Herbal and Drug Interactions with Xarelto

Wednesday 13 May 2020
5 minute(s) read

Table of Contents

I. What is Xarelto?

II. HIV Drugs 

III. Herbal Supplements

IV. Other Medications 

V. Conclusion

What is Xarelto?

Xarelto is a popular blood thinner medication that is prescribed to millions of people in the United States. Blood-thinning medications are also known as anticoagulants or antiplatelets. These drugs prevent the formation of blood clots. Xarelto is an anticoagulant that works by inhibiting clotting factors in the blood, whereas antiplatelets inhibit the enzymes that cause the blood cells to clump together. [1]  

Preventing the formation of blood clots is crucial for many people with heart conditions and those at high risk of stroke. Blood thinners are taken in order to avoid heart attacks, strokes, deep vein thrombosis (DVT), and atrial fibrillation (irregular heartbeat). Xarelto, the brand name for rivaroxaban, is a factor Xa inhibitor. Rivaroxaban prevents blood clots by blocking factor Xa, which decreases the amount of thrombin in the body. Thrombin is an important substance in the blood that is needed to form clots. When thrombin is suppressed, blood clots are less likely to develop. 

an overturned pill bottle with white pills spilled on a wood table

If a clot does form in the blood vessel, it can break off from the arterial wall and travel to the heart, lungs, or brain and cause a serious medical event, such as a heart attack, stroke, or pulmonary embolism. Xarelto can prevent these conditions from occurring.


Get savings updates for Xarelto

Specials offers, medication updates and health news delivered right to your inbox.
By continuing, you agree to Canada Med Pharmacy Terms of Use and Privacy Policy

This drug can also be used in patients who have recently had hip or knee surgery. These surgeries can temporarily inhibit your mobility, which increases your risk of developing a blood clot. Many people need drugs like Xarelto as part of their everyday treatment plan, but it is vital to remain aware of any interactions involved with this drug. Read on to learn more about possible herbal and drug interactions with Xarelto. [2] 

HIV Drugs

There are around one million people in the United States with human immunodeficiency virus. HIV is a virus that attacks white blood cells that the body uses to fight infection. Treatment and testing have come a long way in the last few decades, so HIV is no longer the death sentence it once was. Over half of HIV patients were over 50 years old in 2015. 

Effective antiretroviral therapy keeps HIV patients healthy, but older HIV patients are still more susceptible to infections and other medical conditions. Older HIV patients are more likely to develop cardiovascular disease as well as liver and kidney disease. This increased risk makes it more likely for HIV patients to take antacids and blood thinners.

HIV patients need to be aware of interactions with Xarelto and antiretroviral medications. Research has found that many antiretroviral medications interact with rivaroxaban. When rivaroxaban and antiretroviral drugs mix, it can lower the efficiency of Xarelto and lead to increased risk of bleeding. [3] 

a hand bathed in red light with two pills in the palm

Herbal Supplements

Reportedly half of American adults have taken a dietary supplement in the last month. Research also suggests that only 34 percent of those people tell their doctors about their use of herbal supplements. It is vital to tell your doctor of any supplement you may take because herbs can interact with prescription medications, including drugs for cardiovascular disease. [4] 

Examples of supplements that may interact with Xarelto can include:

St John’s wort: Several studies have found that St. John’s wort interacts with several blood thinners and should be avoided in most cases. One study suggests that patients who take both rivaroxaban and St. John’s wort significantly reduce the amount of rivaroxaban in the system. This interaction decreases the potency and effectiveness of rivaroxaban. [5] 

Danshen: Danshen is also known as red sage. This herbal supplement is typically used in traditional medicine for heart-related problems such as angina, heart attack, and myocarditis. Taking this supplement may increase your risk of bleeding with Xarelto. [6]

Other Medications

In comparison with other blood thinners, Xarelto has fewer dangerous drug interactions. Unlike Warfarin, you do not have to avoid vitamin K-rich food or grapefruit. Still, it is essential to be cautious of Xarelto’s interactions with other drugs that may be necessary for your treatment plan. These drugs may include:  

Aspirin: Those who are trying to prevent heart attacks or stroke are often prescribed a combination treatment. This treatment involves anticoagulants (like Xarelto or Warfarin) and antiplatelets like aspirin. Aspirin is less strong than anticoagulants and is typically used preventively for those at risk for heart attacks. Aspirin works by interfering with the blood’s clotting ability and reduces the clumping action of platelets (blood cells). 

Like Xarelto, aspirin can increase your risk of bleeding. If you sustain an injury or cut, this drug combination may make it difficult to staunch bleeding, putting your life in danger. Aspirin may be available over-the-counter, but always consult your doctor before beginning an aspirin regimen. [7] 

a doctor talking to a patient who is lying in a hospital bed

Anti-Seizure drugs: Since Xarelto came out on the market, there have been some reports of interactions with anti-epileptic drugs. Anti-seizure or anti-epileptic drugs are linked with Xarelto because strokes can result in epilepsy. People with a history of strokes account for 30-40 percent of acquired epilepsy cases in the elderly. The combination of rivaroxaban and anti-seizure drugs can lead to incorrect absorption of the blood thinner. If the bloodstream does not correctly absorb Xarelto, then your risk of blood clots increases significantly. [8] 


Regardless of your medical condition, it is vital to disclose all medication and herbal supplements you take to your doctor. It may not seem important, but it can mean the difference between life and death if you are at risk for blood clots. Drugs like Xarelto have a lot of active and inactive ingredients, and your doctor will be able to tell you which medications will work with your Xarelto prescription. 

The content in this article is intended for informational purposes only. This website does not provide medical advice. In all circumstances, you should always seek the advice of your physician and/or other qualified health professionals(s) for drug, medical condition, or treatment advice. The content provided on this website is not a substitute for professional medical advice, diagnosis or treatment.


Get our newsletter

Health news and medication updates delivered right to your inbox.