Drug interactions
Rivaroxaban + St john's wort
Severity: Major
Rivaroxaban and St john's wort: 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
St John's wort lowers rivaroxaban concentrations and may cause loss of anticoagulant effect, with a risk of stroke or thromboembolism.
What this interaction means in plain words
Rivaroxaban and St john's wort 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 rivaroxaban clearance.
What to do
Avoid the combination and advise patients to stop St John's wort. Use an alternative anticoagulant if the herbal product must continue.
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 Rivaroxaban with St john's wort?
MediHelp rates the interaction as major. Rivaroxaban and St john's wort 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. St John's wort lowers rivaroxaban concentrations and may cause loss of anticoagulant effect, with a risk of stroke or thromboembolism.
How serious is the interaction between Rivaroxaban and St john's wort?
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 advise patients to stop St John's wort. Use an alternative anticoagulant if the herbal product must continue.
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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