1. About rivaroxaban
Rivaroxaban is a type of medicine known as an anticoagulant, or blood thinner.
It makes your blood flow through your veins more easily. This means your blood will be less likely to make a dangerous blood clot.
People who are more at risk of developing a blood clot include those who have:
- an abnormal heartbeat (atrial fibrillation)
- recently had surgery to replace a hip or knee joint
- unstable angina
- coronary heart disease
- peripheral artery disease
It's also used to treat people who have had a health problem caused by a blood clot, such as:
- a stroke
- a heart attack
- a blood clot in the leg (DVT, deep vein thrombosis)
- a blood clot in the lungs (pulmonary embolism)
Rivaroxaban is only available on prescription. It comes as tablets.
2. Key facts
- It's usual to take rivaroxaban once or twice a day.
- Take rivaroxaban just after you have eaten a meal or snack. It's important to take it with food to help your body absorb the whole dose.
- The most common side effect of rivaroxaban is bleeding more easily than normal, such as having nosebleeds, heavier periods, bleeding gums and bruising. It tends to happen in the first few weeks of treatment or if you're unwell.
- Always carry your anticoagulant alert card with you. Show it to your doctor or dentist before you have surgery or dental treatment. It's important they know you're taking rivaroxaban, as it may put you at risk of bleeding.
- Rivaroxaban is also called by the brand name Xarelto.
3. Who can and cannot take rivaroxaban
Rivaroxaban can be taken by adults aged 18 and over.
Rivaroxaban is not suitable for some people. Tell your doctor if you:
- have ever had an allergic reaction to rivaroxaban or any other medicine
- are trying to get pregnant or you're already pregnant – rivaroxaban can be harmful to your baby
- have liver problems
- are taking any other medicines that affect blood clotting, such as warfarin
- have any injuries that are currently bleeding a lot (such as a wound or a stomach ulcer)
- are taking the herbal remedy St John's wort (often taken for depression)
- have antiphospholipid syndrome, a condition that affects the immune system and makes you more likely to get blood clots
4. How and when to take it
It's very important to take rivaroxaban as your doctor has told you.
It's usual to take it once a day just after you have eaten a meal or snack.
It's important to take rivaroxaban with some food to help your body absorb the whole dose. Try to take it at the same time every day.
People who are taking rivaroxaban to treat DVT or a pulmonary embolism may need to take it twice a day for the first few weeks. Your doctor will tell you if you need to do this.
If you have trouble swallowing pills, speak to your doctor or pharmacist.
You can crush rivaroxaban tablets and mix them with water or apple purée. Swallow this mixture, then eat some food straight away.
Your dose of rivaroxaban depends on why you're taking it.
If you have:
- a heart condition called atrial fibrillation – the usual dose is 20mg a day. But your doctor might prescribe a lower dose if you have kidney disease and are at a higher risk of bleeding.
- had a blood clot (DVT or pulmonary embolism) – the usual dose is 20mg a day. You might need to take a dose of 15mg twice a day for the first few weeks of taking rivaroxaban. If you have kidney disease and are at a higher risk of bleeding, your doctor may prescribe a lower dose.
- had an operation to replace a hip or knee joint – the usual dose is 10mg a day.
- had a heart attack or have a heart condition called unstable angina – the usual dose is 2.5mg twice a day.
If you're unsure what dose you need to take, check with your doctor or pharmacist.
What if I forget to take it?
What you need to do depends on the dose you take.
If you usually take:
- 10mg, 15mg or 20mg once a day – take a dose as soon as you remember, unless it's nearly time for your next one. Take your next dose at the usual time and then carry on as normal. Never take more than 1 dose in a single day.
- 15mg twice a day – take a dose as soon as you remember. You can take 2 x 15mg tablets at the same time to get a total of 2 doses in 1 day. Never take more than 2 doses in 1 day.
- 2.5mg twice a day – take a dose as soon as you remember, unless it's nearly time for your next one. Do not take a double dose to make up for a missed one. Take your next dose at the usual time, and then carry on as normal.
It's very important that you remember to take rivaroxaban every day.
If you forget doses often, it may help to set an alarm to remind you.
You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
If you're worried, contact your doctor or pharmacist.
What if I take too much?
Ask your doctor or pharmacist for advice straight away, as overdose puts you at risk of bleeding.
How long will I take it for?
How long you need to take rivaroxaban will depend on why you're taking it.
If you have had an operation to replace your knee or hip joint, you'll probably take rivaroxaban for 2 to 5 weeks.
If you have had a blood clot (DVT or pulmonary embolism), you'll normally take rivaroxaban for at least 3 months. Depending on what caused the blood clot, you might need to take it for longer.
If you have a heart problem like atrial fibrillation or have had a heart attack, you might need to take rivaroxaban long term or even for the rest of your life.
Anticoagulant alert card
Your doctor or pharmacist will give you an anticoagulant alert card.
Carry this with you all the time. It tells healthcare professionals that you're taking an anticoagulant. This can be useful for them to know in case of a medical emergency.
If you need any medical or dental treatment, show your anticoagulant alert card to the nurse, doctor or dentist.
This includes before you have vaccinations and routine sessions with the dental hygienist.
Your doctor may advise you to stop taking rivaroxaban or reduce your dose for a short time.
Switching from warfarin to rivaroxaban
If you need to switch from warfarin to rivaroxaban, your doctor will advise you when to stop taking warfarin. This will probably be a few days before you start rivaroxaban.
Your doctor or anticoagulant clinic will do a blood test called the international normalised ratio (INR) to check how quickly your blood's clotting.
This is to help decide exactly when you should start taking rivaroxaban.
Switching from rivaroxaban to warfarin
If you need to switch from rivaroxaban to warfarin, you may need to take both medicines together for a few days.
Your doctor or anticoagulant clinic will do a blood test called the international normalised ratio (INR) to check how quickly your blood's clotting.
This is to help decide exactly when you should stop taking rivaroxaban.
5. Bleeding and what to do about it
While rivaroxaban has enormous benefits, the downside is that it can make you bleed more than normal.
This is because while you're taking rivaroxaban, your blood will not clot as easily.
Less serious bleeding
It's usual to bleed more easily than normal while you're taking rivaroxaban.
The kind of bleeding you might have includes:
- periods that are heavier and last longer than normal
- bleeding for a little longer than usual if you cut yourself
- occasional nosebleeds (that last for less than 10 minutes)
- bleeding from your gums when you brush your teeth
- bruises that come up more easily and take longer to fade than usual
This type of bleeding is not dangerous and should stop by itself.
If it happens, keep taking the rivaroxaban, but tell your doctor if the bleeding bothers you or does not stop.
Things you can do to help yourself
- Cuts – press on the cut for 10 minutes with a clean cloth.
- Nosebleeds – find out how to stop a nosebleed or watch this video on stopping nosebleeds.
- Bleeding gums – if your gums are bleeding, try using a soft toothbrush and waxed dental floss to clean your teeth.
- Bruises – these are harmless, but can be unsightly. It might help to make them fade more quickly if you put an ice pack wrapped in a towel over the bruise for 10 minutes at a time several times a day.
What you can do to prevent bleeding
While you're taking rivaroxaban, be careful when you do activities that might cause an injury or a cut or bruising.
It can help to:
- stop playing contact sports or other activities than can cause a head injury, such as football, rugby, hockey and horse riding
- wear gloves when you use sharp objects like scissors, knives and gardening tools
- stop wet shaving or removing hair with wax - use an electric razor or hair-removing cream instead
- take dentures (false teeth) or retainers out for a few hours a day, if you wear them, to give your gums a rest - do not wear dentures or retainers that do not fit properly
- tell your doctor, dentist or nurse that you take rivaroxaban before you have any medical or dental procedures or surgery - this includes vaccinations and routine appointments with the dental hygienist
Occasionally, you can have serious bleeding from taking rivaroxaban.
This can be dangerous and needs urgent medical attention.
Urgent advice: Contact your doctor or anticoagulant clinic, or go to A&E if:
- you have red pee or black poo
- you get bruises that happen for no reason, or bruises that are larger than you'd expect or keep growing in size
- you get nosebleeds that last longer than 10 minutes
- you have blood in your vomit or you're coughing up blood
- you get severe headaches
- you have any bleeding from a cut or injury that will not stop or slow down
These are symptoms of serious bleeding.
If you have serious bleeding, stop taking rivaroxaban.
6. Other side effects
Like all medicines, rivaroxaban can cause side effects, although not everyone gets them.
Very rarely, rivaroxaban can lead to bleeding in the brain. This can cause a very severe headache, fits (seizures), changes to your eyesight, numbness or tingling in your arms or legs, and make you feel very tired, weak or sick.
If you suddenly get any of these symptoms, contact your doctor immediately. This is an emergency.
Common side effects
These common side effects happen in more than 1 in 100 people.
They're usually mild and do not last long, but talk to your doctor or pharmacist if these side effects bother you or do not go away:
- tiredness and lack of energy, shortness of breath, noticeable heartbeats (heart palpitations) and pale skin - these can be signs of anaemia
- feeling dizzy or lightheaded
- a mild rash
- feeling or being sick (nausea or vomiting)
Serious allergic reaction
In rare cases, rivaroxaban can cause a serious allergic reaction (anaphylaxis).
Immediate action required: Call 999 or go to A&E now if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of rivaroxaban. For a full list, see the leaflet inside your medicines packet.
You can report any suspected side effect using the Yellow Card safety scheme.
7. How to cope with side effects
What to do about:
- signs of anaemia – talk to your doctor, who may arrange a blood test.
- feeling dizzy or lightheaded – if rivaroxaban makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so you do not faint, then sit until you feel better. If the dizziness does not go away or keeps happening, speak to your doctor. They may arrange a blood test to see if you have anaemia.
- a mild rash – it may help to take an antihistamine, which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you. If the rash does not go away within a few days, speak to your doctor.
- feeling or being sick (nausea or vomiting) – stick to simple meals and do not eat rich or spicy food. If you're vomiting, try having small, frequent sips of water to avoid dehydration.
8. Pregnancy and breastfeeding
Rivaroxaban is not normally recommended during pregnancy or while breastfeeding.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
9. Cautions with other medicines
Some medicines and supplements can affect rivaroxaban.
This can lead to serious side effects.
Tell your doctor if you're taking these medicines before starting rivaroxaban:
- any other anticoagulant, such as warfarin or enoxaparin
- drugs to treat fungal or bacterial infections, such as fluconazole, erythromycin or clarithromycin
- drugs to treat HIV, such as ritonavir
- drugs to treat epilepsy, such as carbamazepine or phenytoin
- non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin
Can I take rivaroxaban with everyday painkillers?
You can take paracetamol while you're taking rivaroxaban.
Mixing rivaroxaban with herbal remedies and supplements
Do not take St John's wort, the herbal remedy for depression, while you're taking rivaroxaban.
It can increase your risk of side effects.
Important: Medicine safety
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
10. Common questions
How does rivaroxaban work?
Rivaroxaban is a type of medicine known as an anticoagulant. It makes your blood clot more slowly.
Blood clotting (thickening) is a complicated process involving substances called clotting factors.
Clotting factors are made by the liver and help stop bleeding. They work with blood cells called platelets that trigger the clotting process to make sure your blood clots properly.
Rivaroxaban works by stopping a clotting factor called factor Xa from working. This thins your blood so it takes longer to clot.
How long does it take to work?
Rivaroxaban works within a few hours of taking it.
Is it safe to take it for a long time?
Rivaroxaban is safe to take for a long time.
There do not seem to be any lasting harmful effects from taking it for many months and years.
What will happen if I stop taking it?
Do not stop taking rivaroxaban without talking to your doctor.
If you stop taking rivaroxaban, the rate at which your blood clots will return to what it was before you started taking it, usually within a day or two of stopping.
Are there any other similar medicines?
There are several other anticoagulants available as tablets or capsules.
There are also anticoagulants that you take by injecting them. These include heparin, enoxaparin, dalteparin and tinzaparin.
Not all medicines that prevent blood clots are suitable for everyone.
Talk to your doctor or pharmacist to find out why you have been recommended a particular medicine.
Can I drink alcohol with it?
You can drink alcohol while taking rivaroxaban as long as you stick to the national guidelines of no more than 14 units a week for men and women.
A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.
Drinking heavily, especially binge drinking lots of alcohol in one go, is dangerous while taking rivaroxaban.
The alcohol can increase rivaroxaban's effect and make you more likely to bleed.
Is there any food or drink I need to avoid?
There are no foods or drinks you need to avoid while taking rivaroxaban.
Will I need to stop rivaroxaban before surgery?
Because of the risk of bleeding, your dose of rivaroxaban may need to be lowered or stopped a few days before you have an operation.
Tell the surgeon that you're taking rivaroxaban and show them your anticoagulant alert card.
Will I need to stop rivaroxaban before dental treatment?
You can still go to your dentist as usual. But tell your dentist that you're taking rivaroxaban, and show them your anticoagulant alert card, before you have any treatment.
This is especially important if you need to have a tooth out.
Most people do not need to change their rivaroxaban dose, but your dentist may contact your doctor for advice before starting the dental treatment.
Can I have vaccinations?
You can have vaccinations while taking rivaroxaban.
Before you have them, be sure to show your anticoagulant alert card to the nurse or doctor.
It's important to tell them that you're taking rivaroxaban.
Will it affect my fertility?
There's no firm evidence to suggest that taking rivaroxaban will reduce fertility in either men or women.
But talk to your doctor first if you're a woman and trying to get pregnant.
This medicine is not usually recommended in pregnancy.
Can I drive or ride a bike?
Most people can drive or ride a bike while taking rivaroxaban.
But if taking rivaroxaban makes you feel dizzy or lightheaded, do not drive or cycle until it goes away.
Can I have a tattoo or piercing?
It's not usually recommended to have a body piercing or tattoo while you're taking rivaroxaban because of the increased risk of bleeding and infection.
If you still want to go ahead, talk to your doctor about your specific risks in case you need antibiotics.
And let the tattooist or piercer know beforehand that you're taking a blood-thinning medicine.
Can I take recreational drugs with it?
It's thought that cannabis can increase your risk of serious bleeding.
It's not clear how other recreational drugs like cocaine and heroin affect rivaroxaban. They could be potentially dangerous.