re taking Xarelto, tell your doctor right away if you have any of the symptoms listed above. However, if your symptoms are severe or seem life threatening, call 911 or your local emergency number.

Your doctor will monitor you closely for blood clots if you need a spinal or epidural injection during Xarelto treatment. They can tell you about any treatment changes that may be necessary before and after the procedure. This may include pausing Xarelto treatment or switching to a different blood thinner.

Be sure to tell your doctor about all the medications you’re taking. They can determine if the other medications increase this risk for you.

Fatigue

You may lack energy or feel tired while taking Xarelto. In clinical studies, adults and children reported fatigue while taking Xarelto.

More children than adults had fatigue during the studies. To see how often people had fatigue during Xarelto’s clinical studies, view the drug’s prescribing information.

What to do

Your doctor may recommend some ways to help prevent fatigue. They may advise:

  • avoiding daytime naps
  • exercising regularly
  • avoiding foods with high amounts of starch or refined sugars

Talk with your doctor if you have bothersome fatigue while taking Xarelto. If your fatigue is severe and affects your daily life, they may recommend a different treatment option.

Thrombocytopenia

Some people have had thrombocytopenia (low level of platelets) while taking Xarelto after it was approved for use. This side effect was not reported during clinical studies.

Platelets are a type of blood cell that help form blood clots and slow bleeding. With thrombocytopenia, there is an increased risk of bleeding and bruising more often than usual. Bleeding is a side effect of Xarelto that occurred in clinical studies. (To learn more, see the section directly below.)

What to do

If you have unusual bleeding, talk with your doctor. Your doctor can give you information about possible low levels of platelets during Xarelto treatment. For symptoms to watch for, see the section directly below.

Bleeding

The most common side effect of Xarelto in clinical studies was bleeding. Because Xarelto is a blood thinner, the body does not form blood clots as easily with the drug. Bleeding can be internal or external, mild or severe. (With internal bleeding, blood leaks out of a damaged blood vessel but stays inside the body. With external bleeding, blood leaks out of your body through injured skin, such as a cut.)

In rare cases, bleeding can be life threatening.

Symptoms of bleeding with Xarelto can include:

  • headache, weakness, or dizziness
  • bruising easily
  • bleeding from gums or nose
  • unusual menstrual bleeding
  • vomiting blood or having vomit that looks similar to coffee grounds
  • urine that looks red, brown, or pink
  • bright red or black tarry stools
  • coughing up blood or clots of blood
  • a wound that reopens or won’t stop bleeding
  • bleeding that lasts longer than usual

Mild bleeding was commonly reported in clinical studies. With mild bleeding, you may bruise easily, have minor nose or gum bleeding, or bleed longer than usual after a minor cut or injury.

Severe bleeding is less common but still possible with Xarelto. Your doctor may stop your Xarelto treatment if you have severe bleeding.

The risk of bleeding may increase if you take certain other medications or have certain other health conditions. Before you start taking Xarelto, discuss your health conditions and any medications you take with your doctor.

What to do

While taking Xarelto, tell your doctor if you have any symptoms of bleeding. This includes mild symptoms, such as bruising easily, minor nose or gum bleeding, or bleeding that lasts longer than usual after a small cut or injury. Your doctor may want to check you for other signs of bleeding.

Tell your doctor right away if you have symptoms of severe bleeding such as vomiting blood, blood in your urine, red or black tarry stools, or bleeding that won’t stop. Headache, weakness, or dizziness can be possible symptoms of bleeding in the brain or head.

However, if your symptoms feel life threatening or severe, call 911 or your local emergency number.

If your bleeding is severe, your doctor may treat it with another drug to reverse the effects of Xarelto.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Xarelto. A more severe allergic reaction is rare but possible.

Possible symptoms of mild and serious allergic reactions are listed in the table below.

Mild allergic reaction symptoms Serious allergic reaction symptoms
• itching trouble breathing
rash • swelling in your throat or mouth
flushing • swelling under your skin, possibly in your hands, feet, lips, or eyelids

If you have an allergic reaction to Xarelto, call your doctor right away. This is important to do because the reaction could become severe.

However, if you’re having a medical emergency or your symptoms feel life threatening, call 911 or your local emergency number.

Xarelto: Precautions

Xarelto comes with several precautions.

Boxed warnings

This drug has a boxed warning about the risk of blood clots from stopping Xarelto treatment too soon.

It also has a boxed warning for the risk of blood clots around the spine or brain that may occur after certain procedures, such as an epidural. These blood clots may lead to long-term paralysis.

Boxed warnings are serious warnings from the Food and Drug Administration (FDA).

For details, see the “Xarelto: Side effects explained” section above.

Other precautions

Be sure to talk with your doctor about your health history before you take Xarelto. This drug may not be the right treatment option for you if you have certain medical conditions or other factors that affect your health.

The conditions and factors to consider include those described below.

Kidney problems. If you have kidney problems, Xarelto can build up in your system. Your doctor may not recommend Xarelto as a treatment option for you if you have this condition. If you develop sudden kidney failure while taking Xarelto, your doctor may lower your dose or stop your treatment. Xarelto typically isn’t prescribed for children with kidney problems.

Liver problems. The safety of Xarelto for adults with severe liver problems is not known. Your doctor will likely not recommend Xarelto as a treatment option if you have moderate or severe liver problems. Xarelto usually isn’t prescribed for children who have liver problems.

Increased risk of bleeding. Xarelto can cause serious or life threatening bleeding. If you have a higher risk of bleeding, talk with your doctor about whether Xarelto is right for you. If you have abnormal bleeding while taking Xarelto, your doctor may stop Xarelto treatment or prescribe a different drug.

Artificial heart valves. There’s limited information available about the safety of Xarelto in people with artificial heart valves. In clinical studies, people with a certain type of heart valve had a higher risk of side effects with Xarelto. If you’ve had a heart valve replacement, talk with your doctor about the best treatment option for you.

Allergic reaction. If you’ve had an allergic reaction to Xarelto or any of its ingredients, your doctor will likely not prescribe Xarelto. Ask your doctor what other medications may be better options for you.

Triple-positive antiphospholipid syndrome (APS). Your risk of blood clots increases if you have APS. Be sure to tell your doctor if you have this condition. Due to the risk of blood clots, doctors will typically not prescribe Xarelto to people with APS.

Consuming alcohol during Xarelto treatment

The side effects of Xarelto and alcohol can be serious if you drink during treatment. Drinking alcohol while taking Xarelto may increase your risk of bleeding.

Bleeding, including severe and life threatening bleeding, is a side effect of Xarelto. Bleeding in your stomach or digestive tract is also an effect of drinking large amounts of alcohol.

If you drink alcohol, talk with your doctor to determine how much is safe to drink while taking Xarelto, if any.

Pregnancy and breastfeeding during Xarelto treatment

Read below for information about taking Xarelto while pregnant or breastfeeding.

Pregnancy. There is limited information available about taking Xarelto during pregnancy. If Xarelto is taken during pregnancy, it increases the risk of bleeding in the pregnant person and the fetus.

If your doctor determines Xarelto’s benefits outweigh its risks, they may prescribe the drug if you’re pregnant. Or, they may recommend a different blood thinning medication for you. If you become pregnant during Xarelto treatment, tell your doctor right away. Also, tell your doctor if you plan to become pregnant during treatment with the drug.

Breastfeeding. Xarelto can pass into your breast milk. However, the effects of the drug on children or breast milk are not known. Discuss with your doctor whether it is safe for you to breastfeed while taking Xarelto. They can advise safe ways to feed your child while taking the medication.

Xarelto: What to discuss with your doctor

Talk with your doctor or pharmacist to find out more information about Xarelto. If you have questions about the drug’s side effects, your pharmacist or healthcare professional can help answer them for you.

In addition to discussing Xarelto with your doctor, you may find the following articles helpful in learning more.

  • Overview of Xarelto. To read an overview of Xarelto, refer to this article.
  • Drug comparison. To learn how Xarelto compares with warfarin, read this article
  • Dosage. To learn about Xarelto’s recommended dosage, refer to this article.
  • Details about deep vein thrombosis (DVT). To learn more about DVT, which Xarelto is prescribed to treat, see this article.

Disclaimer: Healthgrades has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Medical Reviewer: Patricia Weiser, PharmD
Last Review Date: 2022 Oct 17
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.