Drug interactions
Apixaban + Rivaroxaban
Severity: Major
Apixaban and Rivaroxaban: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
These are both direct factor Xa inhibitors, so taking them together duplicates therapy. The anticoagulant effect is additive and the risk of major bleeding rises with no added benefit.
What this interaction means in plain words
Apixaban and Rivaroxaban can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Apixaban belongs to Cardiovascular; Rivaroxaban belongs to Cardiovascular.
Why it happens
Duplicate direct factor Xa inhibition causing additive anticoagulation.
What to do
Do not use together; prescribe a single oral anticoagulant. When switching, start the new drug when the next dose of the other is due.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Rivaroxaban
- Defibrotide + Rivaroxaban Contraindicated
- Ketoconazole + Rivaroxaban Contraindicated
- Ketorolac + Rivaroxaban Contraindicated
- Abciximab + Rivaroxaban Major
- Acalabrutinib + Rivaroxaban Major
- Acetylsalicylic acid + Rivaroxaban Major
Other interactions of Apixaban
- Apixaban + Dabigatran Contraindicated
- Apixaban + Defibrotide Contraindicated
- Apixaban + Edoxaban Contraindicated
- Apixaban + Ketorolac Contraindicated
- Apixaban + Mifepristone Contraindicated
- Abciximab + Apixaban Major
Frequently asked questions
Can I take Apixaban with Rivaroxaban?
MediHelp rates the interaction as major. Apixaban and Rivaroxaban can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. These are both direct factor Xa inhibitors, so taking them together duplicates therapy. The anticoagulant effect is additive and the risk of major bleeding rises with no added benefit.
How serious is the interaction between Apixaban and Rivaroxaban?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Do not use together; prescribe a single oral anticoagulant. When switching, start the new drug when the next dose of the other is due.
What other medicines interact with Rivaroxaban?
MediHelp also lists interactions of Rivaroxaban with, for example, Defibrotide, Ketoconazole, Ketorolac. The full list is on the Rivaroxaban page.
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