Drug Interactions between betrixaban and Xarelto

GENERALLY AVOID: Concomitant use of rivaroxaban with other anticoagulants may increase the risk of bleeding. In patients receiving neuraxial anesthesia or spinal puncture, the risk of developing an epidural or spinal hematoma during rivaroxaban therapy may also be increased by the concomitant use of other drugs that affect coagulation. The development of epidural and spinal hematoma can lead to long-term neurological injury or permanent paralysis. In a drug interaction study, an additive effect on antifactor Xa activity was observed when single doses of enoxaparin (40 mg subcutaneous) and rivaroxaban (10 mg) were given concurrently. Likewise, an additive effect on factor Xa inhibition and prothrombin time occurred when single doses of warfarin (15 mg) and rivaroxaban (5 mg) were given together. The safety of long-term coadministration of these drugs has not been studied.

MANAGEMENT: Due to increased bleeding risk, the use of rivaroxaban with other anticoagulants should generally be avoided except during therapeutic transition periods where patients should be observed closely. Patients should be routinely evaluated for signs and symptoms suggesting blood loss such as a drop in hemoglobin and/or hematocrit, hypotension, or fetal distress (in pregnant women). In patients undergoing neuraxial intervention, the use of rivaroxaban should be approached with caution and only after thorough assessment of risks and benefits. Besides bleeding complications, patients should also be monitored frequently for signs and symptoms of neurologic impairment such as midline back pain, sensory and motor deficits (numbness or weakness in lower limbs), and bowel or bladder dysfunction.