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The Risks of Mixing Xarelto and Alcohol

Blood thinners like Xarelto are designed to prevent clotting in the blood that could lead to a stroke and ultimately save one’s life.

If you’ve ever been prescribed a blood thinner like Xarelto, chances are your doctor advised against mixing it with alcohol. Despite this, research shows that nearly 42% of adults took Xarelto and alcohol together. But can you drink alcohol with Xarelto? Is there a safe amount?

What Is Xarelto?
Xarelto is the brand name for rivaroxaban, which is a type of blood thinner used to prevent and treat blood clots. It’s designed to lower the risk of stroke, deep vein thrombosis (DVT), pulmonary embolism (PE), and other similar conditions that could become fatal. 

Specifically, Xarelto reduces your blood’s ability to clot by blocking an enzyme needed for blood clotting called Factor Xa (“10a”). The risk of experiencing DVT is greater in people who have experienced it once before, and people who have had DVT before may take Xarelto to prevent it from recurring. 

As with any medication, Xarelto can also produce risky side effects, and bleeding is the most severe. Someone who sustains a serious injury while taking Xarelto may be at an increased risk of bleeding out, so it’s important to receive medical attention right away, even if an injury seems minor. 

Can You Drink Alcohol While Taking Xarelto?
To understand when you can drink alcohol when taking Xarelto, it’s important to understand how alcohol works, too. While Xarelto is known for its ability to reduce and prevent blood clotting, many people are unaware that alcohol also acts as a blood thinner. 

Alcohol, or ethanol, is found in beer, wine, and liquor. Research has shown that alcohol can act as a blood thinner by reducing the levels of fibrinogen, which is another protein needed for blood clotting. One study, in particular, found that fibrinogen levels decreased by 14% in people who drank one to three alcoholic drinks per day.1 

Although the Food and Drug Administration (FDA) label of Xarelto doesn’t explicitly mention any drug interactions between Xarelto and drinking alcohol, because alcohol acts as a blood thinner, you should not take the two together. 

Side Effects of Xarelto and Alcohol
Around 2 to 3 million people in the United States take blood thinners like Xarelto.2 Xarelto treats health conditions like atrial fibrillation (AFib), which the Center for Disease Control and Prevention (CDC) predicts an estimated 12.1 million people in the United States will have by 2030.3 

In 2019 alone,  AFib was mentioned on 183,321 death certificates and was the underlying cause of death in 26,535 of those deaths.3 Untreated atrial fibrillation can lead to stroke, which is one of the most common causes of death in the United States, so it’s safe to say that blood thinners like Xarelto can be life-saving. 

With that said, compromising the efficacy of Xarelto by drinking alcohol can place the user at risk of experiencing AFid complications, stroke, and other potentially fatal problems. The biggest risk of mixing blood thinner Xarelto and alcohol are the excessive thinning of the blood, which can lead to unwanted and life-threatening bleeding. 

Generally, side effects of Xarelto and alcohol include:

  • Nuisance bleeding
  • Frequent nose bleeds
  • Bleeding gums (if you brush your teeth too aggressively)
  • Bleeding from shaving that lasts more than 5 minutes
  • Prolonged bleeding from superficial cuts or wounds to the skin
  • Increased risk of bloody urine or stool
  • Increased risk of coughing up blood or blood clots
  • Increased risk of bleeding from wounds that lasts more than 10 minutes
  • Heavier than normal menstrual flow
  • Iron deficiency 
  • Abnormal bruising 
  • Bruising more easily 
  • Severe headaches

Life-threatening bleeding can also occur when Xarelto and alcohol are mixed. The risk of hemorrhaging, for instance, is increased, which can be fatal in those with higher risks of stroke. 

Alcohol is known to thin blood, and even moderate drinking can lead to thinner blood and even exacerbate the adverse effects of Xarelto. Therefore, it’s important not to drink alcohol while taking Xarelto to prevent nuisance bleeding or bleeding problems that could be fatal. 

What are the signs of Rivaroxaban (Xarelto) and drug interactions?

Rivaroxaban, a widely used anticoagulant for conditions like atrial fibrillation and deep vein thrombosis, can have significant interactions with other drugs, which may alter its effectiveness and increase the risk of adverse effects. Monitoring for specific signs and symptoms can help identify these interactions early to manage them effectively.

One of the primary signs to watch for is an increased tendency to bleed or bruise easily. This includes more severe bleeding from small cuts, longer duration of bleeding after an injury, or spontaneous bruising without a known cause.

Additionally, alterations in urine appearance, such as dark-colored or blood-tinged urine, could suggest a negative impact on renal function due to drug interactions.

Patients should also observe for any signs of gastrointestinal upset, including nausea, vomiting, abdominal pain, or the presence of black or tarry stools, which could indicate bleeding in the gastrointestinal tract.

Swelling or edema, particularly in the limbs or around the face, may also occur. This can be a sign of fluid retention or an allergic reaction related to drug interactions.

Unusual changes in heart rate, such as irregular, unusually fast, or slow rhythms, can be a consequence of drug interactions affecting cardiac function.

It is important to keep an eye on liver health, as changes in liver function tests might occur. These changes could indicate a hepatic reaction from combining rivaroxaban with other medications.

Neurological symptoms like dizziness or episodes of fainting could signal cardiovascular or central nervous system issues stemming from drug interactions.

Lastly, signs of an allergic reaction to drug interactions include skin rashes, itching, significant swelling, severe dizziness, or trouble breathing, requiring immediate medical attention.

Being vigilant for these symptoms can help maintain the safety and efficacy of using rivaroxaban alongside other treatments. Regular consultations and updates with healthcare providers are critical for managing these signs and preventing complications.

Will Rivaroxaban (Xarelto) interact with other medications?

Yes, Rivaroxaban can interact with other medications, which may impact its effectiveness or increase the risk of harmful effects. Specifically, it can have interactions with other anticoagulants and antiplatelet agents, as well as with NSAIDs, heightening the chances of bleeding. Furthermore, its metabolism may be altered by drugs that affect liver enzymes, such as certain antifungals and some HIV treatments. It is important for users of Rivaroxaban to divulge all medications they are taking, including over-the-counter options and dietary supplements, to their healthcare provider. This allows the provider to evaluate any potential drug interactions and to tailor the treatment plan to ensure safety and efficacy. Continuous communication with health providers is crucial to safely manage the health conditions being treated with Rivaroxaban.

Who should not use Xarelto?

Rivaroxaban, marketed as Xarelto, is not suitable for everyone. It should be avoided by individuals allergic to rivaroxaban or those allergic to other medications in its class. Additionally, it is contraindicated for patients who are currently experiencing any form of active bleeding or who are at a heightened risk for uncontrollable bleeding, which can occur under various medical conditions or prior to undergoing certain surgical procedures. Pregnant people considering an epidural or those who are breastfeeding should seek alternatives, as the safety of Xarelto for unborn children and nursing infants has not yet been firmly established. Furthermore, individuals who have catheters or hematomas must carefully evaluate the use of this medication with their healthcare provider to avoid potential complications. Consulting with a healthcare professional is crucial to determine if Xarelto is a safe and appropriate medication based on an individual’s particular health circumstances.

How does Xarelto misuse affect older adults?

The article from the Journal of the American Heart Association indicates that a significant fraction of those taking Xarelto are seniors, aged 65 and over. This group is particularly susceptible to the improper use of prescription medications and the development of addiction, a problem that is often not adequately addressed in older adults. Due to a slower metabolism in aging bodies, drugs can stay in the system longer, potentially intensifying their effects. This can make the side effects and dangers of medications like Xarelto more severe. Furthermore, older adults often experience increased social isolation, as family dynamics shift and peers may pass away, which can exacerbate issues related to medication misuse. The National Council on Alcoholism and Drug Dependence reports that approximately 2.5 million seniors struggle with addiction. The symptoms of drug misuse and addiction in older adults can be subtle or mistaken for other age-related conditions. This, combined with the fact that elderly individuals frequently receive multiple prescriptions, can make it challenging for medical professionals and relatives to recognize signs of drug misuse.

For those misusing Xarelto, abrupt cessation is particularly dangerous; abrupt withdrawal can be just as life-threatening as the misuse itself. Health experts recommend a medically supervised detoxification process to safely manage withdrawal from the drug. Continuing with professional addiction treatment can provide the support needed to achieve sustainable recovery, addressing both the physical and psychological aspects of addiction.

Can you spot the signs of Xarelto/Rivaroxaban misuse or addiction?

Identifying misuse or addiction to rivaroxaban (Xarelto) involves observing various behavioral, physical, and psychological indicators. A person may seek multiple doctors to obtain additional prescriptions or continue using the medication despite no longer having a medical justification. Common behavioral signs include taking higher doses than prescribed, hoarding pills in non-labeled containers, or finding an unusual number of empty medication bottles.

Physical signs that may indicate misuse include noticeable mood swings, changes in physical appearance such as pale skin or easy bruising, and any gastrointestinal symptoms like blood in the stool. Changes in social behavior, such as withdrawing from friends and family, losing interest in activities previously enjoyed, or unexplained financial problems can also be red flags.

Addiction can be confirmed through symptoms classified under substance use disorders. These include an inability to quit despite desired efforts, experiencing cravings, using the drug in unsafe conditions, neglecting personal and professional responsibilities, and continuing use despite awareness of its harmful effects.

In summary, rivaroxaban misuse or addiction is marked by unauthorized prescription seeking, compulsive use, and significant life impairment. Recognizing these signs early can help in addressing the issue promptly and seeking necessary medical intervention.

What are the signs of Rivaroxaban (Xarelto) abuse?

Rivaroxaban (Xarelto) abuse can manifest through various signs and behaviors that deviate from prescribed medical use. Indicators of abuse might include consuming the drug in doses or for durations not aligned with medical directions. People might misuse the drug by altering its form, such as crushing it into powder to be snorted, which is a clear signal of abuse.

Detectable behaviors that suggest misuse include doctor shopping to obtain multiple prescriptions, continuing the medication use even when it's no longer medically necessary, and consuming larger amounts than recommended. Visible clues around the home might include finding multiple empty prescription bottles, or storing the pills in non-labeled containers for easier access.

Abuse of Rivaroxaban can also affect personal behavior and relationships. Those misusing the drug might exhibit mood swings, changes in sleep or eating patterns, and a withdrawal from social activities. Additionally, secretive behavior, relationship issues, financial problems due to purchasing the drug illegitimately, and changes in work productivity or school performance are common. Engaging in illegal activities to procure the medication and simultaneous use of alcohol or other drugs with Xarelto can exacerbate risks and side effects, indicating serious abuse issues.

What is the treatment for Rivaroxaban (Xarelto) addiction?

The treatment for Rivaroxaban (Xarelto) addiction should always be overseen by health professionals, ideally at a specialized treatment center. When discontinuing the use of Rivaroxaban, it is crucial to replace it with another anticoagulant to prevent potential health risks. A carefully managed detoxification process is also needed to cleanse the body of the medication. This typically involves gradually reducing the dosage under close medical supervision to ease the patient off the drug and manage any withdrawal symptoms.

The detox period is supported by medical interventions that help stabilize the body and minimize discomfort, ensuring that the patient's health remains secure as the body adjusts to the absence of the medication. Following detox, patients are advised to engage in a comprehensive treatment program for Rivaroxaban addiction, which includes continuous professional support and education about the medication.

Treatment centers also provide support groups and behavioral therapy sessions to help individuals understand and alter their behavior patterns, significantly lowering the risk of relapse. While some physical effects of the medication may not be entirely reversible, proper management and treatment can greatly mitigate these issues and help individuals recover from their dependency.

Help for Alcohol Abuse
While Xarelto is not addictive, alcohol is. While adverse side effects may occur if someone takes higher doses of Xarelto (usually accidental), engaging in alcohol abuse while taking Xarelto is an entirely different matter. 

Despite the dangers, people may combine Xarelto and alcohol abuse simply because they don’t want to quit drinking, even if they’re taking medication. What’s more, those with alcoholism are more likely to experience the adverse effects mentioned earlier because they have an addiction that makes it difficult for them to quit drinking. 

Not only can combining medication with alcohol exacerbate the effects of the latter, but it can also prevent the medication from working properly, which we mentioned could be life-threatening for someone who requires blood thinners. Both substances can also severely impact the liver, increasing the person’s risk of liver disease and cancer. 

If you or a loved one is displaying signs of alcoholism or drug addiction, our faith-based drug and alcohol treatment center can help. Faith in Recovery provides medically monitored detox for alcohol and other substances to help patients safely get through withdrawal symptoms. 

Following detox, clients can then move onto one of our faith-based recovery programs, during which they will receive individual and group therapy to help them overcome the psychological impact of substance abuse. Recovery is possible no matter how far into addiction you are. 

For more information about our Christian drug rehab programs, call us today at 888-280-4763.


Related Reading: 

Antidepressants and Alcohol: The Fatal Cocktail
High-Functioning Alcoholic: Signs and Symptoms


  1. NIH - Randomized Controlled Intervention of the Effects of Alcohol on Blood Pressure in Premenopausal Women
  2. Agency for Healthcare Research and Quality - Blood Thinner Pills: Your Guide to Using Them Safely
  3. CDC - Atrial Fibrillation