Taking Xarelto With Other Medicines

Xarelto Drug Interactions Explained

The following sections explain in detail the potentially negative interactions that can occur when Xarelto is combined with any of the drugs listed above.
 
CYP 3A4 Inducers
Xarelto is broken down (metabolized) by liver enzymes known as CYP 3A4 enzymes. Medications known as CYP 3A4 inducers speed up the activity of these enzymes, lowering the level of Xarelto in the body and decreasing its effectiveness. Check with your healthcare provider before combining Xarelto with one of these drugs.
 
There is a subset of CYP 3A4 inducers that also speed up the activity of P-glycoprotein (an enzyme that helps remove Xarelto from the tissues in the body). If you must take these drugs with Xarelto, an increased Xarelto dosage may be necessary. In general, these medications should not be combined with Xarelto. These medications include carbamazepine, rifampin, phenytoin, and St. John's wort.
 
CYP 3A4 Inhibitors
Xarelto is broken down (metabolized) by liver enzymes known as CYP 3A4 enzymes. Medications known as CYP 3A4 inhibitors slow down the activity of these enzymes, increasing the level of Xarelto in the body and increasing the risk for bleeding. Check with your healthcare provider before combining Xarelto with one of these drugs. This is important for everyone, but is especially important for people with kidney disease, as studies suggest that this interaction may be even more significant for such individuals.
 
There is a subset of CYP 3A4 inhibitors that also slow down the activity of P-glycoprotein (an enzyme that helps remove Xarelto from the tissues in the body). In general, these medications should not be combined with Xarelto. These medications include ketoconazole, itraconazole, lopinavir/ritonavir, ritonavir, and conivaptan.
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Xarelto Drug Information

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