Drug interactions
Prasugrel + Rivaroxaban
Severity: Major
Prasugrel 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
Prasugrel is a potent antiplatelet drug, and combining it with an anticoagulant markedly raises the risk of major bleeding. Triple therapy with prasugrel is generally discouraged.
What this interaction means in plain words
Prasugrel 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.
Prasugrel belongs to Cardiovascular; Rivaroxaban belongs to Cardiovascular.
Why it happens
Additive hemostatic impairment from P2Y12 platelet inhibition and factor Xa inhibition.
What to do
Avoid unless clearly indicated, and prefer clopidogrel as the P2Y12 inhibitor when an anticoagulant is needed. Monitor for bleeding and limit the duration of combined therapy.
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 Prasugrel
Frequently asked questions
Can I take Prasugrel with Rivaroxaban?
MediHelp rates the interaction as major. Prasugrel 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. Prasugrel is a potent antiplatelet drug, and combining it with an anticoagulant markedly raises the risk of major bleeding. Triple therapy with prasugrel is generally discouraged.
How serious is the interaction between Prasugrel 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 unless clearly indicated, and prefer clopidogrel as the P2Y12 inhibitor when an anticoagulant is needed. Monitor for bleeding and limit the duration of combined therapy.
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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