Xarelto is a prescription medication primarily used to prevent blood clots in individuals with certain medical conditions. It belongs to a class of drugs known as anticoagulants, or blood thinners.

Xarelto works by inhibiting the activity of a specific clotting factor in the blood known as factor Xa, which plays a crucial role in the blood clotting process. By blocking factor Xa, Xarelto helps to prevent the formation of blood clots, reducing the risk of strokes, DVT, and PE.

Precautions and Warnings with Xarelto

  • Bleeding Risk: Xarelto increases the risk of bleeding, which can be serious and potentially life-threatening.
  • Spinal/Epidural Hematoma: Patients who undergo spinal or epidural procedures while taking Xarelto are at increased risk of developing a blood clot in the spine, leading to spinal or epidural hematoma, which can cause long-term or permanent paralysis.
  • Liver Function: Xarelto should be used with caution in patients with liver impairment, as the medication is metabolized by the liver.
  • Renal Impairment: Xarelto should be used with caution in patients with renal impairment, as the medication is excreted primarily through the kidneys.
  • Pregnancy and Breastfeeding: Xarelto should not be used during pregnancy, as it may harm the developing fetus.
  • Elderly Patients: Elderly patients may be more sensitive to the effects of Xarelto and may be at higher risk of bleeding complications.
  • Pediatric Use: The safety and efficacy of Xarelto in pediatric patients have not been established, and the medication is not recommended for use in children under 18 years of age.
  • Patients with Prosthetic Heart Valves: Xarelto is not recommended for use in patients with prosthetic heart valves due to an increased risk of thromboembolic events.

Xarelto Side Effects

While Xarelto is generally well-tolerated, like any medication, it may cause side effects in some individuals. Side effects associated with Xarelto may include:

Mild Side Effects

  • Minor bleeding, such as bleeding gums after brushing or flossing your teeth
  • Fatigue (lack of energy)
  • Abdominal pain
  • Back pain
  • Muscle spasm
  • Dizziness
  • Fainting
  • Anxiety
  • Depression
  • Trouble sleeping
  • Itching

Serious Side Effects

  • Increased risk of bleeding
  • Severe allergic reaction
  • Increased risk of blood clots if you stop taking Xarelto too soon
  • Risk of spinal or epidural blood clots if you have a spinal injection while you’re taking Xarelto

Drug Interactions with Xarelto

Xarelto may interact with other medications, supplements, or substances, potentially affecting its effectiveness or increasing the risk of adverse effects. Some notable drug interactions with Xarelto may include:

Strengths and Dosages of Xarelto

Always follow the strengths and dosages that have been prescribed to you by your prescriber.

Available Strengths

  • 5 mg
  • 10 mg
  • 15 mg
  • 20 mg

Recommended Dosages

  • Atrial Fibrillation: The recommended dose for patients with nonvalvular atrial fibrillation is 20 mg once daily with the evening meal.
  • Treatment of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE): The recommended dose for the initial treatment of DVT and PE is 15 mg twice daily with food for the first 21 days, followed by 20 mg once daily with food for the remaining treatment period.
  • Prevention of Recurrent DVT and PE: The recommended dose for the prevention of recurrent DVT and PE is 20 mg once daily with food.

Cost of Xarelto in the USA

At this time of writing, reports the cost for Xarelto oral tablet 10 mg to be approximately $609 for a supply of 30 tablets.

Patients are encouraged to check with their local pharmacies, insurance providers, or explore patient assistance programs to determine the most cost-effective option for obtaining Xarelto.

Why is Xarelto so Expensive?

  • Research and Development: The development of Xarelto involved extensive research and clinical trials to establish its safety and efficacy for various indications. The costs associated with research and development are often reflected in the price of the medication.
  • Manufacturing Costs: Manufacturing pharmaceutical products like Xarelto involves complex processes and quality control measures, which contribute to the overall cost of production.
  • Marketing and Distribution: Pharmaceutical companies invest significant resources in marketing and distributing their products to healthcare providers and patients, which can contribute to the overall cost of the medication.
  • Patent Protection: Xarelto may be protected by patents that prevent generic competition, allowing the manufacturer to set higher prices for the medication until the patents expire.

Xarelto Alternatives

While Xarelto is a commonly prescribed anticoagulant medication, there are several alternatives available for patients who may not tolerate or prefer alternatives to Xarelto. Some alternatives include:

  • Warfarin (Coumadin): Warfarin is a traditional anticoagulant that has been used for many years to prevent blood clots. It requires regular monitoring of blood clotting levels through international normalized ratio (INR) testing and may require dietary restrictions.
  • Apixaban (Eliquis): Apixaban is another oral anticoagulant that, like Xarelto, inhibits factor Xa. It is approved for similar indications as Xarelto, including stroke prevention in atrial fibrillation and treatment and prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE).
  • Dabigatran (Pradaxa): Dabigatran is an oral direct thrombin inhibitor that is used for stroke prevention in atrial fibrillation and treatment and prevention of DVT and PE.
  • Edoxaban (Savaysa): Edoxaban is another oral factor Xa inhibitor that is indicated for stroke prevention in atrial fibrillation and treatment of DVT and PE.
  • Heparin and Low-Molecular-Weight Heparin (LMWH): Heparin and LMWH, such as enoxaparin, are injectable anticoagulants commonly used in hospitalized patients or those requiring short-term anticoagulation.

FAQs of Xarelto

What is Xarelto used for?

Xarelto is primarily used to prevent blood clots in individuals with certain medical conditions, including:

  • Nonvalvular atrial fibrillation (AF)
  • Deep vein thrombosis (DVT)
  • Pulmonary embolism (PE)
  • Prevention of stroke and systemic embolism in patients with AF
  • Treatment and prevention of recurrent DVT and PE

How long does Xarelto stay in your system?

The elimination half-life of Xarelto is approximately 5 to 9 hours in healthy individuals. However, the duration of action may be longer in patients with renal impairment or other specific clinical situations.

Are there any withdrawal symptoms of Xarelto when you stop taking it?

There are no specific withdrawal symptoms associated with stopping Xarelto. However, abrupt discontinuation of Xarelto may increase the risk of thrombotic events, such as stroke or blood clots, particularly in patients with atrial fibrillation or those receiving Xarelto for the treatment or prevention of DVT or PE.

Can I take painkillers while taking Xarelto?

Certain painkillers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin, may increase the risk of bleeding when taken concomitantly with Xarelto.

When should I stop Xarelto before surgery?

The decision to stop Xarelto before surgery should be made in consultation with a healthcare provider and depends on several factors, including the type of surgery, the patient’s risk of bleeding, and the duration of anticoagulation therapy. In general, Xarelto should be discontinued at least 24 hours before elective surgery with a low bleeding risk and up to 48 hours or longer before surgery with a higher bleeding risk.

What anti-inflammatory can I take with Xarelto?

Certain anti-inflammatory medications, such as acetaminophen (Tylenol), may be safer alternatives for pain relief in patients taking Xarelto.

What time should I take Xarelto?

Xarelto is typically taken once daily with or without food, as directed by a healthcare provider. Patients should take Xarelto at the same time each day to maintain consistent blood levels of the medication.

How long does it take for Xarelto to leave your system?

The elimination half-life of Xarelto is approximately 5 to 9 hours in healthy individuals. However, the duration of action may be longer in patients with renal impairment or other specific clinical situations. It may take several days for Xarelto to be completely eliminated from the body.

How long should I take Xarelto for a blood clot?

The duration of Xarelto treatment for a blood clot (DVT or PE) depends on several factors, including the severity of the clot, the risk of recurrence, and the underlying medical conditions of the patient. In general, treatment with Xarelto for acute DVT or PE is recommended for 3 to 6 months. However, longer-term treatment may be necessary in some cases to prevent recurrence.

Can I drink alcohol while taking Xarelto?

Moderate alcohol consumption is generally considered safe while taking Xarelto. However, excessive alcohol intake may increase the risk of bleeding and should be avoided.

Can I take cannabis while taking Xarelto?

The interaction between cannabis and Xarelto is not well studied. Patients should exercise caution when combining cannabis with Xarelto, as cannabis may have potential interactions with other medications or increase the risk of side effects such as dizziness or drowsiness.

Who makes Xarelto?

Xarelto is manufactured by Bayer AG and marketed by Janssen Pharmaceuticals, a subsidiary of Johnson & Johnson.

IMPORTANT NOTE: The information provided here is for educational purposes only and is not intended to serve as medical advice, diagnosis, or treatment recommendations. It should not be taken as an endorsement of any specific medication or treatment. Individual health conditions and responses to treatment can vary greatly; therefore, this information should not be seen as a guarantee of safety, suitability, or effectiveness for any particular individual. Always consult with a healthcare professional for personalized medical advice and before making any decisions regarding your health or treatment plans.

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