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Side Effects of Rivaroxaban (Xarelto)


Description: Rivaroxaban, commonly known by its trade name Xarelto, is an anticoagulant. The drug is commonly used for a number of conditions including as a treatment for deep vein thrombosis (DVT), stroke prevention and venous thromboembolism. Xarelto has a wide range of side effects, ranging from obvious blood anticoagulatory effects to less obvious adverse reactions like anxiety. Common side effects include (occur in more than 1% of patients):

  • Bleeding
  • Anemia (lack of red blood cells)
  • Constipation
  • Diarrhea
  • Dyspepsia (indigestion)
  • Gastrointestinal bleeding
  • Gingival bleeding (from gums)
  • Nausea
  • Toothache
  • Abdominal pain
  • Vomiting
  • Dizziness
  • Headache
  • Syncope
  • Deep vein thrombosis
  • Hematoma (solid swelling of clotted blood)
  • Hypertension (high blood pressure)
  • Hypotension (low blood pressure)
  • Peripheral edema (swelling in lower limbs)
  • Tachycardia (increased heart rate)
  • Anaphylactic shock
  • Urinary retention
  • Urogenital tract hemorrhage (bleeding)
  • Vaginal hemorrhage (bleeding)
  • Hyperglycemia (high blood glucose)
  • Arthralgia (joint pain)
  • Back pain
  • Increased muscle tone and cramping
  • Osteoarthritis (will result in swollen and painful joints)
  • Pain in extremities
  • Anxiety
  • Sleep disorders
  • Fatigue
  • Asthenia (lack of energy)
  • Xarelto Warnings and Serious Adverse Reactions

    Rare side effects, some of which may be life-threatening, include (occur in less than 1% of patients):

  • Bleeding from organs
  • Fatal bleeding
  • Dry mouth
  • Gastric ulcer hemorrhage (bleed from gastric hemorrhage)
  • Cerebral and intracranial hemorrhage (bleeds in the brain)
  • Decreased renal function
  • Allergic dermatitis (rash)
  • Urinary tract infections
  • Malaise (feeling unwell)
  • Know Your Risk for Side Effects with the Rxight® Pharmacogenetic Testing Program

    MD Labs’ pharmacogenetic testing service, Rxight®, is based on the sequencing of many genes that encode liver enzymes to establish how you are likely to react to more than 200 prescription and over-the-counter medications, including Xarelto and other anticoagulants – and a host of other medication classes that are clinically relevant. Rxight® is in fact the most comprehensive PGx testing service available – thus provides healthcare providers a sound method to reduce the potential for adverse reactions and thus poor medication adherence and reduced drug efficacy by increasing patient and prescriber confidence in prescribed drug treatments.

    How Does Pharmacogenetic Testing Work?

    Some patients experience no side effects when taking Xarelto whilst others may experience multiple. This inter-patient variability in side effects has been suggested to result from differences in genetics. Patients with variations in enzymes that metabolize Xarelto for instance may increase the probability of developing toxicity, adverse and allergic reactions, and drug interactions.


    Pharmacogenetics offers insight into how patients’ genetic profiles may affect the outcome of or reaction to specific medications. In this way, pharmacogenetic testing lays part of the groundwork for precision care, based on the individual needs and genetic makeup of a single patient.
    Armed with pharmacogenetic testing results, providers can speak with more authority on an individual patient’s drug treatment plan, ultimately leading to increased patient confidence and medical adherence, as well as treatment efficacy.


    Contributors to this Article:
    Michael Sapko, MD, PhD; Deborah Kallick, PhD, Medicinal Chemistry


    Read more about Rxight® pharmacogenetics