Drug interactions
Rivaroxaban + Tolmetin
Severity: Major
Rivaroxaban and Tolmetin: 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
NSAIDs impair platelet function and can injure the gastric mucosa, so adding tolmetin to rivaroxaban increases the risk of clinically significant bleeding. Gastrointestinal haemorrhage is of particular concern.
What this interaction means in plain words
Rivaroxaban and Tolmetin 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; Tolmetin belongs to Musculoskeletal.
Why it happens
Additive pharmacodynamic effect: NSAID antiplatelet action and mucosal injury combine with factor Xa inhibition.
What to do
Avoid the combination where possible and use paracetamol or another alternative for pain. If an NSAID is unavoidable, use the shortest course, consider gastroprotection, and monitor for signs of bleeding and falling haemoglobin.
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 Tolmetin
- Ketorolac intranasal + Tolmetin Contraindicated
- Ketorolac + Tolmetin Contraindicated
- Aceclofenac + Tolmetin Major
- Acemetacin + Tolmetin Major
- Alteplase + Tolmetin Major
- Amlodipine-hydrochlorothiazide-valsartan + Tolmetin 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 Rivaroxaban with Tolmetin?
MediHelp rates the interaction as major. Rivaroxaban and Tolmetin 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. NSAIDs impair platelet function and can injure the gastric mucosa, so adding tolmetin to rivaroxaban increases the risk of clinically significant bleeding. Gastrointestinal haemorrhage is of particular concern.
How serious is the interaction between Rivaroxaban and Tolmetin?
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 where possible and use paracetamol or another alternative for pain. If an NSAID is unavoidable, use the shortest course, consider gastroprotection, and monitor for signs of bleeding and falling haemoglobin.
What other medicines interact with Tolmetin?
MediHelp also lists interactions of Tolmetin with, for example, Ketorolac intranasal, Ketorolac, Aceclofenac. The full list is on the Tolmetin page.
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