Can You Drink Alcohol While Taking Xarelto?

Gone are the days when “medicine” meant bloodletting, leeches, or (yikes!) trepanation. And thank goodness for that. While our ancestors tried their best, it took humankind some time to figure out that having slimy critters suck our blood or drilling holes in the skulls of suffering patients would probably do more harm than good. Well, as they say, you live and learn.

However, now that we have medications to treat all kinds of problems — including sophisticated ones such as rivaroxaban (Xarelto) that target cardiovascular issues — we’re faced with a different dilemma. You might be asking yourself, Is it okay to mix them with booze? Specifically, can you drink alcohol while taking Xarelto? And how long does Xarelto stay in your system? Let’s find out!

What Is Xarelto?

Xarelto is a widely used anticoagulant medication prescribed to prevent blood clots in patients with atrial fibrillation, deep vein thrombosis (DVT), and pulmonary embolism (PE). It’s also used to prevent stroke. 

Anticoagulants belong to a larger group of medications known as blood thinners. As the name suggests, blood thinners, well, thin our blood — sort of. More precisely, they prevent excessive clots from forming in our blood and blocking blood flow in critical locations of the body, such as the heart, lungs, or brain.

There are two basic types of blood thinners that work in slightly different ways:

• Anticoagulants, such as warfarin and heparin, interrupt the formation of clotting factors — proteins in the blood that keep us from bleeding excessively. These are proteins in the blood that control bleeding. While the OGs such as warfarin and heparin take a bit of a sledgehammer approach and blitz all clotting factors indiscriminately, newer ones are more nuanced and target specific ones. In addition to Xarelto, some examples include dabigatran, apixaban, and edoxaban.
• Antiplatelets, such as aspirin and clopidogrel, work by preventing platelets (cells that help our blood clot to seal up wounds) from clumping together. They’re especially helpful in preventing blood clots from forming in arteries — a common cause of heart attacks and strokes.
  
  Xarelto works by directly inhibiting the clotting factor known as Factor Xa. It can treat a number of different conditions. Here are the frontrunners:
• Nonvalvular atrial fibrillation (AFib). According to Heart.org, atrial fibrillation (AFib) is a common type of arrhythmia that’s expected to affect over 12 million people by 2030. It can cause blood clots, stroke, heart failure, and other complications and happens when the upper chambers of the heart beat irregularly, causing blood to pool around the atria and potentially form clots. 
• Deep vein thrombosis (DVT). Deep vein thrombosis happens when a blood clot forms in a vein deep inside the body, usually in the legs. (You know how they tell you to get up and move around every hour or so when sitting in an airplane or at a desk? Being sedentary for too long is one of the biggest risk factors).
• Pulmonary embolism (PE). A pulmonary embolism — sometimes a complication of DVT and the blood clots that form as a result — is a dangerous traffic jam that happens in our bloodstream. It leads clots to lodge in our lungs, blocking blood flow and causing sudden shortness of breath, dizziness, and chest pain. This one’s always a medical emergency!
• Coronary artery disease (CAD). Coronary artery disease results from damage to blood vessels that bring oxygen- and nutrient-rich blood to the heart to keep it pumping. The damage can have many causes, such as arterial plaque that narrows our blood vessels. Blood thinners like Xarelto, in turn, keep the flow going a bit more smoothly.
• Peripheral artery disease (PAD). Similar to coronary artery disease, peripheral artery disease takes place in the arteries and potentially blocks blood supply to the arms or legs, causing pain. Once again, Xarelto can help smooth things out by restoring flow.

Like any medication, Xarelto comes with instructions we should make sure to follow. If we have questions, it’s important to always ask our doctor or pharmacist for advice. 

For now though, let’s focus on the question that’s on our mind today: What happens if we mix alcohol and Xarelto?

Can You Drink Alcohol While Taking Xarelto?

It’s not a good idea to combine Xarelto and alcohol. Here are the main reasons why Xarelto and alcohol are not a good mix.

Intensified Side Effects

Many of Xarelto’s side effects don’t mix well with booze.

• Tiredness and lack of energy. Both Xarelto and alcohol can sap our energy reserves. You know that brief burst of energy you get from alcohol that makes it seem like a good idea to race down the street without our shoes or sing five karaoke solos in a row? Well, it’s usually followed by a crash. And if Xarelto is in the mix, we’ll probably feel groggy right away.
• Heart palpitations. Noticeable heartbeats (or feeling as if there’s a bird flapping its wings in our chest) is a common side effect of Xarelto. While heart palpitations can be unnerving, they’re usually not dangerous in and of themselves. However, if we add alcohol to the mix, things get a bit more serious. Alcohol can stress the heart, causing rapid heartbeat and fluctuations in blood pressure — not what we want, especially, if we’re taking Xarelto.
• Dizziness or lightheadedness. Xarelto can make us dizzy. Adding alcohol to the mix can make the world spin even faster due to its effects on the inner ear.
• Digestive discomfort. In addition to Xarelto, alcohol can mess with our gut, causing nausea or even vomiting. Not how we want to feel on a night out (or in)!
• Shortness of breath. As a depressant, alcohol can slow down our central nervous system and lead to breathing difficulties. In large amounts over a long period of time, it can even cause serious lung problems. Adding Xarelto to the mix could put us in danger by depressing our breathing even further.
• A mild rash. Xarelto can leave us looking a bit splotchy. Alcohol is known to cause facial redness and might leave us feeling less party-ready than we’d like.
• Pale skin. On the other side of the spectrum, our face might also appear unusually pale. While alcohol won’t necessarily make us look more ghostly, the paleness is often a sign of fatigue — and alcohol can certainly add to it.

As we can see, the combination of Xarelto and alcohol can leave us feeling less than stellar. Plus, the double dose of dizziness and breathing difficulties could be dangerous!

Alcohol and the Cardiovascular System

In spite of what some headlines might imply, alcohol isn’t as heart-friendly as we once thought. In fact, it can cause heart palpitations, send our blood pressure haywire (by causing dips followed by rebound spikes), and it can even cause serious heart disease in the long run. So drinking while trying to treat our vascular health problems can be counterproductive, to say the least.

Overtasking the Liver

Xarelto is processed by the liver, and adding alcohol to the mix could create a heavier burden. While the liver can certainly multitask, it has a limit. (For more information, check out “How Much Alcohol Causes Liver Damage?”).

Risk of Bleeding

Last (but certainly not least), alcohol has an effect on our blood, and combining alcohol and Xarelto increases the risk of bleeding. Science shows that drinking increases our risk of gastrointestinal bleeding and even amps up the risk of hemorrhagic stroke caused by bleeding in the brain. (For more insights, see “What Does Alcohol Do to Your Blood?”)

Other Substances To Avoid Mixing With Xarelto

Alcohol isn’t the only substance that can increase our chances of bleeding when taking Xarelto. Here are more to be careful with:

• Aspirin. Aspirin itself or any aspirin-containing products increases our risk of bleeding. The bleeding in question can happen in the brain and potentially cause a stroke — the very condition that Xarelto is designed to prevent (albeit through a different mechanism). 
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Especially when used for long periods of time, NSAIDs can up our chances of bleeding.
• Warfarin sodium (Coumadin and Jantoven). This medication acts as an anticoagulant that targets a different clotting factor (one that involves vitamin K as part of its structure). As a blood thinner, it increases our risk of heavy bleeding.
• Heparin. Any medicine containing heparin (another anticoagulant) will increase bleeding risk.
• Clopidogrel (Plavix). Clopidogrel is another blood thinner. This one works by preventing platelets from sticking together, but the result is the same — more potential for heavy bleeding.
• Some antidepressants. Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) can increase bleeding. By lowering serotonin levels in platelets in our blood, they decrease clot formation, leading to heavier bleeding.
• Other medicines. Any medications used to prevent or treat blood clots can also amplify the risk of bleeding.

In addition to other substances, any activities that increase our chances of bleeding are ones to be careful with (more on that below!)

How Long Does Xarelto Stay in Your System?

When is it “safe” to drink after taking Xarelto? It depends.

Xarelto has a half-life of about 5 to 9 hours in younger folks and 13 to 15 in older adults. That means that it’s out of our system completely within about two days.

But while it’s technically “safe” to drink after the two-day mark, there are other factors to consider before getting in line for that margarita at happy hour. For example, if we’re concerned about our vascular health, booze might not be our best option. If we’re recovering from an injury or illness, it could delay our recovery. And if we’ve been on Xarelto or other medications for a while, we might want to give our liver a much-needed break.

Tips To Stay Safe While Taking Xarelto

To finish off, here are some tips to stay safe and healthy while taking Xarelto:

1. Avoid risky combos. In addition to taking a break from booze while you’re on Xarelto (or beyond!), be careful with any other substances that might increase the risk of heavy bleeding.
2. Avoid injuries. We all like to have fun (and taking Xarelto doesn’t mean you can’t be active!), but it might not be the best time for contact sports like rugby, hockey, or MMA fighting. Also, be extra careful with sharp objects, such as scissors, razors, gardening shears (or angry cats!).
3. Keep your medical team in the loop. The NHS recommends telling your doctor or dentist that you’re on Xarelto before having any procedures.
4. Nourish your body. Xarelto is great for keeping our vascular system in top shape, but so is a healthy diet! The Circulation Foundation says to aim for plenty of fruits, vegetables, and fiber-rich whole grains while reducing saturated fats, salt, and sugar.
5. Exercise. What goes together with a healthy diet? Exercise! Pick an activity you enjoy and stick with it. If the gym isn’t your thing — no problem! Walking around the park, hiking, or doing a YouTube exercise routine in your living room are all excellent ways to get moving.
6. Use technology. If you have an Apple Watch, pay attention to those “stand” hours, especially if your job requires sitting. No watch? No problem! Just set a timer on your phone to get up and stretch every hour or so. And while you’re at it, check out Reframe for more great tips, information, and community support!

With these tips, you can stay safe while taking Xarelto. They’re also great for staying safe and healthy in general. Vascular health is important for all of us, and prevention is always a good idea.

Summing Up

In the end, Xarelto, alcohol, and vascular health in general are all important pieces of the puzzle to consider when it comes to our overall wellness. Let’s give our body and mind a chance to function at their best! In the wise words of Thomas Carlyle, “He who has health, has hope; and he who has hope, has everything.”