Drug interactions
Clopidogrel + Rivaroxaban
Severity: Major
Clopidogrel 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
Adding clopidogrel to rivaroxaban increases the risk of major and minor bleeding compared with rivaroxaban alone. The combination is used in some patients with atrial fibrillation and coronary stenting, but the bleeding cost is real.
What this interaction means in plain words
Clopidogrel 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.
Clopidogrel belongs to Cardiovascular; Rivaroxaban belongs to Cardiovascular.
Why it happens
Additive hemostatic effects from irreversible P2Y12 inhibition and factor Xa inhibition.
What to do
Combine only when clearly indicated, use the lowest effective rivaroxaban dose, and limit duration. Monitor for bleeding and consider a proton pump inhibitor.
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 Clopidogrel
Frequently asked questions
Can I take Clopidogrel with Rivaroxaban?
MediHelp rates the interaction as major. Clopidogrel 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. Adding clopidogrel to rivaroxaban increases the risk of major and minor bleeding compared with rivaroxaban alone. The combination is used in some patients with atrial fibrillation and coronary stenting, but the bleeding cost is real.
How serious is the interaction between Clopidogrel 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: Combine only when clearly indicated, use the lowest effective rivaroxaban dose, and limit duration. Monitor for bleeding and consider a proton pump inhibitor.
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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