Table of Contents

I. Drug Interactions With Xarelto

II. Xarelto Interactions With Supplements

III. HIV Drugs

IV. The Consensus on Xarelto Interactions

V. FAQ: What Should I Check Before Taking Supplements or Other Medications With Xarelto?

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.

Drug Interactions With Xarelto

In comparison with other anticoagulants, Xarelto has fewer dangerous drug interactions. Unlike warfarin, you do not have to avoid vitamin K-rich foods. [1] 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: For some adults with coronary artery disease or peripheral artery disease, Xarelto may be prescribed with low-dose aspirin to reduce the risk of serious cardiovascular events. However, taking aspirin with Xarelto can increase the risk of bleeding. This combination should only be used when prescribed by a doctor. Although aspirin is available over the counter, do not start taking it while using Xarelto without speaking with your doctor. Seek medical help for severe bleeding, bleeding that will not stop, red or black stools, blood in the urine, coughing or vomiting blood, dizziness, or weakness. [2]
• Anti-seizure drugs: Some anti-seizure medications may interact with Xarelto and reduce how well the blood thinner works. Certain medications can increase the activity of enzymes and transport proteins that help process Xarelto. This may lower the amount of Xarelto in the body. Tell your doctor about any seizure medications you take before starting Xarelto. [3]

Xarelto Interactions With Supplements

It is vital to tell your doctor about any supplement you may take because herbs can interact with prescription medications, including drugs for cardiovascular disease. Examples of supplements that may interact with Xarelto can include:

• St John’s wort: St. John’s wort is an herbal supplement that can affect how the body processes Xarelto. It increases the activity of P-glycoprotein and CYP3A, which can lower the amount of rivaroxaban in the bloodstream. This may make Xarelto less effective and increase the risk of a blood clot. [2]
• Danshen: Danshen is an herbal medicine sometimes used for heart and blood vessel conditions. Researchers suggested that certain components of Danshen may inhibit CYP3A and CYP2J enzymes, which help the body process rivaroxaban. This interaction could cause rivaroxaban to remain in the body longer and may increase the risk of side effects, including bleeding. [4]

HIV Drugs

Some HIV medications can affect how Xarelto works in the body. Certain drugs may increase rivaroxaban levels and raise the risk of bleeding, while others may lower its levels and make it less effective at preventing or treating blood clots. [5]

Not every HIV medication is expected to cause a significant interaction. However, patients should give their doctor and pharmacist a complete list of their medications before taking Xarelto. In some cases, a different HIV treatment or anticoagulant may be recommended. [5]

The Consensus on Xarelto Interactions

Regardless of why you are taking Xarelto, tell your doctor and pharmacist about every prescription medication, over-the-counter drug, vitamin, and herbal supplement you use. Some substances can raise the amount of rivaroxaban in your body and increase your risk of bleeding, while others can lower its concentration and make it less effective at preventing blood clots. 

FAQ: What Should I Check Before Taking Supplements or Other Medications With Xarelto?

Before taking any new supplement, over-the-counter product, or prescription medication with Xarelto, check with your doctor or pharmacist first. Even though Xarelto has fewer restrictions than some older blood thinners, certain drugs and herbs can still affect how it works. Some can increase the amount of rivaroxaban in your body and raise your bleeding risk, while others can lower its levels and make it less effective at preventing blood clots.

This is especially important with aspirin, anti-seizure medications, St. John’s wort, Danshen, and some HIV medications. Aspirin may increase bleeding risk, St. John’s wort may make Xarelto less effective, and some HIV medications may either raise or lower rivaroxaban levels. Natural products should be treated like medications because they can still cause interactions.

Before adding anything new while taking Xarelto:

1. Ask your doctor or pharmacist before starting a prescription medication, supplement, herbal product, or over-the-counter medication.
2. Do not start aspirin unless your doctor specifically recommends it.
3. Avoid St. John’s wort unless your doctor says it is safe.
4. Ask about possible interactions if you take HIV medications.
5. Watch for warning signs such as unusual bruising, bleeding that will not stop, red or black stools, blood in the urine, coughing or vomiting blood, dizziness, or weakness.

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.