grapefruits, foods that affect Xarelto, eat grapefruit

People at risk for dangerous blood clots frequently need to take anticoagulant medication to prevent clots from forming. Perhaps the best-known of these is warfarin. It is inexpensive, and its side effects are well known, but patients sometimes find it challenging to use. It interacts with many different foods. As a result, people on warfarin have to watch their diets and have their blood tested frequently to make sure the dose is in the right range. One reader asked whether there are foods that affect Xarelto, a newer anticoagulant.

Foods That Affect Xarelto:

Q. You often speak of food interactions with the blood thinner warfarin (Coumadin), but rarely address the anticoagulant Xarelto. I take Xarelto for atrial fibrillation and would like to know what food interactions I might need to be aware of.

A. Your question seems quite simple on the surface, but it turned into a challenging assignment. People with the irregular heart rhythm called AFib (atrial fibrillation) are frequently prescribed anticoagulants like warfarin or rivaroxaban (Xarelto) to prevent strokes.

Warfarin’s blood thinning effect is counteracted by many foods including green leafy vegetables. The maker of Xarelto promotes its drug as advantageous:

“Enjoy a full variety of healthy food with no known dietary restrictions.”

Take Xarelto with a Proper Meal:

An article in the Journal of Thrombosis and Haemostasis (May 9, 2015) concluded that patients prescribed rivaroxaban (Xarelto) for blood clot protection should take it “together with a proper meal.” That is because the drug is not absorbed as well when taken on an empty stomach. One person who skipped meals due to shift work ended up with pulmonary embolisms (blood clots in the lungs) despite taking the drug conscientiously.

Watch Out for Grapefruit:

We also think it would be advisable to limit intake of grapefruit or grapefruit juice while taking Xarelto. Although there is no such warning in the official prescribing information, we found a reference that urged caution (Bailey, Dresser & Arnold, CMAJ, March 5, 2013).

One FDA review suggested that

“Grapefruit juice may also increase plasma concentrations of Xarelto and should be avoided.”

It appears that grapefruit and grapefruit juice may be among the foods that affect Xarelto.

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  1. Marcia

    I took Coumadin for four years. There were many dietary restrictions. Basically, no green veggies because they are loaded with Vitaman K which coagulates your blood. Also, no cranberries (although I think studies have confirmed that cranberries are ok but go by what your doctor says). Herbal teas are not recommended. Many vitamins are not either. Neither is alcohol. I am now taking Xarelto. It costs a few dollars a month more but it is worth it. I had diarrhea almost daily for 4 years. When I changed to Xarelto, it stopped. I didn’t realize it the Coumadin was causing it.

  2. Eric

    I’m reading contradictory remarks and read different things about what to eat and not to eat…I guess I don’t know what I’m supposed to eat or drink

  3. Eric

    I am so confused.. I was recently diagnosed with AFib and they put me on Xarelto. I am also taking a BP meds and they have me on a med to lower my heart rate and I take metformin for diabetes. I’m scheduled next Wednesday to have cardioversion and TEE

    • Terry

      I see you had cardio conversion. I am scheduled May 15, and am concerned. How did that work for you?

  4. david
    » UK

    I have just started taking rivaroxaban and I have also started to eat much healthier with leafy green veg and lots of watercress during the day. I notice that mustard greens ( watercress being one of them ) is a no-no with warfin but is it ok with rivaroxaban, please ?

  5. Suzanne
    Staten Island, N.Y.

    Hello, I have been taking Xarelto for five years with success of no emergencies to the ER. However, I recently experienced during the past couple of months that whenever I eat Salmon, within a couple of days I bleed through my gums very little. Salmon has a high percent of “Omega 3”!! The same happened about 2 years ago taking Omega 3 capsules, which I immediately stopped taking. Would you have any information on eating Cranberries or drinking a (Superfood) with cranberries in the juice. Little by little I am reading where Xarelto does have foods to stay away from through everyday experience. Please reply to my question on cranberries. Thank you. Suzanne.

  6. Sandi

    A friend gave me your site to check out as I am interested in the natural as much as possible altough I am on medication for blood pressure and afib which I hate as I do not like medications or chemicals of any kind.

  7. Jan
    Vista, CA

    What about taking Eloquis and different foods?

    Thank you

  8. Barb A.

    Would this also be true of the RX blood thinner drug Eliquis (apixaban) that I am taking for atrial fib ?

    • Terry Graedon

      There are some suggestions, though not perfect evidence, that apixaban may interact with grapefruit or grapefruit juice.

  9. Karen
    Lynchburg VA

    re. Xarelto
    I, too, take it for afib. My problem is that I was told to take it with a full meal and avoid alcohol. I tend to eat small portions several times a day so my main meal is evening dinner. At dinner, I enjoy a glass of wine or two. Not sure how to reconcile my preferences with
    drug requirements.

  10. Tony

    Wafarin is a much safer drug if directions for its use if followed. A leading cardiolist that I see advises against the new drugs because the long term effects are not known.

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