Does Xarelto Cause Muscle Weakness? Understanding the Risks and Symptoms

October 8, 2025 •

3 min read

While not a primary side effect, muscle weakness can be a symptom associated with taking the anticoagulant medication Xarelto. It is particularly concerning when it occurs in the legs and feet, especially following a spinal procedure, as it can indicate a serious complication like a spinal or epidural hematoma.

Quick Summary

Muscle weakness is a potential symptom associated with Xarelto, often linked to rare but serious complications like internal bleeding or spinal hematomas. Back pain, spasms, and fatigue are also reported side effects. Patients should know the signs and seek medical advice for any new or worsening symptoms.

Key Points

Muscle weakness is a potential sign of serious complication: Muscle weakness, particularly in the legs, while on Xarelto can signal a rare but serious issue like a spinal hematoma.
High risk with spinal procedures: The risk of severe complications, including muscle weakness and potential paralysis, is elevated following spinal anesthesia, punctures, or epidural injections.
Spinal hematoma is a medical emergency: If muscle weakness is accompanied by back pain, numbness, tingling, or loss of bladder/bowel control, seek immediate medical care.
Fatigue is a more common side effect: General fatigue or low energy levels are reported more frequently than localized muscle weakness but are typically less severe.
Other musculoskeletal issues exist: Less severe but more common side effects include muscle spasms and back pain, which can often be managed with medical guidance.
Never stop Xarelto abruptly: Abruptly discontinuing Xarelto increases the risk of blood clots and stroke; always consult your doctor.

Xarelto and Musculoskeletal Side Effects

Xarelto (rivaroxaban) is a powerful anticoagulant medication prescribed to prevent blood clots in conditions such as atrial fibrillation, deep vein thrombosis (DVT), and pulmonary embolism (PE). While it is highly effective for these purposes, patients must be aware of its potential side effects. Muscle weakness, while not a very common adverse effect reported in general clinical use, is a significant symptom to monitor, especially when combined with other neurological signs. The most critical association is with spinal or epidural hematoma, a rare but life-threatening complication.

The Link Between Xarelto, Muscle Weakness, and Spinal Hematomas

One of the most serious risks associated with Xarelto is the formation of a spinal or epidural hematoma, a buildup of blood around the spine. This risk is heightened for patients who undergo spinal anesthesia, a spinal puncture (spinal tap), or have an epidural catheter placed while on the medication. A spinal hematoma can compress the spinal cord, potentially leading to long-lasting or even permanent paralysis. Muscle weakness, specifically in the legs and feet, is a key indicator of this severe condition.

If muscle weakness occurs alongside other symptoms, it warrants immediate medical attention. The US Food and Drug Administration (FDA) has issued a boxed warning for Xarelto regarding this risk, emphasizing the need for prompt evaluation if such symptoms arise.

Other Related Muscular Symptoms

Beyond the potential link to spinal complications, Xarelto can cause other, less severe musculoskeletal side effects. Clinical studies and post-marketing reports have indicated the following:

Muscle Spasms: In some trials, muscle spasms were reported by patients taking Xarelto. These involuntary muscle tightenings are not uncommon and are generally manageable.
Back Pain: Back pain is a more frequently reported side effect than muscle weakness, occurring in some patients during clinical studies. While often mild, back pain combined with other neurological symptoms could signal a more serious issue and should not be ignored.
Fatigue: Many patients on Xarelto report fatigue or a general lack of energy. This feeling of tiredness can sometimes be confused with or contribute to a perceived sense of overall muscle weakness. Unlike the specific muscle weakness that can signal a spinal hematoma, general fatigue is a more common and typically less severe side effect.

Differentiating Symptoms: Weakness vs. Fatigue

It is important for patients to distinguish between general fatigue and localized muscle weakness. General fatigue is a widespread feeling of being tired or lacking energy. Muscle weakness is a reduction in the power of muscles, specifically when attempting to perform an action. It is often localized to a specific area, such as the legs.

What to Do If You Experience Muscle Weakness on Xarelto

If you develop muscle weakness while taking Xarelto, especially in your legs and feet, or if it is accompanied by other symptoms like back pain, tingling, numbness, or loss of bladder/bowel control, you should seek immediate medical attention. Do not stop taking Xarelto on your own, as this can increase your risk of a blood clot or stroke. Your healthcare provider needs to evaluate the cause of the symptoms and determine the appropriate course of action.

Comparison of Muscle Symptoms Associated with Xarelto


Symptom	Severity	Commonality	Key Associated Symptoms	What to Do	Potential Cause
Muscle Weakness (especially legs)	Potentially Severe	Uncommon	Back pain, numbness, tingling, incontinence	Seek IMMEDIATE medical attention.	Spinal or epidural hematoma, internal bleeding
Muscle Spasms	Mild to Moderate	Less Common	Pain, cramping	Consult doctor if bothersome.	Medication side effect
Back Pain	Mild to Moderate	More Common	Localized soreness	Can often be managed at home, but report if severe or accompanied by other neurological symptoms.	Medication side effect, possible spinal hematoma
Fatigue	Mild to Moderate	Fairly Common	Low energy, tiredness	Talk to doctor about management.	Medication side effect, anemia from bleeding

Conclusion

While the answer to "Does Xarelto cause muscle weakness?" is yes, it's a critical symptom rather than a mild inconvenience. The primary concern is the potential link between localized muscle weakness and a spinal hematoma, especially following spinal procedures. Other, less serious musculoskeletal issues like back pain and muscle spasms have also been reported, as has general fatigue. Patients taking Xarelto should be vigilant in monitoring their symptoms and, most importantly, should seek immediate medical help if they experience muscle weakness, especially in the lower body, accompanied by any other neurological signs. Timely recognition and communication with a healthcare provider can prevent potentially severe, life-altering complications. For further information on rivaroxaban side effects, consider visiting the authoritative MedlinePlus Rivaroxaban Information page.

Frequently Asked Questions

Yes, muscle spasms and back pain have been reported as side effects of Xarelto. Pain in the extremities has also been noted in some clinical studies. While often mild, any new or worsening muscle or joint pain should be discussed with a healthcare provider.

You should be immediately concerned and seek medical help if muscle weakness appears suddenly, especially in your legs and feet, or if it is accompanied by severe back pain, numbness, tingling, or any loss of bladder or bowel control.

No, significant muscle weakness is not a common side effect of Xarelto during general use. However, its occurrence can be a serious warning sign, particularly in patients who have recently had spinal or epidural procedures.

Fatigue is a general feeling of tiredness and low energy. Serious muscle weakness, on the other hand, is a specific reduction in muscle strength, often localized to the legs and feet, and may be accompanied by numbness or tingling. If you can't differentiate, or if symptoms are concerning, contact your doctor.

Treatment for muscle weakness on Xarelto depends entirely on its cause. If it is related to a serious complication like a spinal hematoma, immediate intervention is required. Less serious muscular issues can sometimes be managed with physical therapy or a discussion with your doctor about your medication.

You should not take nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen for muscle pain while on Xarelto without first consulting your doctor. These medications can increase the risk of bleeding.

While general side effects like bleeding can be more prevalent in older adults, muscle weakness is more of a risk in the context of specific procedures rather than age alone. However, older patients may face greater challenges with mobility and should be carefully monitored.