Drug interactions
Efavirenz + Rivaroxaban
Severity: Moderate
Efavirenz 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
Efavirenz may reduce rivaroxaban exposure through CYP3A4 and P-gp induction, which could lower anticoagulant efficacy and raise thrombosis risk. Labeling advises caution with combined strong inducers.
What this interaction means in plain words
Efavirenz 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.
Efavirenz belongs to Anti Virals; Rivaroxaban belongs to Cardiovascular.
Why it happens
Efavirenz induces CYP3A4 and possibly P-glycoprotein, increasing rivaroxaban clearance.
What to do
Monitor for signs of thrombosis and consider an alternative anticoagulant such as dose-adjusted LMWH or warfarin with INR monitoring if efficacy is a concern.
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 Efavirenz
- Cobimetinib + Efavirenz Contraindicated
- Dienogest / estradiol valerate + Efavirenz Contraindicated
- Dihydroergotamine intranasal + Efavirenz Contraindicated
- Dihydroergotamine + Efavirenz Contraindicated
- Doravirine + Efavirenz Contraindicated
- Efavirenz + Elbasvir / grazoprevir 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 Efavirenz with Rivaroxaban?
MediHelp rates the interaction as moderate. Efavirenz 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. Efavirenz may reduce rivaroxaban exposure through CYP3A4 and P-gp induction, which could lower anticoagulant efficacy and raise thrombosis risk. Labeling advises caution with combined strong inducers.
How serious is the interaction between Efavirenz 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 thrombosis and consider an alternative anticoagulant such as dose-adjusted LMWH or warfarin with INR monitoring if efficacy is a concern.
What other medicines interact with Efavirenz?
MediHelp also lists interactions of Efavirenz with, for example, Cobimetinib, Dienogest / estradiol valerate, Dihydroergotamine intranasal. The full list is on the Efavirenz page.
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