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Drug Info

How long does Xarelto stay in your system?

This blood thinner is processed out of your body one to two days after your last dose
Sarah Bradley writer headshot
By | Dec. 27, 2024 Medically reviewed by Karen Berger, Pharm.D.
A clock and a bottle of pills | How long does Xarelto stay in your system?

Key takeaways

  • Xarelto is a brand-name blood thinning medication used to treat and prevent dangerous blood clots and reduce your risk of stroke in certain conditions like atrial fibrillation.

  • Xarelto starts working quickly, within two to four hours of your starting dose. After a dose, half of the drug concentration is cleared from your system in five to nine hours.

  • For most adults without any medical conditions, Xarelto is fully eliminated from the body after one to two days. Still, it may remain longer in older adults and people with liver and/or kidney impairment.

In this article:

Blood thinners, or anticoagulants, can be used to treat and prevent potentially life-threatening blood clots like deep vein thrombosis (DVT) and pulmonary embolism (PE). Xarelto (rivaroxaban), a popularly prescribed blood thinner, does not literally thin the blood. Instead, it works by blocking a clotting protein called factor Xa, reducing the ability of blood to form clots.

According to Christopher Yi, MD, a vascular surgeon at Memorial Orange Coast Medical Center in Fountain Valley, California, Xarelto is typically prescribed to treat blood clots or to prevent them in people who have an irregular heartbeat (atrial fibrillation) or recently had orthopedic surgery (such as knee replacement surgery or hip replacement surgery) that limits their mobility. It is also used in conjunction with aspirin, he adds, to reduce your risk of heart attack and stroke.

Although blood thinners like Xarelto play an important role in reducing your risk of blood clots, they also have side effects, including an increased risk of bleeding. Here’s what to know about how long Xarelto stays in your system and the potential adverse effects it can cause.

How long does Xarelto stay in your system?

Xarelto reaches maximum concentration in your bloodstream two to four hours after you take it, and it has a relatively short half-life of five to nine hours, says Allison Hinkle, Pharm.D., CPH, clinical pharmacy manager at HCA Florida Highlands Hospital.

The half-life of a medication is the amount of time it takes for half of the starting dose to be metabolized by your body or eliminated from your system. For healthy, non-elderly patients, Dr. Hinkle says a drug like Xarelto is considered fully metabolized after five half-lives, which equals about 25 to 45 hours. Older adults and people with kidney problems may take longer to clear the medicine from their system.

In other words, some amount of Xarelto stays in your system for about one to two days after you take it. However, according to Dr. Hinkle, the half-life of Xarelto isn’t dose-dependent. Whether you take 10 milligrams or 20 milligrams, half of that dosage will be eliminated from your system in five to nine hours (but if you take 20 milligrams, you’ll have a higher concentration of Xarelto in your system at the half-life point than if you only took 10 milligrams). With continued use, the concentration of Xarelto will build up over time, reaching steady levels.

Factors that influence how long Xarelto stays in your system

Some drugs are highly influenced by factors like age, gender, and body weight when it comes to how quickly they can be metabolized. Still, Dr. Yi says Xarelto is relatively consistent in how long it lasts in most people’s systems, with only a couple of exceptions (such as in older adults or people with kidney problems). 

A 2013 review of studies looked at many common factors that often affect the absorption of drugs like Xarelto and found that sex, body weight, and ethnicity did not significantly affect how quickly the drug is cleared from the body; only advanced age and kidney and/or liver disease were shown to impact its half-life.

Age

Older adults commonly need to allow more time for a drug to clear their system because of normal, age-related changes to their body composition and their liver and kidney function. The half-life of Xarelto may be closer to 11 to 13 hours in people aged 60 and older but also says that age alone isn’t a reason to make dose adjustments for otherwise healthy seniors taking Xarelto.

Liver or kidney disease

Dr. Hinkle says the half-life of Xarelto varies in people with kidney or liver impairment because these organs are responsible for breaking down the drug in the body. If you have kidney or liver disease, it will take longer for your organs to metabolize Xarelto, so depending on the severity of your condition, your healthcare provider may need to adjust your dose of Xarelto accordingly.

For example, the 2013 review found that people with mild liver impairment cleared Xarelto at roughly the same rate as people in the healthy control group. Still, the half-life was extended when people had moderate liver impairment or kidney impairment.

Side effects and risks of Xarelto

Unless you are using it preventatively after a surgery that limits your mobility, Dr. Yi says Xarelto is meant to be used long-term and is a relatively safe anticoagulant. In fact, some studies suggest it has fewer side effects and drug interactions than warfarin, another popular drug thinner.

However, taking Xarelto long-term increases your risk of bleeding, says Dr. Yi, including gastrointestinal bleeds and serious bleeding if you fall or become injured. Other common side effects of Xarelto include:

  • Back pain
  • Abdominal pain
  • Dizziness
  • Itching
  • Fatigue

Your healthcare provider will explain what side effects to watch out for that could indicate bleeding, such as nosebleeds, bleeding gums, or dark stools. Additionally, there are a few steps you can take to decrease your bleeding risk, such as:

  • Limiting alcohol intake
  • Being extra careful with objects that could cause bleeding, such as knives, scissors, or gardening tools
  • Avoiding sports that could cause injuries
  • Using a soft toothbrush to minimize gum irritation
  • Wearing shoes or nonskid slippers inside your home
  • Taking care when clipping your nails

If you’re prescribed Xarelto, make sure you talk to a healthcare professional about any other medications you’re taking, including prescription drugs and over-the-counter medicines, vitamins, or supplements, because some drugs interact with Xarelto, either by increasing the side effects or affecting its absorption rate. According to the prescribing information from the manufacturer, this is especially important if you take any of the following medications or supplements because you may need to avoid combining them with Xarelto:

Unless approved by your provider, you may need to avoid nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, as they increase the risk of bleeding when combined with other medications that affect coagulation. If you are pregnant or breastfeeding, talk to a provider before taking Xarelto.

How long does it take for side effects to go away after stopping Xarelto?

Because Xarelto fully clears your system in 25 to 45 hours, anyone experiencing side effects from this medication can expect them to resolve quickly after stopping the medication. Dr. Yi says most people stop having any Xarelto-associated side effects within 24 hours of your last dose. However, you should never stop taking Xarelto except under the direction of your healthcare provider. Many side effects go away as your body adjusts to the medication. If a side effect is particularly bothersome, seek medical advice from a healthcare professional before skipping a dose.

Dr. Yi adds people taking Xarelto and undergoing a planned surgery are typically told to stop taking it 24 to 48 hours before a minor procedure and 72 hours before a major surgery; this ensures there is no increased risk of bleeding during or after the procedure. 

Xarelto alternatives

If you’re experiencing serious side effects or can’t take Xarelto because of interactions with existing health conditions or medications, it’s important to seek medical advice from a healthcare provider about your options so you can weigh the pros and cons together. You should not stop taking Xarelto without consulting with a provider first.

However, there are alternatives to Xarelto, including oral anticoagulants such as Eliquis (apixaban), Plavix (clopidogrel), Pradaxa (dabigatran), Lovenox (enoxaparin), and warfarin. Some of these drugs can be used for the same indications as Xarelto, but others only treat and prevent DVT and PE without providing a reduced risk of heart attack and stroke (or vice versa). Your provider can work with you to find a Xarelto alternative that provides the benefits you need based on your overall health and existing medical conditions.