AVOID CONCOMITANT USE OF RIVAROXABAN WITH DRUGS THAT ARE COMBINED P-GP AND STRONG CYP3A4 INDUCERS (E.G., CARBAMAZEPINE, PHENYTOIN, RIFAMPIN, ST. JOHN'S WORT) SINCE THET DECREASE RIVAROXABAN EXPOSURE & EFFECT BY UP TO 50%.
AVOID CONCOMITANT ADMINISTRATION OF RIVAROXABAN WITH COMBINED P-GP AND STRONG CYP3A4 INHIBITORS LIKE KETOCONAZOLE, RITONAVIR, CLARITHROMYCIN, AND ERYTHROMYCIN) OR A MODERATE CYP3A4 INHIBITOR FLUCONAZOLE SINCE IT INCREASES RIVAROXABAN EXPOSURE AND PHARMACODYNAMIC EFFECTS (I.E., FACTOR XA INHIBITION AND PT PROLONGATION). THE INCREASES IN EXPOSURE RANGED FROM 30% TO 160% SIGNIFICANTLY INCREASING BLEEDING RISK.
SINGLE DOSES OF ENOXAPARIN AND RIVAROXABAN GIVEN CONCOMITANTLY RESULTED IN AN ADDITIVE EFFECT ON ANTI-FACTOR XA ACTIVITY. SINGLE DOSES OF WARFARIN AND RIVAROXABAN RESULTED IN AN ADDITIVE EFFECT ON FACTOR XA (FXA) INHIBITION AND PT. CONCOMITANT ASPIRIN USE HAS BEEN IDENTIFIED AS AN INDEPENDENT RISK FACTOR FOR MAJOR BLEEDING IN EFFICACY TRIALS. NSAIDS ARE KNOWN TO INCREASE BLEEDING, AND BLEEDING RISK MAY BE INCREASED WHEN NSAIDS ARE USED CONCOMITANTLY WITH RIVAROXABAN. COADMINISTRATION OF THE PLATELET AGGREGATION INHIBITOR CLOPIDOGREL AND RIVAROXABAN RESULTED IN AN INCREASE IN BLEEDING TIME FOR SOME SUBJECTS