Drug interactions
Phenobarbital + Rivaroxaban
Severity: Major
Phenobarbital 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
Phenobarbital induces CYP3A4 and P-glycoprotein and may lower rivaroxaban exposure, risking loss of anticoagulant protection and thrombosis or stroke.
What this interaction means in plain words
Phenobarbital 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.
Why it happens
Induction of CYP3A4 and P-glycoprotein increases clearance of rivaroxaban.
What to do
Avoid combined use where possible and consider a different anticonvulsant or anticoagulant such as warfarin with INR monitoring. If unavoidable, monitor for thromboembolic events.
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 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 Phenobarbital with Rivaroxaban?
MediHelp rates the interaction as major. Phenobarbital 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. Phenobarbital induces CYP3A4 and P-glycoprotein and may lower rivaroxaban exposure, risking loss of anticoagulant protection and thrombosis or stroke.
How serious is the interaction between Phenobarbital 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 combined use where possible and consider a different anticonvulsant or anticoagulant such as warfarin with INR monitoring. If unavoidable, monitor for thromboembolic events.
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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