Drug interactions
Lopinavir + Rivaroxaban
Severity: Major
Lopinavir 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
Lopinavir, which is co-formulated with ritonavir, raises rivaroxaban exposure considerably. This increases the risk of serious bleeding.
What this interaction means in plain words
Lopinavir 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.
Lopinavir belongs to Anti Virals; Rivaroxaban belongs to Cardiovascular.
Why it happens
Ritonavir-boosted lopinavir inhibits CYP3A4 and P-glycoprotein, reducing rivaroxaban clearance.
What to do
Avoid the combination and choose an alternative anticoagulant or antiretroviral. If it cannot be avoided, 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 Rivaroxaban
- Defibrotide + Rivaroxaban Contraindicated
- Ketoconazole + Rivaroxaban Contraindicated
- Ketorolac + Rivaroxaban Contraindicated
- Abciximab + Rivaroxaban Major
- Acalabrutinib + Rivaroxaban Major
- Acetylsalicylic acid + Rivaroxaban Major
Other interactions of Lopinavir
- Alfuzosin + Lopinavir Contraindicated
- Avanafil + Lopinavir Contraindicated
- Cisapride + Lopinavir Contraindicated
- Dronedarone + Lopinavir Contraindicated
- Eletriptan + Lopinavir Contraindicated
- Eplerenone + Lopinavir Contraindicated
Frequently asked questions
Can I take Lopinavir with Rivaroxaban?
MediHelp rates the interaction as major. Lopinavir 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. Lopinavir, which is co-formulated with ritonavir, raises rivaroxaban exposure considerably. This increases the risk of serious bleeding.
How serious is the interaction between Lopinavir 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 choose an alternative anticoagulant or antiretroviral. If it cannot be avoided, monitor closely for bleeding.
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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