Rivaroxaban/Clarithromycin; Erythromycin; Verapamil Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Serious. These medicines may interact and cause very harmful effects. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

Some medicines may slow down how quickly your body processes rivaroxaban.

What might happen:

The amount of rivaroxaban in your blood may increase, which may increase your risk of bleeding, including bleeding from your gums, nosebleeds, unusual bruising, or dark stools.

What you should do about this interaction:

Let your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together. If you have any signs of bleeding, such as bleeding from your gums, nosebleeds, unusual bruising, or dark stools, contact your doctor right away.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

  • 1.Xarelto (rivaroxaban) US prescribing information. Janssen Pharmaceuticals, Inc. March, 2020.
  • 2.Xarelto (rivaroxaban) UK summary of product characteristics. Bayer plc August, 2021.
  • 3.Xarelto (rivaroxaban) Canadian prescribing information. Bayer July 20, 2015.
  • 4.US Food and Drug Administration (FDA). Drug Development and Drug Interactions: Table of Substrates, Inhibitors and Inducers. Available at: https://www.fda.gov/drugs/drug-interactions-labeling/drug-development-and- drug-interactions-table-substrates-inhibitors-and-inducers. Updated 11/14/2017.
  • 5.This information is based on an extract from the Certara Drug Interaction Database (DIDB) Platform, Copyright Certara 1999-2023..
  • 6.Gouin-Thibault I, Delavenne X, Blanchard A, Siguret V, Salem JE, Narjoz C, Gaussem P, Beaune P, Funck-Brentano C, Azizi M, Mismetti P, Loriot MA. Interindividual variability in dabigatran and rivaroxaban exposure: contribution of ABCB1 genetic polymorphisms and interaction with clarithromycin. J Thromb Haemost 2017 Feb;15(2):273-283.
  • 7.Fralick M, Juurlink DN, Marras T. Bleeding associated with coadministration of rivaroxaban and clarithromycin. CMAJ 2016 Jun 14; 188(9):669-72.
  • 8.Wannhoff A, Weiss KH, Schemmer P, Stremmel W, Gotthardt DN. Increased levels of rivaroxaban in patients after liver transplantation treated with cyclosporine A. Transplantation 2014 Jul 27;98(2):e12-3.
  • 9.Escobar C, Arceluz M, Montes de Oca R, Mori R, Lopez-Sendon JL, Merino JL. Concomitant Rivaroxaban and Dronedarone Administration in Patients With Nonvalvular Atrial Fibrillation. Rev Esp Cardiol (Engl Ed) 2017 Feb; 70(2):121-122.
  • 10.Moore KT, Vaidyanathan S, Natarajan J, Ariyawansa J, Haskell L, Turner KC. An open-label study to estimate the effect of steady-state erythromycin on the pharmacokinetics, pharmacodynamics, and safety of a single dose of rivaroxaban in subjects with renal impairment and normal renal function. J Clin Pharmacol 2014 Dec;54(12):1407-20.
  • 11.Washam JB, Hellkamp AS, Lokhnygina Y, Piccini JP, Berkowitz SD, Nessel CC, Becker RC, Breithardt G, Fox KAA, Halperin JL, Hankey GJ, Mahaffey KW, Singer DE, Patel MR. Efficacy and Safety of Rivaroxaban Versus Warfarin in Patients Taking Nondihydropyridine Calcium Channel Blockers for Atrial Fibrillation (from the ROCKET AF Trial). Am J Cardiol 2017 Aug 15;120(4):588-594.
  • 12.Greenblatt DJ, Patel M, Harmatz JS, Nicholson WT, Rubino CM, Chow CR. Impaired Rivaroxaban Clearance in Mild Renal Insufficiency With Verapamil Coadministration: Potential Implications for Bleeding Risk and Dose Selection. J Clin Pharmacol 2018 Apr;58(4):533-540.
  • 13.Hill K, Sucha E, Rhodes E, Carrier M, Garg AX, Harel Z, Hundemer GL, Clark EG, Knoll G, McArthur E, Sood MM. Risk of Hospitalization With Hemorrhage Among Older Adults Taking Clarithromycin vs Azithromycin and Direct Oral Anticoagulants..
  • 14.Hanigan S, Das J, Pogue K, Barnes GD, Dorsch MP. The real world use of combined P-glycoprotein and moderate CYP3A4 inhibitors with rivaroxaban or apixaban increases bleeding..
  • 15.Wiggins BS, Dixon DL, Neyens RR, Page RL 2nd, Gluckman TJ. Select Drug-Drug Interactions With Direct Oral Anticoagulants: JACC Review Topic of the Week..

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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.