Rivaroxaban (Xarelto) interactions
Rivaroxaban (Xarelto) interacts with some medicines, but it doesn’t appear to interact with foods.
Tell your doctor about all the medicines you are taking
Rivaroxaban can interact with many different medicines so it is very important that you tell all your health professionals about all the medicines you are taking — including prescription, over-the-counter and complementary medicines (herbal, ‘natural’, and vitamin and mineral supplements). This is because all medicines, including herbal and natural medicines, can cause side effects and may interact with rivaroxaban.
Keep a list of all your medicines and take it with you when you visit the doctor or pharmacist.
What medicines interact with rivaroxaban?
Do not take rivaroxaban if you are taking the following medicines:
- medicines for HIV infection, such as lopinavir/ritonavir (Kaletra) and saquinavir (Invirase)
- medicines for fungal infections, such as oral ketoconazole (Nizoral), itraconazole (Sporanox), voriconazole (Vfend) and posaconazole (Noxafil).
Note: The antifungal fluconazole (e.g. Diflucan) does not need to be avoided completely, but your doctor may need to monitor you fairly closely to make sure you are not at an increased risk of bleeding. Tell your doctor if you are taking this medicine.
Other medicines can also interact with rivaroxaban, but you may not need to avoid them entirely. However, the doses may need to be changed or you may need to be monitored regularly.
Tell your doctor or pharmacist if you are taking:
- pain relief or anti-inflammatory medicines like aspirin (e.g. Aspro Clear, Disprin, Solprin), ibuprofen (e.g. Advil, Nurofen) and diclofenac (e.g. Fenac, Voltaren)
- other medicines used to prevent blood clots, such as warfarin (Coumadin, Marevan), enoxaparin (Clexane), dalteparin (Fragmin), clopidogrel (e.g. Plavix), dabigatran (Pradaxa), apixaban (Eliquis) and fondaparinux (Arixtra)
- medicines used to treat epilepsy, such as carbamazepine (e.g. Tegretol) and phenytoin (e.g. Dilantin)
- an antibiotic called rifampin or rifampicin (e.g. Rifadin)
- vitamin, herbal or complementary remedy (e.g. St John’s wort).
This is not a full list of all the medicines that can interact with rivaroxaban. For more information on interactions, see the rivaroxaban (Xarelto) Consumer Medicine Information (CMI), available on this website or from your pharmacist.
If you have any concerns about interactions, talk to your doctor. Do not change your dose or stop taking any of your medicines — unless advised by your doctor. They can advise you whether you need to adjust the dose of one medicine or avoid it all together.
Who can I ask about interactions?
People with questions about their medicines or seeking general information about side effects and interactions can call the NPS Medicines Line on 1300 633 424 (Monday–Friday, 9am–5pm AEST). To report possible side effects call the Adverse Medicine Events (AME) Line on 1300 134 237 from anywhere in Australia (Monday–Friday, 9am–5pm AEST).
Find out more about rivaroxaban
- Rossi S, ed. eAMH [online]. Australian Medicines Handbook, January 2013. www.amh.net.au (accessed June 2013).
- Cardiovascular Expert Group. Therapeutic guidelines: cardiovascular. Therapeutic Guidelines Ltd; 2013. www.tg.org.au (accessed June 2013).
- NPS Medicine Update, April 2010. Rivaroxaban (Xarelto) for preventing blood clots after hip or knee replacement surgery
- NPS Medicine Update, December 2012. Rivaroxaban (Xarelto) for preventing stroke in people with atrial fibrillation