Drug interactions
Itraconazole + Rivaroxaban
Severity: Major
Itraconazole 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
Itraconazole substantially increases rivaroxaban exposure and therefore bleeding risk. Combined strong CYP3A4 and P-glycoprotein inhibitors are not recommended with rivaroxaban.
What this interaction means in plain words
Itraconazole 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.
Itraconazole belongs to Anti Fungals; Rivaroxaban belongs to Cardiovascular.
Why it happens
Combined inhibition of CYP3A4 and P-glycoprotein reduces rivaroxaban clearance.
What to do
Avoid the combination and use an alternative antifungal or anticoagulant. If unavoidable, monitor closely for bleeding.
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 Itraconazole
- Alfuzosin + Itraconazole Contraindicated
- Alprazolam + Itraconazole Contraindicated
- Avanafil + Itraconazole Contraindicated
- Conivaptan + Itraconazole Contraindicated
- Dihydroergotamine intranasal + Itraconazole Contraindicated
- Dihydroergotamine + Itraconazole 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 Itraconazole with Rivaroxaban?
MediHelp rates the interaction as major. Itraconazole 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. Itraconazole substantially increases rivaroxaban exposure and therefore bleeding risk. Combined strong CYP3A4 and P-glycoprotein inhibitors are not recommended with rivaroxaban.
How serious is the interaction between Itraconazole 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 and use an alternative antifungal or anticoagulant. If unavoidable, monitor closely for bleeding.
What other medicines interact with Itraconazole?
MediHelp also lists interactions of Itraconazole with, for example, Alfuzosin, Alprazolam, Avanafil. The full list is on the Itraconazole page.
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