Drug interactions
Azithromycin + Rivaroxaban
Severity: Moderate
Azithromycin and Rivaroxaban: moderate interaction.
Last updated
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
Azithromycin may modestly increase rivaroxaban exposure through P-glycoprotein inhibition, which could raise bleeding risk. The effect is more relevant in patients with renal impairment, in whom both elimination pathways are already reduced.
What this interaction means in plain words
Azithromycin and Rivaroxaban can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Azithromycin belongs to Anti Bacterial; Rivaroxaban belongs to Cardiovascular.
Why it happens
Possible inhibition of P-glycoprotein efflux of rivaroxaban, with a minor effect on CYP3A4.
What to do
Monitor for signs of bleeding during the antibiotic course, particularly in patients with renal impairment. Reassess the need for the combination if creatinine clearance is reduced.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Azithromycin
- Azithromycin + Cisapride Contraindicated
- Azithromycin + Domperidone Contraindicated
- Azithromycin + Dronedarone Contraindicated
- Azithromycin + Pimozide Contraindicated
- Azithromycin + Piperaquine Contraindicated
- Azithromycin + Thioridazine Contraindicated
Other interactions of Rivaroxaban
- Defibrotide + Rivaroxaban Contraindicated
- Ketoconazole + Rivaroxaban Contraindicated
- Ketorolac + Rivaroxaban Contraindicated
- Abciximab + Rivaroxaban Major
- Acalabrutinib + Rivaroxaban Major
- Acetylsalicylic acid + Rivaroxaban Major
Frequently asked questions
Can I take Azithromycin with Rivaroxaban?
MediHelp rates the interaction as moderate. Azithromycin and Rivaroxaban can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Azithromycin may modestly increase rivaroxaban exposure through P-glycoprotein inhibition, which could raise bleeding risk. The effect is more relevant in patients with renal impairment, in whom both elimination pathways are already reduced.
How serious is the interaction between Azithromycin and Rivaroxaban?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for signs of bleeding during the antibiotic course, particularly in patients with renal impairment. Reassess the need for the combination if creatinine clearance is reduced.
What other medicines interact with Azithromycin?
MediHelp also lists interactions of Azithromycin with, for example, Cisapride, Domperidone, Dronedarone. The full list is on the Azithromycin page.
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