Drug interactions
Naproxen + Rivaroxaban
Severity: Major
Naproxen and Rivaroxaban: major 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
Naproxen combined with rivaroxaban increases the risk of clinically significant bleeding, notably gastrointestinal bleeding. The risk comes from both the anticoagulant effect and NSAID platelet and mucosal effects.
What this interaction means in plain words
Naproxen 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.
Naproxen belongs to Musculoskeletal; Rivaroxaban belongs to Cardiovascular.
Why it happens
Additive hemostatic impairment: factor Xa inhibition plus NSAID platelet inhibition and gastric mucosal injury.
What to do
Avoid regular NSAID use in patients on rivaroxaban and prefer paracetamol for pain. If unavoidable, use the lowest dose briefly with gastroprotection and monitor for bleeding and anemia.
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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Other interactions of Naproxen
- Ketorolac intranasal + Naproxen Contraindicated
- Ketorolac + Naproxen Contraindicated
- Aceclofenac + Naproxen Major
- Acemetacin + Naproxen Major
- Acetylsalicylic acid + Naproxen Major
- Alteplase + Naproxen Major
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 Naproxen with Rivaroxaban?
MediHelp rates the interaction as major. Naproxen 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. Naproxen combined with rivaroxaban increases the risk of clinically significant bleeding, notably gastrointestinal bleeding. The risk comes from both the anticoagulant effect and NSAID platelet and mucosal effects.
How serious is the interaction between Naproxen 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 regular NSAID use in patients on rivaroxaban and prefer paracetamol for pain. If unavoidable, use the lowest dose briefly with gastroprotection and monitor for bleeding and anemia.
What other medicines interact with Naproxen?
MediHelp also lists interactions of Naproxen with, for example, Ketorolac intranasal, Ketorolac, Aceclofenac. The full list is on the Naproxen page.
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