Xarelto interactions: Alcohol, medications, and other factors

Xarelto (rivaroxaban) is a brand-name prescription drug. It’s used to treat or help prevent blood clots in certain situations.

As with other medications, Xarelto can interact with other drugs. It can also interact with some foods and supplements. An interaction occurs when one substance causes another substance to have a different effect than expected.

For details about Xarelto’s interactions, keep reading. For additional information about Xarelto, including details about its uses, see this article.

In some cases, a factor or condition could prevent your doctor from prescribing Xarelto due to the risk of harm. This is known as a contraindication. The contraindications of Xarelto include:

Having active bleeding

Doctors typically will not prescribe Xarelto if you have active bleeding. (Active bleeding refers to current bleeding, such as a bleeding ulcer.) Taking Xarelto while you have active bleeding could worsen any bleeding you already have. If you have active bleeding, your doctor can advise you on other treatments that may be better for your condition.

Having had an allergic reaction to Xarelto or any of its ingredients

If you have had an allergic reaction to Xarelto or any of its ingredients, your doctor will likely not prescribe Xarelto. Taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.

Note: Before you start treatment with Xarelto, it’s important to tell your doctor if either of these contraindications apply to you. They can determine whether to prescribe Xarelto.

There is not a known interaction between Xarelto and alcohol.

However, both Xarelto and alcohol can prevent blood from clotting. This can increase your risk of bleeding. As a result, consuming alcohol during Xarelto treatment could increase your risk of bleeding further.

If you drink alcohol, talk with your doctor. They can tell you whether there’s a safe amount of alcohol to drink while taking Xarelto.

Before you start treatment with Xarelto, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a chart of drugs that can interact with Xarelto. Doctors may not prescribe Xarelto with these medications. Keep in mind that this chart does not include all drugs that may interact with Xarelto. Some of these interactions are described in detail just below in “Drug interactions in depth.”

* For more information about the side effects of Xarelto, see this article.
† To learn more, see “Certain antibiotic drugs” in the “Drug interactions in depth” section below.

Here’s a closer look at certain drug interactions of Xarelto.

Nonsteroidal anti-inflammatory drugs

It may not be safe to take Xarelto with nonsteroidal anti-inflammatory drugs (NSAIDs). These are a type of pain reliever. NSAIDS are typically used to treat inflammation and pain.

Interaction result. Taking Xarelto in combination with an NSAID can increase the risk of bleeding.

Interaction explained. Xarelto works by blocking the action of factor Xa. (Factor Xa is a clotting factor, which is a substance that helps blood clot.) By blocking the action of factor Xa, Xarelto helps prevent blood clots from forming or becoming larger. This can increase your risk of bleeding.

NSAIDs can prevent platelets (a type of red blood cell) from grouping together to form a blood clot. By affecting platelets, NSAIDs can also increase your risk of bleeding.

Therefore, taking Xarelto together with an NSAID can further increase your risk of bleeding.

Examples of NSAIDs. Below are a few NSAIDs that may interact with Xarelto:

• ibuprofen (Advil, Motrin)

• naproxen (Aleve, Naprosyn)
• magnesium salicylate (Doan’s)

• diclofenac (Cambia, Cataflam, Zipsor, others)
• celecoxib (Celebrex, Elyxyb)

Steps you or your doctor may take. Keep in mind that many NSAIDs are available over the counter (OTC), meaning you’re able to purchase them without a prescription. It’s important to talk with your doctor or pharmacist before taking any OTC products with Xarelto. They can see whether the products include NSAIDs as ingredients.

If your doctor says that it’s safe to take an NSAID with Xarelto, tell them right away if you have symptoms of bleeding. Examples include coughing up blood, having unexplained bruising, and having bloody urine or stool. Your doctor can instruct you on what to do about this side effect.

Certain antibiotic drugs

Doctors may not prescribe Xarelto with certain antibiotic drugs. Antibiotics are used to treat different types of bacterial infections.

Interaction result. The interaction between Xarelto and the antibiotic drug depends on the specific antibiotic.

Taking Xarelto with erythromycin (E.E.S., Ery-Tab, EryPed, others) could increase your risk of side effects from Xarelto.* However, taking Xarelto with rifampin (Rifadin) could make Xarelto less effective than usual.

Interaction explained. Xarelto is broken down in the body by an enzyme called cytochrome P450 3A4 (CYP3A4). An enzyme is a type of protein.

Erythromycin inhibits (slows down) the activity of CYP3A4. This means that Xarelto may not break down in your body as quickly, which could increase the level of the drug in your system. The result may be a greater risk of side effects from Xarelto.

Rifampin, on the other hand, speeds up the activity of CYP3A4. This means that Xarelto may break down in your body more quickly, which could decrease the level of the medication in your system. As a result, Xarelto could be less effective than usual.

Steps you or your doctor may take. Before taking Xarelto, be sure to tell your doctor if you’re taking erythromycin or rifampin. They can recommend whether it’s safe to take either drug with Xarelto.

If your doctor prescribes an antibiotic during Xarelto treatment, it’s important that they know you’re taking Xarelto. They can advise you on whether it’s safe to take Xarelto with the specific antibiotic you’re prescribed.

* For more information about the side effects of Xarelto, see this article.

Antiplatelet drugs

It may not be safe to take Xarelto with antiplatelet drugs. These drugs are used to help prevent blood clots from forming.

Interaction result. Taking Xarelto with an antiplatelet drug can increase the risk of bleeding.

Interaction explained. Xarelto works by blocking the action of a clotting factor called factor Xa. (Clotting factors are proteins that help your blood clot.) By blocking the action of this clotting factor, Xarelto helps prevent blood clots from forming or getting larger. This can increase your risk of bleeding.

Antiplatelet drugs work by preventing platelets (a type of red blood cell) from sticking together to form a blood clot. By affecting this process, antiplatelet drugs can also increase your risk of bleeding.

As a result, taking Xarelto with antiplatelet drugs can increase your risk of bleeding further.

Examples of antiplatelet drugs. Here are examples of antiplatelet drugs that may interact with Xarelto:

• aspirin
• prasugrel (Effient)
• clopidogrel (Plavix)
• ticagrelor (Brilinta)

Steps you or your doctor may take. Before taking Xarelto, be sure your doctor knows if you’re taking an antiplatelet drug. They can advise you on whether it’s safe to take these medications together.

If your doctor tells you it’s safe to take an antiplatelet drug with Xarelto, watch for symptoms of bleeding. Tell your doctor right away if you cough up blood or have unexplained bruising, bloody urine, or bloody stool. They can tell you how to manage this side effect.

Xarelto may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below.

Xarelto interactions with supplements

Before you start treatment with Xarelto, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Note: Xarelto may interact with a form of magnesium called magnesium salicylate (Doan’s), which is a nonsteroidal anti-inflammatory drug (NSAID). However, Xarelto has not been reported to interact with other forms of magnesium, including magnesium supplements. For details about the interaction between Xarelto and magnesium salicylate, see “Nonsteroidal anti-inflammatory drugs” in the “Drug interactions in depth” section above.

Xarelto interactions with herbs

An herb called St. John’s wort may interact with Xarelto. (This supplement is sometimes used to treat depression.) St. John’s wort could make Xarelto less effective than usual.

Doctors may advise you to avoid taking St. John’s wort during Xarelto treatment.

Xarelto and vitamins

Omega-3 fatty acids are technically vitamins, and they may interact with Xarelto. In supplement form, omega-3 fatty acids are sometimes used to help lower blood pressure and levels of triglycerides (a type of fat). Taking an omega-3 fatty acid supplement with Xarelto may increase the risk of side effects from Xarelto.*

Before you start Xarelto treatment, tell your doctor if you’re taking an omega-3 fatty acid supplement. They may monitor you closely for side effects, such as anxiety or fatigue.

* For more information about the side effects of Xarelto, see this article.

Xarelto interactions with food

Eating grapefruit or drinking grapefruit juice while taking Xarelto could raise the level of the medication in your body. A higher level of Xarelto could increase your risk of side effects from the drug. Your doctor may advise you to avoid eating grapefruit or drinking grapefruit juice during Xarelto treatment.

Also, keep in mind that foods containing omega-3 fatty acids were not reported to interact with Xarelto. Omega-3 fatty acid supplements, on the other hand, may interact with the medication.* The amount of omega-3 fatty acids in food is typically much less than what’s in an omega-3 fatty acid supplement.

If you have other questions about what not to eat or drink while taking Xarelto, talk with your doctor or pharmacist.

* To learn more, see “Xarelto interactions with supplements” above.

Xarelto and vaccines

No specific interactions have been reported between Xarelto and vaccines. If you have questions about getting vaccines during Xarelto treatment, talk with your doctor or pharmacist.

Xarelto and lab tests

Lab tests have not been reported to interact with Xarelto. Your doctor or pharmacist can give you additional information about having lab tests during Xarelto treatment.

Xarelto interaction with cannabis or CBD

Cannabis (marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Xarelto.

The effects of cannabis on Xarelto may vary depending on the exact cannabis product used. Certain cannabis products may raise the level of Xarelto in the body, which could increase your risk of side effects from Xarelto. (To learn about possible side effects of Xarelto, see this article.)

Other cannabis products may decrease the level of Xarelto in the body, which could cause Xarelto to be less effective than usual.

Before you start treatment with Xarelto, tell your doctor and pharmacist if you take cannabis. By sharing this information with them, you may help prevent possible interactions.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Xarelto. Before you take Xarelto, be sure to talk with your doctor about your health history. Xarelto may not be the right treatment option for you if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Xarelto include the following:

Triple-positive antiphospholipid syndrome. Doctors may not prescribe Xarelto for people with triple-positive antiphospholipid syndrome (APS). This condition causes blood clots. Xarelto can increase the risk of blood clots in people with APS. Therefore, if you have triple-positive APS, your doctor will likely prescribe a treatment other than Xarelto.

Liver problems. If you have a severe liver problem, your doctor may not prescribe Xarelto. Examples of severe liver problems include hepatitis and cirrhosis. It’s not known whether Xarelto is safe for people with severe liver problems. If you have a problem with your liver, your doctor may prescribe a different treatment.

Kidney problems. Before taking Xarelto, be sure your doctor knows whether you have a kidney problem. Your risk of side effects with the medication may increase if your kidneys do not work as well as they should. For more information about the side effects of Xarelto, see this article.

If you have a kidney problem, your doctor may prescribe a different treatment. Or they may prescribe a lower dosage of Xarelto than usual. For details about Xarelto’s dosage, see this article.

Artificial heart valve. Doctors are not likely to prescribe Xarelto for people who have an artificial heart valve. The drug has not been studied in people who have one. So it’s not known for certain whether the drug is safe to take in this case. If you have an artificial heart valve, your doctor can recommend a different treatment for your condition.

Planned surgery. If you plan to have surgery while taking Xarelto, talk with your doctor. They may have you stop taking the drug at least 1 day before the procedure. This is because having surgery while taking Xarelto could increase your risk of bleeding. Stopping use of the drug before the procedure could reduce this risk. Your doctor can advise you on what to do if you have a surgery planned during Xarelto treatment.

Active bleeding. Doctors typically will not prescribe Xarelto if you have active bleeding, such as a bleeding ulcer. For details, see the “When to avoid Xarelto” section above.

Pregnancy. It’s not known for certain whether Xarelto is safe to take during pregnancy. For details about taking Xarelto while pregnant, see this article.

Breastfeeding. Xarelto passes into breast milk. However, it’s not known whether the drug causes side effects in a breastfed child. If you’re breastfeeding or considering it, talk with your doctor. They can review the potential risks and benefits of the drug with you.

Allergic reaction. If you’ve had an allergic reaction to Xarelto or any of its ingredients, your doctor will likely not prescribe this drug. To learn more, see the “When to avoid Xarelto” section above.

Here are some frequently asked questions about Xarelto and possible interactions.

Does Xarelto interact with pain relievers, such as tramadol or paracetamol?

Neither tramadol (ConZip, Qdolo, Ultram) nor paracetamol have been reported to interact with Xarelto. (In the United States, paracetamol is known as acetaminophen. It’s available under multiple brand names, including Tylenol.)

Both tramadol and acetaminophen are pain relievers. Although Xarelto does not interact with these medications, it does interact with certain other pain relievers. These include nonsteroidal anti-inflammatory drugs (NSAIDs). To learn more, see “Nonsteroidal anti-inflammatory drugs” in the “Drug interactions in depth” section above.

If you need pain relief while taking Xarelto, talk with your doctor or pharmacist. They can recommend an appropriate treatment.

Is it safe to take Xarelto with Viagra?

It’s probably safe to take Xarelto with sildenafil (Viagra). The drug Viagra is used to treat erectile dysfunction. There are no specific reports of Xarelto interacting with Viagra.

If you’d like to learn more about Xarelto and Viagra, talk with your doctor.

Can I take Xarelto with amoxicillin?

You can likely take Xarelto with amoxicillin (Amoxil, Larotid). There are not any known interactions between these medications.

Amoxicillin is a type of antibiotic drug. It’s used to treat certain infections caused by bacteria.

However, Xarelto has been reported to interact with antibiotic drugs other than amoxicillin. To learn more, see “Certain antibiotic drugs” in the “Drug interactions in depth” section above.

Your doctor and pharmacist can tell you more about Xarelto, amoxicillin, and other antibiotics.

You can take certain steps to help prevent interactions with Xarelto. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan the following:

• Let them know if you drink alcohol or take cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the label of Xarelto and other paperwork that comes with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the prescribing information, may contain details about interactions. If this information is difficult to understand, ask your doctor or pharmacist to help explain it.

You can also help prevent interactions with Xarelto by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Xarelto. These resources might help:

• Overview of Xarelto. For a general overview of Xarelto, you can read this article.
• Side effects. If you’re interested in the side effects of Xarelto, see this article. Another option is to refer to the Xarelto prescribing information.
• Dosage specifics. To learn about the dosage of Xarelto, see this article.
• Drug comparison. Find information abouthow Xarelto compares with Eliquis and warfarin.
• Facts about your condition. For details about heart disease, you can refer to our cardiovascular hub. You can also see our lists of articles about heart disease and venous thromboembolism.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.