Drug interactions
Rivaroxaban + Ticagrelor
Severity: Major
Rivaroxaban and Ticagrelor: 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
Ticagrelor is a potent antiplatelet agent and combined with rivaroxaban substantially increases the risk of major bleeding. The combination is used deliberately in some acute coronary syndrome or vascular settings but requires careful selection.
What this interaction means in plain words
Rivaroxaban and Ticagrelor 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.
Rivaroxaban belongs to Cardiovascular; Ticagrelor belongs to Cardiovascular.
Why it happens
Additive pharmacodynamic effect from P2Y12 platelet inhibition together with factor Xa inhibition.
What to do
Use only where there is a clear indication, at the lowest effective rivaroxaban dose and for the shortest duration. Monitor for bleeding and consider gastroprotection.
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
Other interactions of Ticagrelor
- Itraconazole + Ticagrelor Contraindicated
- Ketoconazole + Ticagrelor Contraindicated
- Levoketoconazole + Ticagrelor Contraindicated
- Abciximab + Ticagrelor Major
- Abrocitinib + Ticagrelor Major
- Acalabrutinib + Ticagrelor Major
Frequently asked questions
Can I take Rivaroxaban with Ticagrelor?
MediHelp rates the interaction as major. Rivaroxaban and Ticagrelor 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. Ticagrelor is a potent antiplatelet agent and combined with rivaroxaban substantially increases the risk of major bleeding. The combination is used deliberately in some acute coronary syndrome or vascular settings but requires careful selection.
How serious is the interaction between Rivaroxaban and Ticagrelor?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use only where there is a clear indication, at the lowest effective rivaroxaban dose and for the shortest duration. Monitor for bleeding and consider gastroprotection.
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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