According to the 2016 National Survey on Drug Use and Abuse (NSDUH), just over 6 million Americans abused a prescription psychotherapeutic medication in the month prior to the survey. Xarelto (generic: rivaroxaban) is a prescription blood thinner, or anticoagulant, medication.

Rivaroxaban may be misused by taking it in higher doses than prescribed, taking it for longer than prescribed, using the drug in between doses, or any use of rivaroxaban without a necessary and legitimate prescription. If a person chews the tablets or crushes them to snort the powder, this is also a form of abuse.

Xarelto is a potentially dangerous medication with a risk for irreversible internal bleeding and hemorrhaging, the journal Medicine reports. It can also cause permanent paralysis.

The Institute for Safe Medication Practices (ISMP) placed anticoagulant medications, including rivaroxaban, in the category of “highest priority drug safety problems” according to the Quarterwatch Reports. Abuse of this drug raises the odds for a life-threatening complication and increases the risk for addiction.

Spotting Rivaroxaban Abuse and Addiction

Pills spilled on table with hand of addict
Rivaroxaban use comes with several common physical side effects, such as cough, respiratory infection, headache, dizziness, lightheadedness, fatigue, nausea, nosebleeds, chest pain, and pain in the extremities, the U.S. National Library of Medicine (NLM) PubMed Health publishes. Signs of the most concerning possible side effect of Xarelto, internal bleeding, include pale skin, easy bruising, bloody stool, dizziness, abdomen swelling, and fatigue. These signs should be considered an immediate medical emergency.
All of these physical side effects of rivaroxaban can occur from regular use as well as from misuse or abuse. Additional signs that a person may be abusing Xarelto can include:

  • Doctor shopping, or going to multiple doctors to obtain prescriptions for Xarelto
  • Continuing to take rivaroxaban after there is no more medical need to do so
  • Taking higher doses than required and/or taking Xarelto in between doses
  • Empty pill bottles in the trash and pills stashed in easily accessible locations
  • Mood swings
  • Changes in sleeping and eating patterns and habits
  • Increased secrecy and social isolation
  • Alterations in social circles and relationship difficulties
  • Possible financial strain due to money spent on drugs
  • Potential criminal behaviors and/or legal issues related to drug use
  • Drop in grades at school and/or production at work
  • Taking multiple drugs at a time or mixing rivaroxaban with alcohol, which can increase the side effects and all risk factors
  • Personality shifts and actions that seem out of character


Xarelto use can become abuse even if the drug was initially prescribed for a medical reason. A person may misuse the drug and then keep doing so, eventually leading to a loss of control over use, and therefore addiction.

The Journal of the American Heart Association (JAHA) publishes information showing that most people who are prescribed Xarelto are over the age of 65, an age demographic that is especially vulnerable to prescription drug abuse and addiction. Both of these issues are often overlooked in this population.

Elderly individuals have slower metabolisms, meaning that the drug can stay active in the bloodstream for longer and have greater impact. Social and circumstantial isolation is common in the older population as well, as loved ones move away, friends and family members pass away, and living situations change.

The National Council on Alcoholism and Drug Dependence (NCADD) reports that around 2.5 million senior citizens in the United States battle addiction. Drug abuse and addiction are often misdiagnosed or simply missed in an older adult, both by medical professionals and by loved ones. Symptoms may mimic that of another disorder, and older adults typically take multiple prescriptions at a time so it can be harder to realize when drugs are being misused.

Abuse of Xarelto can have life-threatening complications, including some irreversible side effects. It is important to be able to recognize potential misuse of this medication. Xarelto is not a drug that should be stopped suddenly, as it can have dangerous and even potentially fatal withdrawal symptoms. Instead, use of a medical detox program followed by a complete addiction treatment program is optimal to achieve lasting recovery.