Does Xarelto affect blood sugar levels? (3+ interactions)

This article will answer the question, “Does Xarelto affect blood sugar levels?”. We will also discuss the potential interactions between Xarelto and antidiabetic medications, along with the precautionary measures to follow while taking Xarelto. 

Does Xarelto affect blood sugar levels? 

No, Xarelto does not affect the blood sugar levels. However, antidiabetic medications such as gliclazide, metformin and pioglitazone may increase the plasma concentration of Xarelto by inhibiting P-glycoprotein and CYP3A4 enzyme, which is responsible for the metabolism of Xarelto. (1)

Xarelto is a direct oral anticoagulant (DOAC) that acts by inhibiting clotting factor Xa by binding to it reversibly, which prevents the process of coagulation and clot formation, thereby prolonging the clotting time. (2)

Xarelto is a blood-thinning agent that prevents blood clotting in the body. Xarelto is used to prevent stroke in patients with cardiac arrhythmia and atrial fibrillation, as prophylaxis and in the treatment of acute venous thromboembolism, prevention of coronary syndrome and in patients who have restricted mobility to avoid thrombotic events. (2)

What does the research suggest? 

Anticoagulant such as warfarin, when administered with sulfonylurea, is associated with a higher risk of hypoglycemia, which is not seen with the use of direct oral anticoagulants such as rivaroxaban, apixaban and dabigatran. (3)

A study by Liu et al. revealed that all three DOACs (dabigatran, apixaban and rivaroxaban) were associated with reduced risk of diabetes. The study finally concluded that DOACs can reduce the risk of diabetes in patients with atrial fibrillation and in patients who are at a higher risk of new-onset diabetes in both males and females. (4)

A meta-analysis demonstrated that DOACs were more effective in patients with diabetes mellitus and also showed a lower risk of bleeding with minimal drug interaction when compared to warfarin. (3)

What are the factors affecting glucose levels while taking Xarelto? 

Xarelto does not influence blood sugar levels directly. However, there are several factors which can influence glucose levels while taking Xarelto, such as: 

Underlying health condition: If you suffer from diabetes or pancreatitis, your blood sugar levels will rise. It is important to check glucose levels if you are at risk of having diabetes and get proper treatment. 

Diet and nutrition: The foods you consume play an important role in regulating blood glucose levels. If you have diabetes or are at risk, maintain a well-balanced diet with appropriate amounts of carbohydrates, proteins, and other nutrients.

Other medications: Some medications taken along with Xarelto can influence the level of glucose in the body. Corticosteroids and a few diuretics can fluctuate the levels of glucose in the body. Hence, it is important to consult a qualified physician before taking any medications. 

Liver damage: If your liver is not working properly, it may impact the metabolism of the drugs and glucose levels. 

High levels of glucose in the body can lead to life-threatening complications such as diabetic ketoacidosis, and very low levels of glucose can induce coma. Hence, it is important to get your glucose level tested upon every visit to your doctor. 

What are the things you should know while taking Xarelto? 

Xarelto is a blood thinning agent that helps prevent clot formation and blockage of the arteries. Xarelto is used to reduce the risk of stroke associated with thromboembolism (blockage of arteries), cardiac arrhythmia and atrial fibrillation to prevent any blockage in the arteries or veins, which can cut blood supply to a particular part of the body. (2)

Xarelto is typically prescribed once daily in the evening, although the dose of Xarelto may vary and can be prescribed twice daily. The dose of Xarelto ranges from 2.5mg to 20mg. Xarelto should be taken as prescribed by your physician. (2)

Do not stop taking the medication before completion of the treatment course because it can increase the risk of stroke and embolism, which can be life-threatening. If you missed a dose of Xarelto, take it as soon as you remember on the same day and avoid double dosing of the drug. 

If you are planning to undergo any invasive procedure which involves cuts on your skin or dental surgery, make sure you inform the respective physician about your anticoagulant therapy to avoid excessive bleeding. 

What are the precautionary measures to take while on Xarelto? 

It is important to follow certain measures while taking Xarelto to ensure its safe and effective use, such as:

  • Always take the medication as prescribed by your physician. 
  • Do not stop taking the medication without first consulting your physician. 
  • Do not take a double dose of Xarelto if you missed a dose on the same day.
  • Set up an alarm that can remind you to take your dose so that you don’t miss a dose of Xarelto. 
  • Xarelto comes with a risk of bleeding. Keep monitoring for any signs of bleeding, bruising, blood in stools, etc. 
  • If you notice blood in stools, vomiting, or easy bruising, make sure you consult your physician for a proper evaluation. 
  • Attend regular health check-ups to monitor your INR and blood glucose levels. 
  • Be cautious when engaging in any activities that involve the risk of cuts on the skin.
  • Avoid eating foods such as grapefruit, ginger, cinnamon, oats, etc., which can enhance the plasma concentration of Xarelto and increase the risk of bleeding. 
  • Avoid taking OTC medications such as NSAIDs (ibuprofen, naproxen) for pain and flu symptoms. Acetaminophen is a safer drug to take with Xarelto. 
  • Other drugs which can interact with Xarelto include antidepressants (sertraline, fluoxetine), antifungals (fluconazole, ketoconazole), herbal supplements (St John’s wort), etc.
  • Have a knowledge about the foods and drugs which can interact with Xarelto 

In my experience 

According to my knowledge, Xarelto does not influence blood sugar levels in the body. However, if you have diabetes and you take medications to control your blood glucose levels, some drugs may interact with antidiabetic medications and decrease their effectiveness, which can lead to an increase in blood sugar levels. It is recommended to monitor glucose levels every now and then if you have diabetes. 

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Abbasi MM, Valizadeh H, Hamishehkar H, Zakeri-Milani P. Inhibition of P-glycoprotein expression and function by anti-diabetic drugs gliclazide, metformin, and pioglitazone in vitro and in situ. Research in pharmaceutical sciences. 2016 May;11(3):177. Available from:,P%2Dgp%20expression%20in%20vitro. 


Singh R, Emmady PD. Rivaroxaban. [Updated 2023 Apr 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:



Alwafi H, Alotaibi B, Naser AY, Salawati E, Qadus S, Sweiss K, Dairi MS, Hassouneh L, Aldalameh Y, Samannodi M. The safety and efficacy of the use of oral anticoagulant medications in patients with diabetes mellitus: A systematic review. Saudi Pharmaceutical Journal. 2021 Dec 1;29(12):1374-82. Available from: 


Liu X, Feng S, Chen Z, Zhou Y, Yin K, Xue Z, Zhu W. Is the risk of diabetes lower in patients with atrial fibrillation treated with direct oral anticoagulant compared to warfarin?. Frontiers in Cardiovascular Medicine. 2022 May 19;9:874795. Available from:,warfarin.