Xarelto vs. Pradaxa

See how Xarelto and Pradaxa compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Xarelto is taken once a day for most approved uses, while Pradaxa is taken twice a day for every approved use.

  • Both drugs carry a boxed warning about stopping treatment early and about spinal procedures, and both can cause serious bleeding.

  • Xarelto has a broader FDA label, covering knee replacement prophylaxis and acutely ill hospitalized patients, uses Pradaxa does not have.

Xarelto vs. Pradaxa Drug Summary

Xarelto

Xarelto (rivaroxaban) is a factor Xa inhibitor, a blood thinner used to lower the risk of stroke in atrial fibrillation and to treat or prevent blood clots like DVT and PE. Most people take it as a once-daily tablet, though the starting dose for active clots is taken twice a day for three weeks.

Pradaxa

Pradaxa (dabigatran) is a direct thrombin inhibitor, a different type of blood thinner used to lower stroke risk in atrial fibrillation and to treat or prevent blood clots like DVT and PE. It is taken as a capsule twice a day and must be swallowed whole.

Xarelto vs. Pradaxa Side Effects

Xarelto

Most common
Major bleeding (3.6% per year)
Gastrointestinal bleeding (2.0% per year)
Pruritus (1% to 10%)
Rash (1% to 10%)

Pradaxa

Most common
Dyspepsia (up to 5%)
Epistaxis (up to 3.3%)
Nausea (up to 3.3%)
Menorrhagia (up to 2.8%)

Xarelto vs. Pradaxa Dosage

Xarelto

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 15 mg twice daily Days 1-21
Maximum dose 10 mg once daily If needed
Dose changes 3 increases Every 21 days

Pradaxa

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 110 mg on surgery day At the start
Maximum dose 75 mg twice daily If needed
Dose changes 3 increases As tolerated

Xarelto vs. Pradaxa Indications

Xarelto

Xarelto is FDA-approved to reduce the risk of stroke in people with nonvalvular atrial fibrillation and to treat active blood clots in the legs or lungs. It's also used to prevent clots from coming back after initial treatment and to prevent clots after hip or knee replacement surgery.

  • Reduce risk of stroke in nonvalvular atrial fibrillation

  • Treatment of deep vein thrombosis (DVT)

  • Treatment of pulmonary embolism (PE)

  • Reduce risk of DVT or PE recurrence

  • Prevent DVT after hip or knee replacement

Pradaxa

Pradaxa is FDA-approved to reduce the risk of stroke in people with nonvalvular atrial fibrillation and to treat blood clots in the legs or lungs after initial treatment with an injectable anticoagulant. It also reduces the chance of clots returning and prevents clots after hip replacement surgery.

  • Reduce risk of stroke in nonvalvular atrial fibrillation

  • Treatment of DVT or PE after initial injection

  • Reduce risk of DVT or PE recurrence

  • Prevent DVT or PE after hip replacement

  • Treat blood clots in children age 8 to 17

Xarelto vs. Pradaxa Pros and Cons

Xarelto

Xarelto fits into daily routines with once-daily dosing for most approved uses and no routine blood monitoring, and its FDA label covers more situations than Pradaxa's, including knee replacement prophylaxis and clot prevention in hospitalized medical patients. Its main tradeoff is a twice-daily start for active clot treatment and a food requirement at higher doses.

Pros

  • Once-daily dosing for most approved uses, versus Pradaxa's twice-daily schedule

  • Broader FDA label, including knee replacement prophylaxis and acutely ill patients

  • Available as an oral suspension for patients who cannot swallow pills

Cons

  • Requires twice-daily dosing for the first three weeks of clot treatment

  • Higher-dose tablets must be taken with food for full absorption

  • No pediatric oral tablet indication like Pradaxa's capsule

Pradaxa

Pradaxa requires twice-daily dosing for every approved use and its capsules must be swallowed whole and discarded four months after opening, which adds extra day-to-day steps. Its label is narrower than Xarelto's, excluding knee replacement prophylaxis and acutely ill medical patients, but it offers a pediatric option and its own dedicated bleeding reversal drug.

Pros

  • Has idarucizumab, a dedicated reversal agent for emergency bleeding

  • FDA-approved to treat blood clots in children ages 8 to 17

  • Not processed by liver enzymes, which may matter with liver disease

Cons

  • Twice-daily dosing for every approved use, with no once-daily option

  • Capsules must be swallowed whole and discarded four months after opening

  • Not approved for knee replacement prophylaxis or acutely ill medical patients

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