Drug interactions
Bivalirudin + Rivaroxaban
Severity: Major
Bivalirudin 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
Bivalirudin is a parenteral direct thrombin inhibitor, and combining it with rivaroxaban gives additive anticoagulation and a higher risk of major bleeding. Overlap is normally limited to transitions of therapy or procedural settings.
What this interaction means in plain words
Bivalirudin 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.
Why it happens
Additive anticoagulation through direct thrombin inhibition and factor Xa inhibition.
What to do
Avoid concurrent use except for deliberate transitions, timing the switch according to each drug's half-life. Monitor closely for bleeding and check coagulation parameters and hemoglobin.
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?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Bivalirudin and Rivaroxaban, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 7 days on the web. No card needed.
References
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 Bivalirudin with Rivaroxaban?
MediHelp rates the interaction as major. Bivalirudin 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. Bivalirudin is a parenteral direct thrombin inhibitor, and combining it with rivaroxaban gives additive anticoagulation and a higher risk of major bleeding. Overlap is normally limited to transitions of therapy or procedural settings.
How serious is the interaction between Bivalirudin 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 concurrent use except for deliberate transitions, timing the switch according to each drug's half-life. Monitor closely for bleeding and check coagulation parameters and hemoglobin.
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.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
