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Anticoagulant drug Xarelto (Rivaroxaban) for sale



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XARELTO (RIVAROXABAN) TABLETS: DRUG INTERACTIONS

General Inhibition and Induction Properties

Rivaroxaban (Xarelto) is a substrate of CYP3A4/5, CYP2J2, and the P-gp and ATPbinding cassette G2 (ABCG2) transporters. Combined P-gp and strong CYP3A4 inhibitors increase exposure to rivaroxaban and may increase the risk of bleeding. Combined P-gp and strong CYP3A4 inducers decrease exposure to rivaroxaban and may increase the risk of thromboembolic events.

Drugs that Inhibit Cytochrome P450 3A4 Enzymes and Drug Transport Systems

Interaction with Combined P-gp and Strong CYP3A4 Inhibitors

Avoid concomitant administration of Rivaroxaban (Xarelto) tablets with known combined P-gp and strong CYP3A4 inhibitors (e.g., ketoconazole and ritonavir).

Although clarithromycin is a combined P-gp and strong CYP3A4 inhibitor, pharmacokinetic data suggests that no precautions are necessary with concomitant administration with Xarelto as the change in exposure is unlikely to affect the bleeding risk.

Interaction with Combined P-gp and Moderate CYP3A4 Inhibitors in Patients with Renal Impairment

Xarelto (Rivaroxaban) should not be used in patients with CrCl 15 to < 80 mL/min who are receiving concomitant combined P-gp and moderate CYP3A4 inhibitors (e.g., erythromycin) unless the potential benefit justifies the potential risk.

Drugs that Induce Cytochrome P450 3A4 Enzymes and Drug Transport Systems

Avoid concomitant use of Xarelto with drugs that are combined P-gp and strong CYP3A4 inducers (e.g., phenytoin, carbamazepine, rifampin, St. John's wort).

Anticoagulants and NSAIDs/Aspirin

Coadministration of warfarin, enoxaparin, aspirin, clopidogrel and chronic NSAID use may increase the risk of bleeding.

Avoid concurrent use of Xarelto (Rivaroxaban) tablets with other anticoagulants due to increased bleeding risk unless benefit outweighs risk. Promptly evaluate any signs or symptoms of blood loss if patients are treated concomitantly with aspirin, other platelet aggregation inhibitors, or NSAIDs.

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