Fluorouracil, 5-FU: An additive risk of bleeding may be seen in thrombocytopenic patients receiving antineoplastic agents and anticoagulants concomitantly.However, coadministration of rivaroxaban and topiramate may result in decreased rivaroxaban exposure and may decrease the efficacy of rivaroxaban.Tipranavir is a potent inhibitor CYP3A4 and mild inducer of P-gp, and rivaroxaban is a substrate of CYP3A4 and P-gp.After a 3-day oral aprepitant regimen, the AUC of midazolam (given on days 1, 4, 8, and 15) increased by 25% on day 4, and then decreased by 19% and 4% on days 8 and 15, respectively.Plasma concentrations and efficacy of rivaroxaban may be reduced if these drugs are administered concurrently.Agents which may lead to an increased incidence of bleeding in patients with thrombocytopenia include anticoagulants.Because omega-3 fatty acids inhibit platelet aggregation, caution is advised when icosapent ethyl is used concurrently with anticoagulants, platelet inhibitors, or thrombolytic agents.Animal studies show risk and human studies not available or neither animal nor human studies done.
Felbamate: Coadministration of rivaroxaban and felbamate may result in decreased rivaroxaban exposure and may decrease the efficacy of rivaroxaban.Indicated for prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE) in patients undergoing knee or hip replacement surgery.Vilazodone: Patients should be instructed to monitor for signs and symptoms of bleeding while taking vilazodone concurrently with anticoagulants and to promptly report any bleeding events to the practitioner.
DHEA is converted to androgens and estrogens within the human body and thus may affect hemostasis via androgenic or estrogenic effects.Azithromycin is a combined mild CYP3A4 inhibitor and P-glycoprotein (P-gp) inhibitor.The risk of bleeding should be weighed against the risk of thrombotic events in deciding whether to initiate rivaroxaban therapy in patients at increased risk of bleeding.
Testosterone is an inhibitor of P-gp, and rivaroxaban is a substrate of P-gp.AUC: 29-56% decrease when released in proximal small intestine compared with gastric absorption.Sapropterin: Caution is advised with the concomitant use of sapropterin and rivaroxaban as coadministration may result in increased systemic exposure of rivaroxaban.
Rivaroxaban Better Than Warfarin for Preventing Recurrent VTE.The change in bleeding time was approximately twice the maximum increase seen with either drug alone.
Felodipine is a combined mild CYP3A4 inhibitor and P-glycoprotein (P-gp) inhibitor.Similar effects may be expected with concurrent itraconazole use.
Monitor INR levels when venlafaxine is added to or discontinued from warfarin therapy.Not recommended acutely as an alternative to unfractionated heparin in patients with pulmonary embolism who present with hemodynamic instability or who may receive thrombolysis or pulmonary embolectomy.Patients who choose to consume methylsulfonylmethane, MSM while receiving warfarin should be observed for increased bleeding.If these medications are administered together, monitor for tenofovir-associated adverse reactions.Ticagrelor is a combined mild CYP3A4 inhibitor and mild P-glycoprotein (P-gp) inhibitor.
Avoid concurrent use of herbs which interact with warfarin when possible.If anticoagulation must be discontinued to reduce the risk of bleeding with surgical or other procedures, discontinue rivaroxaban at least 24 hours before the procedure.Aminosalicylate sodium, Aminosalicylic acid: Salicylates such as aspirin are known to increase bleeding, and bleeding risk may be increased when these drugs are used concomitantly with rivaroxaban.If used concurrently, monitor patients closely for bleeding at the IM injection site.In a single-dose drug interaction study, no pharmacokinetic or pharmacodynamic interactions were observed after concomitant administration of naproxen or acetylsalicylic acid with rivaroxaban.Lapatinib is a combined CYP3A4 and P-glycoprotein (P-gp) inhibitor.Boceprevir is a combined mild P-gp inhibitor and strong CYP3A4 inhibitor.Animal reproduction studies showed no increased risk of structural malformations but showed increased post-implantation pregnancy loss in rabbits.
Approximately 30% of patients in the second study had the event.Print this section Print the entire contents of Close Dosing Calculator.Incidence of adverse effects was found not to differ significantly from that of enoxaparin.Tolvaptan is an inhibitor of P-gp (potency unknown), and rivaroxaban is a substrate of P-gp.