Xarelto Interactions: Alcohol, Medications, and Others

Xarelto (rivaroxaban) is a prescription drug that’s used to prevent and treat certain kinds of blood clots in adults and some children. Examples include deep vein thrombosis (DVT) and pulmonary embolism. Like other drugs, Xarelto may have interactions.

Some interactions occur because one substance causes another substance to have a different effect than expected. For example, sometimes alcohol, another drug, or a supplement can affect how a drug acts in your body. Interactions can also occur if you have certain health conditions.

Keep reading to learn about Xarelto’s possible interactions. And for more information about Xarelto, including details about its uses, see this article.

Certain health conditions or other factors could raise your risk of harm if you take Xarelto. In such cases, your doctor may not prescribe Xarelto for you. These are known as contraindications. The list below includes contraindications of Xarelto.

If you have active bleeding. You should not take Xarelto if you have active bleeding, including internal bleeding (bleeding inside your body). An example of this is gastrointestinal bleeding (bleeding in your intestines or stomach). Because Xarelto increases your risk of bleeding, using the medication could worsen active bleeding.

If you’ve had an allergic reaction. If you’ve had an allergic reaction to Xarelto or any of its ingredients, your doctor likely won’t prescribe Xarelto. You can ask them about other treatments that may be better options for you.

Before you start taking Xarelto, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether Xarelto is safe for you to take.

There isn’t a known interaction between taking Xarelto and consuming alcohol.

But it’s important to note that alcohol thins your blood. Combining alcohol and Xarelto may make it harder for your blood to form a clot, increasing your risk of bleeding.

If you drink alcohol, talk with your doctor about how much is safe to consume while you’re taking Xarelto.

Before you start taking Xarelto, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions.

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

The chart below lists drugs that may interact with Xarelto. Keep in mind that this chart does not include all drugs that may interact with Xarelto. For more information about some of these interactions, see the “Drug interactions explained” section below.

Learn more about certain drug interactions that can occur with Xarelto.

Interaction with nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) can interact with Xarelto, as described in the table below. NSAIDs are a type of medication used to relieve pain.

What you can do

You should avoid using NSAIDs and Xarelto together, unless your doctor says it’s safe to do so. If you’re taking Xarelto, talk with your doctor before using an NSAID. They may suggest using a pain reliever that doesn’t interact with Xarelto, such as acetaminophen.

Interaction with anticoagulants

Xarelto is a type of anticoagulant, which are drugs used to prevent or treat blood clots. Taking other anticoagulants with Xarelto may cause a drug interaction. This is described in more detail in the table below.

What you can do

Due to the risk of bleeding, doctors usually will not prescribe another anticoagulant to you if you’re taking Xarelto. If you’re taking another anticoagulant, be sure to let your doctor know before you begin using Xarelto. They’ll likely recommend that you take either one or the other, but not both.

Interaction with certain antiepileptic drugs

Xarelto can interact with certain antiepileptic drugs. Antiepileptic drugs are medications prescribed to treat epilepsy.

Only certain antiepileptic drugs interact with Xarelto. This is because certain antiepileptics can affect how your body breaks down Xarelto after you take a dose.

What you can do

Doctors usually won’t prescribe Xarelto and antiepileptic drugs together. Instead, your doctor can adjust your treatment plan. For example, they may suggest using another anticoagulant besides Xarelto that won’t interact with your antiepileptic drug.

Be sure to let your doctor know about any medications you take before you start Xarelto treatment so they can check for interactions.

Xarelto may have other interactions. They could occur with foods, supplements, vaccines, or even lab tests. See below for details.

Does Xarelto interact with food?

Your risk of side effects from Xarelto, particularly bleeding, may be higher if you consume grapefruit while taking the drug. So it’s recommended that you avoid consuming grapefruit and any grapefruit products, such as grapefruit juice, while taking Xarelto.

If you regularly consume grapefruit and wish to continue doing so, talk with your doctor about other anticoagulants that may be a safer choice for you.

Does Xarelto interact with supplements?

Before you start taking Xarelto, talk with your doctor and pharmacist about any supplements, herbs, and vitamins you take. Sharing this information with them may help you avoid possible interactions.

If you have questions about interactions that may affect you, talk with your doctor or pharmacist.

Xarelto interactions with herbs

The herb St. John’s wort may interact with Xarelto. Specifically, it can lower Xarelto levels in your body, making the medication less effective than usual. Because of this risk, doctors usually recommend against using Xarelto and St. John’s wort together.

If you’d like to continue using St. John’s wort, talk with your doctor. They can discuss other anticoagulants that may be a safer choice for you.

Xarelto and vitamins

There are currently no reports of Xarelto interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products during Xarelto treatment.

Does Xarelto interact with vaccines?

Xarelto isn’t known to interact with any vaccines.

Before getting a vaccine, tell your doctor or pharmacist what medications you take. They can let you know whether any of your medications interact with the vaccine.

Does Xarelto interact with lab tests?

There aren’t any lab tests known to interact with Xarelto.

If you’re concerned about your medications interacting with a lab test, talk with your doctor.

Does Xarelto interact with cannabis or CBD?

Cannabis (commonly called marijuana) and cannabis products, such as cannabidiol (CBD), have been reported to interact with Xarelto. Specifically, cannabis may increase your risk of side effects from Xarelto, including bleeding.

Before you start treatment with Xarelto, tell your doctor and pharmacist if you use 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 or other health factors may increase the risk of interactions with Xarelto. Before taking Xarelto, talk with your doctor about your health history. They’ll determine whether Xarelto is right for you.

Health conditions or other factors that might interact with Xarelto include:

Active bleeding. You should not take Xarelto if you have active bleeding. For more information, see the “When should I avoid Xarelto?” section above.

Antiphospholipid syndrome (APS). In people with APS, taking Xarelto can increase the risk of blood clots. Due to this risk, doctors usually won’t prescribe Xarelto to people who have this condition. If you have APS, talk with your doctor about other treatments that may be safer for you.

Bleeding problems. Xarelto works by making it harder for the blood to clot. If you have a bleeding problem, such as hemophilia, Xarelto may not be safe for you to take. Talk with your doctor to learn more about whether Xarelto is safe for you to use. Depending on your bleeding problem, they may recommend a treatment other than Xarelto.

Kidney problems. Having a kidney problem, such as chronic kidney disease, may make it harder for the body to break down Xarelto. This can cause Xarelto levels to build up in the body, increasing the risk of side effects from the drug.

If you have a kidney problem, tell your doctor before starting Xarelto treatment. Depending on the severity of the problem, your doctor may prescribe a lower Xarelto dosage for you. Or they may suggest that you use a different anticoagulant.

Liver problems. Having liver problems, such as alcoholic liver disease, may cause the body to have trouble breaking down Xarelto. As a result, Xarelto levels can build up in the body, increasing the risk of side effects from the drug. Because of this risk, doctors usually won’t prescribe Xarelto to people who have moderate or severe liver problems.

If you have a liver problem, tell your doctor before you start taking Xarelto. Depending on how severe your liver problem is, they may recommend other anticoagulants that may be safer for you to take.

Pregnancy. Taking Xarelto while pregnant may increase the risk of bleeding for you and the fetus. If you’re pregnant or planning to become pregnant, talk with your doctor about anticoagulants that may be safe for you to take.

Breastfeeding. Xarelto passes into breast milk. But it’s not known what effects this may have on a breastfed child. If you’re taking Xarelto and breastfeeding or considering breastfeeding, talk with your doctor. They can discuss with you whether it’s safe to take Xarelto while breastfeeding.

Allergic reaction. If you’ve had an allergic reaction to Xarelto or any of its ingredients, your doctor will likely not prescribe Xarelto. Ask them about other treatments that may be better choices for you.

Find answers to some frequently asked questions about Xarelto and possible interactions.

Is it safe to take paracetamol while I’m taking Xarelto?

Yes, it’s thought that paracetamol is safe to take with Xarelto. Paracetamol is the international name for the drug known as acetaminophen in the United States.

Acetaminophen (Tylenol) is a pain reliever that may be purchased over the counter (OTC). This means it’s available without a prescription. There are other OTC and prescription pain relievers, called nonsteroidal anti-inflammatory drugs (NSAIDs), that do interact with Xarelto. But this interaction isn’t expected with acetaminophen.

To learn more about how Xarelto and NSAIDs interact, see the “Drug interactions explained” section above. And if you have questions about taking acetaminophen with Xarelto, ask your doctor or pharmacist.

Are there any antibiotics that interact with Xarelto? Is it safe to take Xarelto with amoxicillin?

Yes, there are some antibiotics that Xarelto may interact with, such as clarithromycin and erythromycin (Eryc). But it’s not expected to interact with amoxicillin.

Clarithromycin and erythromycin can prevent the body from breaking down Xarelto. This can cause levels of Xarelto in the body to become too high, increasing the risk of side effects from this drug. An example is bleeding.

Due to this risk, doctors may avoid prescribing clarithromycin or erythromycin to people taking Xarelto, especially if they have kidney problems. Having kidney problems can also affect how the body breaks down Xarelto. To learn more, see the “Does my health history affect whether I should take Xarelto?” section above.

Amoxicillin isn’t known to interact with Xarelto. Amoxicillin may interact with the anticoagulant warfarin, but this effect isn’t expected with Xarelto.

For more information about taking antibiotics with Xarelto, talk with your doctor or pharmacist.

Will Viagra interact with Xarelto? Can I safely use these medications together?

No, sildenafil (Viagra) isn’t known to interact with Xarelto. Viagra is prescribed to treat erectile dysfunction (ED).

Xarelto can be prescribed to people with certain cardiovascular diseases. (This refers to diseases affecting the blood vessels and heart.) If you have this kind of disease, your heart may not be healthy enough for sex. Depending on the severity of your heart condition, your doctor may not prescribe Viagra to you.

To learn more about whether your heart is healthy enough for sex and treatment with Viagra, talk with your doctor.

Taking certain steps can help you avoid interactions with Xarelto. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:

• Whether you drink alcohol or use cannabis.
• Other medications you take, as well as any vitamins, supplements, and herbs. Your doctor or pharmacist can help you fill out a medication list.
• What to do if you start taking a new drug during your Xarelto treatment.

It’s also important to read Xarelto’s label and other paperwork that comes with the drug. You may see colored stickers on the label that describe interactions. And the paperwork (sometimes called the prescribing information) may have other details about interactions. If you need help understanding this information, discuss it with your doctor or pharmacist.

Taking Xarelto exactly as prescribed can also help prevent interactions.

If you still have questions about Xarelto and its possible interactions, talk with your doctor.

Questions you may want to ask your doctor include:

• Will I be monitored more closely during treatment if I have certain health conditions and take Xarelto?
• Do other anticoagulants have similar interactions as Xarelto? Are any of these medications safer for me to take?
• Will my Xarelto dosage affect my risk of interactions?

For more information about Xarelto, you may be interested in these articles:

• Side Effects of Xarelto: What You Need to Know
• Dosage for Xarelto: What You Need to Know
• Xarelto and Cost: What You Need to Know

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Disclaimer: Healthline 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.