Armodafinil is a mild inducer of CYP3A4, and rivaroxaban is a substrate of CYP3A4.Coadministration in patients with renal impairment may result in increased exposure to rivaroxaban compared with patients with normal renal function and no inhibitor use since both pathways of elimination are affected.The authors concluded that fish oil supplementation in doses of 3 to 6 grams per day does not have a statistically significant effect on the INR of patients receiving chronic warfarin therapy.Similar effects may be expected with concurrent conivaptan use.This eMedTV page examines some important dosing recommendations for this blood-thinning medicine.
Xarelto Bleeding Risks - Drug DangersVortioxetine: Platelet aggregation may be impaired by vortioxetine due to platelet serotonin depletion, possibly increasing the risk of a bleeding complication (e.g., gastrointestinal bleeding, ecchymoses, epistaxis, hematomas, petechiae, hemorrhage) in patients receiving anticoagulants.Bleeding events related to drugs that inhibit serotonin reuptake have ranged from ecchymosis to life-threatening hemorrhages.
Avoid coadministration of rivaroxaban and doxorubicin if possible.Intramuscular injections of other medications should not be administered to patients receiving dabigatran.Clopidogrel: Avoid concurrent administration of platelet inhibitors such as clopidogrel with rivaroxaban unless the benefit outweighs the risk of increased bleeding.
From low molecular weight heparin or non-warfarin oral anticoagulant to rivaroxaban.
Xarelto (rivaroxaban) dosing, indications, interactionsInhibitors and inducers of CYP450 enzymes or transporters (ex.Although these effects have not been confirmed in published medical literature or during clinical studies, clinicians should consider using methylsulfonylmethane, MSM with caution in patients who are taking anticoagulants such as warfarin until data confirming the safety of MSM in patients taking these drugs are available.In addition, both vilazodone and warfarin are highly protein bound, which may result in displacement of warfarin from protein binding sites and an increased anticoagulant effect.Mestranol is rapidly metabolized by demethylation to ethinyl estradiol, the biologically active form, up on absorption.It is not intended to be a substitute for the exercise of professional judgment.
Obstetric delivery, pregnancy Rivaroxaban is a FDA pregnancy category C drug.Rivaroxaban has been shown to be effective and safe in large trials on the prevention10 and treatment of venous thromboembolism,11 treatment of pulmo-.According to the manufacturer, rivaroxaban or breast-feeding should be discontinued because of the potential for serious adverse reactions in nursing infants from rivaroxaban and because many drugs are excreted in human milk.
After oral administration, 66% of the dose was recovered in urine (36% as unchanged drug and 30% as metabolites) and 28% was recovered in feces (7% as unchanged drug and 21% as metabolites).Similar effects may be expected with concurrent itraconazole use.
In healthy subjects, the relative bioavailability for AUC and Cmax of afatinib was 119% and 104%, respectively, when coadministered with ritonavir, and 111% and 105% when ritonavir was administered 6 hours after afatinib.Ibuprofen: An additive risk of bleeding may be seen in patients receiving anticoagulants in combination with other agents known to increase the risk of bleeding such as nonsteroidal antiinflammatory drugs (NSAIDs).Fosamprenavir: Coadministration of rivaroxaban and fosamprenavir may result in elevated fosamprenavir and altered rivaroxaban exposures, which may increase bleeding risk or decrease efficacy of rivaroxaban.If pharmacotherapy is necessary in the nursing mother, the American Academy of Pediatrics (AAP) considers warfarin to be usually compatible with breast-feeding.Avoid use of rivaroxaban with combined P-gp and strong CYP3A4 inhibitors, which cause significant increases in rivaroxaban exposure that may increase bleeding risk.If these drugs are administered concurrently, monitor the patient for signs and symptoms of bleeding and lack of efficacy.
Armodafinil: Coadministration of rivaroxaban and armodafinil may result in decreased rivaroxaban exposure and may decrease the efficacy of rivaroxaban.Coadministration of rivaroxaban and danazol may result in increases in rivaroxaban exposure and may also increase bleeding risk.Coadministration of rivaroxaban and ethanol may result in decreased rivaroxaban exposure and may decrease the efficacy of rivaroxaban.
Concurrent use of rivaroxaban and ketoconazole, another combined P-gp and strong CYP3A4 inhibitor, led to an increase in the steady-state rivaroxaban AUC by 160% and Cmax by 70%.If not possible, closely monitor for increased side effects of doxorubicin including myelosuppression and cardiotoxicity.Thus, patients receiving anticoagulation due to a history of these conditions are not candidates for prasterone treatment.Estrogens increase the production of clotting factors VII, VIII, IX, and X.Mefenamic Acid: An additive risk of bleeding may be seen in patients receiving anticoagulants in combination with other agents known to increase the risk of bleeding such as nonsteroidal antiinflammatory drugs (NSAIDs).Prasugrel: Avoid concurrent administration of platelet inhibitors such as clopidogrel with rivaroxaban unless the benefit outweighs the risk of increased bleeding.Nifedipine is a mild inhibitor of P-gp, and rivaroxaban is a substrate of P-gp.
If these medications are administered together, monitor for tenofovir-associated adverse reactions.Concurrent use of single-dose rivaroxaban and clarithromycin, a combined P-gp and strong CYP3A4 inhibitor, led to an increase in the rivaroxaban AUC by 50% and to an increase in Cmax by 40%.Co-administration of vortioxetine and warfarin has not been shown to significantly affect the pharmacokinetics of either agent.Vemurafenib: Coadministration of rivaroxaban and vemurafenib may result in increases or decreases in rivaroxaban exposure and may increase bleeding risk or decrease efficacy of rivaroxaban.The use of other procoagulant reversal agents like activated prothrombin complex concentrate (APCC) or recombinant factor VIIa (rFVIIa) has not been evaluated.Oxcarbazepine: Coadministration of rivaroxaban and oxcarbazepine may result in decreased rivaroxaban exposure and may decrease the efficacy of rivaroxaban.
Vilazodone: Patients should be instructed to monitor for signs and symptoms of bleeding while taking vilazodone concurrently with anticoagulants and to promptly report any bleeding events to the practitioner.Avoid concurrent administration of platelet inhibitors such as clopidogrel with rivaroxaban unless the benefit outweighs the risk of increased bleeding.However, in clinical trials with abciximab, aspirin and heparin were administered concomitantly.Absorption of rivaroxaban is dependent on the site of drug release in the GI tract.Consider the benefits and risks before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis.
Etodolac: An additive risk of bleeding may be seen in patients receiving anticoagulants in combination with other agents known to increase the risk of bleeding such as nonsteroidal antiinflammatory drugs (NSAIDs).Oral Route The absolute bioavailability of rivaroxaban is estimated to be 80% to 100% for the 10 mg dose and is not affected by food.The creatinine clearance threshold for which the Beers expert panel recommends avoiding use of rivaroxaban is based on clinical trial exclusion criteria and may not be the same as that in the product labeling.Sapropterin: Caution is advised with the concomitant use of sapropterin and rivaroxaban as coadministration may result in increased systemic exposure of rivaroxaban.Enteral feeding should immediately follow administration of a crushed 15 mg or 20 mg dose.Vemurafenib is an inducer of CYP3A4 and a mild inhibitor of P-gp.Theoretically, the risk of bleeding may be increased, but some studies that combined these agents did not produce clinically significant bleeding events.Collagenase: Cautious use of injectable collagenase by patients taking anticoagulants is advised.