Drug interactions
Atazanavir + Rivaroxaban
Severity: Major
Atazanavir 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
Atazanavir, a strong CYP3A4 inhibitor that is generally boosted with ritonavir or cobicistat, can raise rivaroxaban exposure considerably. Higher exposure increases the risk of bleeding.
What this interaction means in plain words
Atazanavir 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.
Atazanavir belongs to Anti Virals; Rivaroxaban belongs to Cardiovascular.
Why it happens
Inhibition of CYP3A4 and P-glycoprotein-mediated clearance of rivaroxaban.
What to do
Avoid the combination, as labeling advises against rivaroxaban with strong dual CYP3A4 and P-gp inhibitors. Use an alternative anticoagulant or antiretroviral and monitor for bleeding if it cannot be avoided.
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 Atazanavir
- Alfuzosin + Atazanavir Contraindicated
- Atazanavir + Avanafil Contraindicated
- Atazanavir + Dronedarone Contraindicated
- Atazanavir + Eletriptan Contraindicated
- Atazanavir + Eplerenone Contraindicated
- Atazanavir + Ergotamine Contraindicated
Frequently asked questions
Can I take Atazanavir with Rivaroxaban?
MediHelp rates the interaction as major. Atazanavir 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. Atazanavir, a strong CYP3A4 inhibitor that is generally boosted with ritonavir or cobicistat, can raise rivaroxaban exposure considerably. Higher exposure increases the risk of bleeding.
How serious is the interaction between Atazanavir 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: Avoid the combination, as labeling advises against rivaroxaban with strong dual CYP3A4 and P-gp inhibitors. Use an alternative anticoagulant or antiretroviral and monitor for bleeding if it cannot be avoided.
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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