Table of Contents

I. What Is an Anticoagulant?

II. How Does a Blood Clot Form?

III. What is Xarelto?

IV. Side Effects of Xarelto

V. What to Know Before Taking Xarelto

VI. Price of Xarelto

VII. FAQ: How can I save on Xarelto without putting my treatment at risk?

If you or someone you care for has been prescribed Xarelto, you probably have questions: What is it actually doing? What should I watch for? And why is it so expensive? 

Below, we walk through how blood clots form, how Xarelto works, its side effects and precautions, and how the cost compares across pharmacies. 

What Is an Anticoagulant?

Anticoagulants are medications that delay blood clotting. Although they are commonly called blood thinners, they work by making it harder for new clots to form and helping prevent existing clots from growing larger. This can reduce the risk of serious complications caused by blocked blood flow, including heart attacks and strokes. [1]

There are two main types of blood-thinning medications: anticoagulants and antiplatelets. Antiplatelet medications make it harder for platelets to stick together, while anticoagulants act at different stages of the clotting process to reduce clot formation. [2] Examples of anticoagulants include heparin, warfarin, dabigatran, apixaban, rivaroxaban, and edoxaban. [1]

How Does a Blood Clot Form?

Blood clotting is a natural and necessary process that helps prevent excessive bleeding. When a blood vessel is damaged, platelets stick to one another and to the damaged area. Strands of fibrin then help hold the platelets and other blood cells together, creating a solid clot that stops the bleeding. Once the injury has healed, the body usually dissolves the clot. [3]

Problems can occur when a blood clot forms inside a blood vessel without an obvious injury or does not dissolve naturally. Blood clots may develop when the lining of a blood vessel is damaged, blood flow becomes slow, or the blood is more likely to clot than usual. [4] Atherosclerosis can also cause unwanted clots. This condition occurs when plaques containing fat, cholesterol, calcium, and other substances build up inside the arteries. If a plaque breaks open, a blood clot may form at the site. [3]

A clot that blocks blood flow to the heart can cause a heart attack, while one that blocks an artery supplying the brain can cause a stroke. Deep vein thrombosis occurs when a clot forms in a vein deep inside the body, usually in an arm or leg. If part of the clot breaks loose, it can travel to the lungs and cause a pulmonary embolism. [3]

Blood Clot Symptoms

Blood clot symptoms can vary depending on where the clot is located, and some people may not have noticeable symptoms. A clot that blocks an artery can prevent oxygen-rich blood from reaching the heart or brain, potentially causing a heart attack or stroke. A blood clot in a deep vein, known as deep vein thrombosis (DVT), can also break loose and travel to the lungs, causing a pulmonary embolism. [3]

Possible symptoms may include:

• Arms or legs: Swelling, sudden or gradual pain, tenderness, warmth [3]
• Heart: Chest pain, lightheadedness, shortness of breath, sweating, nausea, or discomfort in the neck, back, jaw, or arm [3]
• Lungs: Difficulty breathing, chest pain that may worsen with deep breathing or coughing, a fast or irregular heartbeat, coughing or coughing up blood, lightheadedness, or fainting [5]
• Brain: Numbness or weakness in the face, arm, or leg, especially on one side of the body, slurred speech, trouble speaking or understanding others, dizziness, a sudden severe headache, or vision problems [3]

Seek medical care if you experience possible symptoms of a blood clot. 

What is Xarelto?

Xarelto is the brand name for rivaroxaban, a prescription anticoagulant that belongs to a group of medications called factor Xa inhibitors. It slows the body’s ability to form blood clots by selectively blocking factor Xa, an enzyme involved in the clotting process. [6]

Xarelto may be prescribed to:

• Reduce the risk of stroke and blood clots in adults with nonvalvular atrial fibrillation
• Treat deep vein thrombosis and pulmonary embolism
• Reduce the risk of DVT or PE returning after initial treatment
• Help prevent DVT and PE following hip or knee replacement surgery
• Prevent venous thromboembolism in certain adults hospitalized with an acute illness
• Reduce the risk of major cardiovascular events in adults with coronary artery disease or peripheral artery disease when taken with aspirin
• Treat or prevent recurring venous thromboembolism in children
• Help prevent blood clots in children aged 2 years and older who have congenital heart disease after the Fontan procedure [6]

Xarelto received its initial U.S. approval in 2011. [6] Compared with warfarin, it generally requires less routine monitoring. However, patients may still need regular medical appointments and blood tests to check kidney and liver function. [2] 

Side Effects of Xarelto

Bleeding is the most common side effect of Xarelto in adults. Because Xarelto reduces the blood’s ability to clot, you may bruise more easily, and bleeding may take longer than usual to stop. Some bleeding can be serious or life-threatening. [6]

Call your doctor or seek medical help right away if you experience signs of serious bleeding, including:

• Unexpected bleeding or bleeding that lasts a long time
• Bleeding that is severe or cannot be controlled
• Frequent nosebleeds or unusual bleeding from the gums
• Menstrual bleeding that is heavier than normal or other vaginal bleeding
• Red, pink, or brown urine
• Bright red or black, tar-like stools
• Coughing up blood or blood clots
• Vomiting blood or vomit that resembles coffee grounds
• Headaches or feeling dizzy, weak, or faint
• Pain, swelling, or new drainage around a wound [7]

Certain medications can further increase the risk of bleeding when taken with Xarelto. These include aspirin, long-term use of nonsteroidal anti-inflammatory drugs, warfarin, heparin, clopidogrel, certain antidepressants, and other medications used to prevent or treat blood clots. Tell your doctor about all prescription medications, over-the-counter drugs, vitamins, and herbal supplements you take. [7]

To use Xarelto safely:

• Take it exactly as prescribed.
• Do not change your dose or stop treatment without speaking with your doctor.
• Report unusual bleeding or bruising.
• Tell your doctors and dentists that you take Xarelto.
• Speak with the prescribing doctor before any surgery, dental work, or medical procedure. [7]

What to Know Before Taking Xarelto

Before taking Xarelto, tell your doctor about all your medical conditions, especially if you have ever had bleeding problems, liver or kidney problems, or antiphospholipid syndrome. You should not take Xarelto if you have certain types of active abnormal bleeding or are allergic to rivaroxaban or any of its ingredients. Xarelto is also not recommended for people with artificial heart valves or antiphospholipid syndrome, particularly those with positive triple-antibody testing. [6]

Xarelto can increase the risk of a spinal or epidural hematoma in people who receive spinal anesthesia, have medicine injected into the spinal or epidural area, or undergo a spinal puncture. This complication can cause long-term or permanent paralysis. The risk may be higher if you have an epidural catheter, take NSAIDs or other medications that affect blood clotting, have had difficult or repeated spinal punctures, or have a history of spinal problems or surgery. [6]

Tell your doctor immediately if you develop back pain, tingling, numbness, muscle weakness (especially in your legs or feet), or loss of bladder or bowel control after a spinal procedure. You should also tell every healthcare professional treating you that you take Xarelto before having surgery, dental work, spinal anesthesia, or another procedure. [7]

Price of Xarelto

The cost of Xarelto can vary depending on where you purchase it and whether you choose the brand-name or generic version.

⁺ [8]

At these listed prices, brand-name Xarelto 20 mg from a U.S. pharmacy costs about $20.67 per tablet. Through Canada Med Pharmacy, brand-name Xarelto costs about $4.29 per tablet, while generic rivaroxaban costs about $2.57 per tablet. Prices and availability may change, so patients should confirm the current cost before placing an order. 

Where Is the Generic Version?

Generic Xarelto, which contains the active ingredient rivaroxaban, has been approved by the FDA and is beginning to reach the U.S. market. [9] Prices and availability are still settling and may differ depending on the pharmacy, location, and insurance plan.

U.S. patients with a valid prescription may be able to order generic rivaroxaban through Canada Med Pharmacy. This provides another option for comparing prices while access to generic rivaroxaban continues to expand in the United States.

FAQ: How can I save on Xarelto without putting my treatment at risk?

If Xarelto is too expensive, the safest next step is to compare lower-cost options without changing your treatment on your own. Xarelto is a blood thinner, so skipping doses, stopping suddenly, or switching medications without medical guidance can increase the risk of serious blood clots or bleeding problems. Before making any change, ask your doctor or pharmacist whether brand-name Xarelto or generic rivaroxaban is appropriate for your condition.

What you pay can vary considerably based on where you fill the prescription, your insurance coverage, and whether you're getting the brand or the generic. The FDA has approved generic rivaroxaban, though pricing and availability are still stabilizing and differ by pharmacy, region, and insurance plan. Some patients also look to Canadian pharmacies as a safe, lower-cost source for brand-name and generic Xarelto.

To save on Xarelto safely:

1. Ask your doctor if generic rivaroxaban is an option for you.
2. Compare brand-name and generic pricing before filling your prescription.
3. Use a reputable Canadian pharmacy that requires a valid prescription.
4. Do not stop Xarelto, skip doses, or change your dose unless your doctor tells you to.
5. Tell your doctor and pharmacist about all medications and supplements you take.
6. Seek medical help if you notice signs of serious bleeding, such as black stools, red or brown urine, vomiting blood, unusual bleeding, severe dizziness, weakness, or fainting.

The content in this article is intended for informational purposes only. This website does not provide medical advice. In all circumstances, you should always seek the advice of your physician and/or other qualified health professionals(s) for drug, medical condition, or treatment advice. The content provided on this website is not a substitute for professional medical advice, diagnosis or treatment.