Xarelto (rivaroxaban) is a prescription drug that’s used for blood clots and certain other conditions. Xarelto can cause side effects that range from mild to serious. Examples include fatigue (lack of energy) and back pain.

Xarelto is taken to:

  • treat or prevent certain kinds of blood clots, such as deep vein thrombosis, in adults and some children in specific situations
  • decrease the risk of serious heart and blood vessel problems in certain adults

The active ingredient in Xarelto is rivaroxaban. (An active ingredient is what makes a drug work.) It’s part of a group of drugs called blood thinners.

Xarelto comes as a tablet or a liquid suspension, both of which you swallow.

Keep reading to learn about the common, mild, and serious side effects (also called adverse effects) that Xarelto can cause. For a general overview of the drug, including details about its uses, see this article.

Some people may have mild to serious side effects during their Xarelto treatment. Examples of Xarelto’s commonly reported side effects include:

* To learn more about this side effect, see the “Side effects explained” section below.

Examples of mild side effects that have been reported with Xarelto include:

* To learn more about this side effect, see the “Side effects explained” section below.
† An allergic reaction is possible after using Xarelto. But this side effect was not reported during studies. It was only reported after the drug became available on the market.

In most cases, these side effects should be temporary. And some may be easily managed. But if you have any symptoms that are ongoing or bother you, talk with your doctor or pharmacist. And do not stop taking Xarelto unless your doctor recommends it.

Xarelto may cause mild side effects other than the ones listed above. See the drug’s prescribing information for details.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you’d like to notify the FDA about a side effect you’ve had with Xarelto, visit MedWatch.

Mild side effects are most common with Xarelto. But it’s possible to develop serious side effects from this medication. Serious side effects that have been reported with Xarelto include:

  • bleeding, which may be serious or even life threatening
  • risk of blood clots after stopping Xarelto treatment too early*
  • risk of blood building up around the brain or spine after certain spinal injections*
  • changes in mood, such as anxiety or depression†
  • severe allergic reaction†‡

* 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 “Side effects explained” section below.
† To learn more about this side effect, see the “Side effects explained” section below.
‡ An allergic reaction is possible after using Xarelto. But this side effect was only reported after the drug became available on the market.

If you develop serious side effects while taking Xarelto, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

If you’re an older adult, you may wonder if you’ll have different side effects from Xarelto than someone who’s younger.

In studies, most of the people taking Xarelto were ages 65 years and older. For the most part, side effects in older adults were the same as those in younger people. But older adults may have an increased risk of blood clots or bleeding from the drug compared with younger adults.

If you have any questions about the side effects of Xarelto in older adults, talk with your doctor or pharmacist.

In children, the most common side effects reported from Xarelto include:

Children may also have the same side effects as adults from taking this medication. For more information, see the “Mild side effects” and “Serious side effects” sections above.

If you have questions about side effects that your child may develop due to Xarelto, talk with their doctor or a pharmacist.

Get answers to some frequently asked questions about Xarelto’s side effects.

Does Xarelto cause weight gain or weight loss?

No, Xarelto shouldn’t cause any changes to your body weight.

In studies of people taking Xarelto, weight gain and weight loss were not reported as side effects.

But it’s possible to lose weight from side effects that Xarelto causes. The drug can cause stomach infections, such as stomach flu or vomiting, which could affect body weight.

If you notice a change in your body weight during treatment with Xarelto, talk with your doctor. They can find out what may be causing your weight change and the best ways to treat or manage it.

Does the risk of Xarelto side effects vary based on the strength (such as 10-mg tablets vs. 20-mg tablets)?

It’s possible that you may have an increased risk of side effects when you take a higher dose of Xarelto. But this wasn’t reported in studies of the drug.

Xarelto comes as tablets in strengths of 2.5 milligrams (mg), 10 mg, 15 mg, and 20 mg. It also comes as a liquid suspension that has 1 mg of medication per milliliter (mL) of liquid.

If you take a higher strength of Xarelto, the amount of the drug in your body is higher. This may increase the risk of side effects.

If you’re having bothersome side effects from Xarelto, talk with your doctor. They can determine if your dose of Xarelto needs adjusting.

For more information about Xarelto’s dosages, see this article.

Are hair loss or headaches side effects of Xarelto?

No, hair loss and headaches are not side effects that you should have from taking Xarelto. These were not reported in studies of the drug.

Other blood thinners, such as Jantoven (warfarin), may cause hair loss. But this does not seem to be the case with Xarelto. If you have hair loss during Xarelto treatment, talk with your doctor about what may be causing it.

Headaches also were not reported in studies of Xarelto. But headaches may be a sign of bleeding, which is a side effect of the drug. In addition to headache, other symptoms of bleeding include:

If you have symptoms of bleeding, contact your doctor immediately or go to a hospital right away.

Does Xarelto cause thrombocytopenia (low platelet count)?

It’s possible that Xarelto may cause a low platelet count. This side effect was not reported in studies of the drug. But it was reported after the drug became available on the market.

Symptoms of a low platelet count include:

If you notice symptoms of a low platelet count, tell your doctor. They can order a blood test to see if your platelet levels are low and treat this condition if needed.

Could I experience liver problems from taking Xarelto?

It’s possible that Xarelto may cause liver problems. This side effect was not reported in studies of Xarelto. But it was reported after the drug became available on the market.

Symptoms of liver problems include:

If you develop symptoms of liver problems, talk with your doctor. They can find out what might be causing the problem and discuss the best treatment.

Learn more about some of the side effects Xarelto may cause.

Risk of blood clots after stopping Xarelto treatment too early

Xarelto has a boxed warning for the risk of blood clots after stopping treatment too early. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA). They alert doctors and patients about drug effects that may be dangerous.

If you stop taking any blood thinner, including Xarelto, too early, you may increase your risk of blood clots. This can lead to serious or even life threatening reactions, such as a heart attack or stroke.

What might help

If you need to stop Xarelto treatment for any reason, be sure to talk with your doctor first. They can recommend another medication for your condition to help decrease your risk of blood clots.

Risk of blood building up around the brain or spine after certain spinal injections

Xarelto has a boxed warning for the risk of blood building up around the brain or spine after certain spinal injections. Boxed warnings are the most serious warnings from the FDA. They alert doctors and patients about drug effects that may be dangerous.

If you have a certain kind of spinal injection while taking Xarelto, your risk of blood building up around your brain or spine increases. Examples of spinal injections that might cause this side effect include spinal or epidural blocks and lumbar punctures.

A buildup of blood around the brain or spine can cause serious side effects, such as paralysis.

Symptoms of blood buildup around the brain or spine include:

What might help

If you need to have a spinal procedure during Xarelto treatment, tell your doctor. To prevent blood buildup around your brain or spine, they may recommend timing the procedure so you have the lowest amount of Xarelto in your body. This can decrease your risk of these side effects.

After the procedure, watch for the symptoms of blood buildup listed above. If you develop any of these symptoms, go to a hospital right away.

For more information about this side effect, talk with your doctor.

Fatigue

It’s possible to develop fatigue (low energy) during your treatment with Xarelto. This side effect was common in studies of the drug.

What might help

Fatigue is usually mild and will go away over time. But if it’s severe or affects your daily activities, tell your doctor. They may recommend another treatment for your condition.

Mental health problems, such as anxiety or depression

It’s possible to develop a mental health condition, such as anxiety or depression, from taking Xarelto. This was reported in studies of people taking the medication, though it was rare.

Symptoms of this side effect include:

  • losing interest in activities that used to excite you
  • feeling lonely or sad
  • feeling irritable
  • changes in sleep patterns, such as sleeping too much or too little

What might help

If you develop any symptoms of a mental health problem during your treatment with Xarelto, tell your doctor right away. They’ll be able to recommend ways to manage this side effect. Sometimes, they may suggest that you speak with another specialist, such as a psychiatrist.

If you have severe mental health problems, your doctor may recommend a different treatment option for you.

Back pain

It’s possible to develop back pain during treatment with Xarelto. But back pain was not a common side effect reported in studies of Xarelto.

What might help

If you have back pain during your treatment, tell your doctor. It’s possible for back pain to be a sign of a more serious condition, such as blood buildup around your brain or spine.* Your doctor will try to determine what is causing your back pain.

If Xarelto is causing your back pain, your doctor may recommend taking an over-the-counter pain medication to treat it. An example is Tylenol (acetaminophen).

* 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 “Risk of blood building up around the brain or spine after certain spinal injections” above.

Allergic reaction

Like most drugs, Xarelto can cause an allergic reaction in some people. This side effect wasn’t reported in studies, but it was reported after the drug became available on the market.

Symptoms can be mild to serious and include:

  • skin rash
  • itchiness
  • flushing (temporary warmth, redness, or deepening of skin color)
  • swelling under your skin, usually in your eyelids, lips, hands, or feet
  • swelling of your mouth, tongue, or throat, which can make it hard to breathe

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest a treatment to manage your symptoms. Examples include:

  • an antihistamine you take by mouth, such as Benadryl (diphenhydramine)
  • a product you apply to your skin, such as hydrocortisone cream

If your doctor confirms you’ve had a mild allergic reaction to Xarelto, they’ll decide if you should continue using it.

If you have symptoms of a severe allergic reaction, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms you’ve had a serious allergic reaction to Xarelto, they will likely have you switch to a different treatment.

Keeping track of side effects

During your Xarelto treatment, consider taking notes on any side effects you’re having. You can then share this information with your doctor. This is especially helpful when you first start taking new drugs or using a combination of treatments.

Your side effect notes can include things such as:

  • what dose of the drug you were taking when you had the side effect
  • how soon you had the side effect after starting that dose
  • what your symptoms were
  • how it affected your daily activities
  • what other medications you were taking
  • any other information you feel is important

Keeping notes and sharing them with your doctor will help them learn more about how Xarelto affects you. They can then use this information to adjust your treatment plan if needed.

Xarelto comes with several warnings, which may affect whether the drug is a good treatment for your condition. These warnings are discussed below.

Boxed warnings

Xarelto has the boxed warnings listed below. Boxed warnings are the most serious warnings from the Food and Drug Administration (FDA).

  • Risk of blood clots after stopping Xarelto too early. If you stop taking Xarelto too early, you may have an increased risk of developing a blood clot. If you need to stop Xarelto treatment for any reason, talk with your doctor. They may recommend that you take a different blood thinner to decrease the risk of this side effect.
  • Risk of blood building up around the brain or spine after certain spinal injections. If you have a certain kind of spinal injection during Xarelto treatment, you may have an increased risk of blood buildup in your brain or spine. Let your doctor know if you’ve got a spinal procedure planned while taking Xarelto. They can let you know when you should take your doses of the drug around the time of your procedure.

To learn more, see the “Side effects explained” section above.

Other warnings

Xarelto may not be right for you if you have certain medical conditions. These are known as drug-condition interactions. Other factors may also affect whether Xarelto is a good treatment option for you.

Talk with your doctor about your health history before starting Xarelto. The list below includes factors to consider.

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

Liver problems. Xarelto is broken down in the body by the liver. If your liver isn’t working properly, Xarelto may build up in your body. This can increase the risk of side effects from the drug. If you have liver problems, tell your doctor before taking Xarelto. This can help them determine if Xarelto is a safe treatment option for you.

Kidney problems. If your kidneys aren’t working properly, Xarelto may build up in your body, increasing your risk of side effects. Before starting treatment with Xarelto, tell your doctor about any kidney problems that you have. They may recommend that you take a lower dose of Xarelto. Or they may suggest a different medication to treat your condition.

Triple positive antiphospholipid syndrome (APS). People with triple positive APS may have an increased risk of blood clots from Xarelto. If you have this condition, talk with your doctor before you start taking Xarelto. They’ll likely recommend a different treatment option for you.

Artificial heart valve. Xarelto is not recommended for use in people with artificial heart valves. If you have an artificial heart valve, tell your doctor before starting Xarelto treatment. Your doctor will suggest a different treatment option for you.

Current bleeding. If you currently have bleeding, Xarelto may worsen the bleeding. In this case, your doctor will likely not prescribe Xarelto. Instead, they’ll recommend treating your bleeding before you start Xarelto.

Alcohol and Xarelto

There are no known interactions between alcohol and Xarelto. But it’s possible that alcohol may increase your risk of bleeding. Bleeding is also a possible side effect of Xarelto. So drinking alcohol during Xarelto treatment can worsen this side effect.

If you would like to consume alcohol while taking Xarelto, talk with your doctor. They can let you know how much alcohol is safe for you to drink during Xarelto treatment.

Pregnancy and breastfeeding while taking Xarelto

It’s not known if it’s safe to take Xarelto during pregnancy or while breastfeeding. Taking Xarelto during pregnancy can increase the risk of bleeding for the person who is pregnant as well as the developing fetus.

If you do take Xarelto during pregnancy, your doctor will monitor you for blood loss. This may include doing blood tests more often. They’ll also recommend that you watch for symptoms of blood loss, such as:

  • fatigue (low energy)
  • weakness
  • confusion

Xarelto can pass into breast milk. But it’s not known if this may have any effect on a child who is breastfed.

If you’re pregnant or breastfeeding or planning to become pregnant or breastfeed, talk with your doctor before taking Xarelto. They can discuss with you whether the drug is safe to take during this time.

Side effects from Xarelto are common and usually mild. But it’s also possible for serious side effects to occur from taking this drug.

Before starting treatment with Xarelto, talk with your doctor about possible side effects that may occur. Here are some questions to help you get started:

  • Does my risk of side effects increase due to other medications that I take?
  • What should I do if I become pregnant during treatment with Xarelto?
  • How do the side effects of Xarelto compare with the side effects of other medications to prevent or treat blood clots?
  • Is my risk of bleeding higher when I first start taking Xarelto?

To learn more about Xarelto, see these articles:

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Disclaimer: Healthline 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.