MAJOR — Use With Caution
🔴 CAUTION — Major interaction between St. Johns Wort and Rivaroxaban. Avoid unless under direct medical supervision.
Evidence level: MODERATE
St. John's Wort reduces Xarelto effectiveness, risking blood clots.
CYP3A4/P-gp induction reduces rivaroxaban levels.
St. Johns Wort affects how your body processes Rivaroxaban, which may change its effectiveness. Your doctor may need to adjust dosages or consider an alternative. Do not change doses on your own.
Use caution. Many botanicals affect blood clotting — ginkgo, garlic, ginger, turmeric, and dong quai all have antiplatelet activity that can amplify Rivaroxaban. St. John's Wort can REDUCE anticoagulant effectiveness. Take at separate times and inform your prescriber about all herbal supplements. Request more frequent INR monitoring if on warfarin.
Higher risk with: liver impairment, genetic CYP enzyme variations (poor or ultra-rapid metabolizers), older age, polypharmacy (many medications).
Monitor for any unusual symptoms and report them to your healthcare provider promptly.
Ask your doctor: "Is there a safer alternative to St. Johns Wort that I can take with Rivaroxaban?" Bring a list of ALL supplements and medications you take.
Blood thinners have narrow safety margins. Instead of St. Johns Wort, consider safer options: CoQ10 (with INR monitoring), vitamin D3, or probiotics — these have minimal anticoagulant interactions. Always inform your anticoagulation clinic about any supplements.
St. John's Wort reduces Xarelto effectiveness, risking blood clots.
Use caution. Many botanicals affect blood clotting — ginkgo, garlic, ginger, turmeric, and dong quai all have antiplatelet activity that can amplify Rivaroxaban. St. John's Wort can REDUCE anticoagulant effectiveness. Take at separate times and inform your prescriber about all herbal supplements. Request more frequent INR monitoring if on warfarin.
Monitor for any unusual symptoms and report them to your healthcare provider promptly.
Blood thinners have narrow safety margins. Instead of St. Johns Wort, consider safer options: CoQ10 (with INR monitoring), vitamin D3, or probiotics — these have minimal anticoagulant interactions. Always inform your anticoagulation clinic about any supplements.
Ask your doctor: "Is there a safer alternative to St. Johns Wort that I can take with Rivaroxaban?" Bring a list of ALL supplements and medications you take.
Or browse the full interaction database (121,000+ pairs).