MAJOR — Use With Caution
FDA-documented interaction. Avoid strong dual CYP3A4/P-gp inhibitors with rivaroxaban. Use alternative antibiotics when possible.
Evidence level: STRONG
Clarithromycin can increase Xarelto (rivaroxaban) levels in your blood, raising your risk of bleeding. Since Xarelto does not have routine blood monitoring, this makes detection difficult.
Clarithromycin inhibits CYP3A4 and P-gp. Rivaroxaban is a CYP3A4 and P-gp substrate. Increased rivaroxaban levels and bleeding risk. FDA rivaroxaban label warns about strong CYP3A4/P-gp inhibitors.
Tell your doctor you take Xarelto before starting antibiotics. Ask about azithromycin or other alternatives that do not affect Xarelto levels.
Monitor closely. Many antibiotics amplify anticoagulant effects by disrupting gut flora that produce vitamin K. Rivaroxaban levels may spike during antibiotic courses. If on warfarin, request more frequent INR monitoring. Take each at their normal prescribed times.
Higher risk for: elderly patients, those with liver disease, history of GI bleeding, concurrent use of multiple blood thinners, recent surgery, vitamin K intake changes, alcohol use, or low body weight.
Unusual bruising, blood in urine or stool, nosebleeds, heavy menstrual bleeding, prolonged bleeding
Use alternative antibiotics. If clarithromycin is essential, consider temporary dose adjustment and heightened bleeding surveillance.
This medication combination requires careful medical oversight. Your doctor or anticoagulation clinic can adjust doses or select alternatives with fewer bleeding risks. Frequent INR monitoring is essential.
Clarithromycin can increase Xarelto (rivaroxaban) levels in your blood, raising your risk of bleeding. Since Xarelto does not have routine blood monitoring, this makes detection difficult.
Monitor closely. Many antibiotics amplify anticoagulant effects by disrupting gut flora that produce vitamin K. Rivaroxaban levels may spike during antibiotic courses. If on warfarin, request more frequent INR monitoring. Take each at their normal prescribed times.
Unusual bruising, blood in urine or stool, nosebleeds, heavy menstrual bleeding, prolonged bleeding
This medication combination requires careful medical oversight. Your doctor or anticoagulation clinic can adjust doses or select alternatives with fewer bleeding risks. Frequent INR monitoring is essential.
Use alternative antibiotics. If clarithromycin is essential, consider temporary dose adjustment and heightened bleeding surveillance.
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