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
Pradaxa
Xarelto vs. Pradaxa Dosage
Xarelto
Pradaxa
| 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 |
| 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
| 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
| 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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