Can you take Ramucirumab with Rivaroxaban?

Rivaroxaban has a moderate potential interaction with Antiphospholipid syndrome.

Direct acting oral anticoagulants including factor Xa inhibitors and some thrombin inhibitors as dabigatran, are not recommended for use in patients with antiphospholipid syndrome (APS). Treatment with these drugs has been associated with increased rates of recurrent thrombotic events, especially in patients with triple positive APS.

Ramucirumab has a major potential interaction with Bleeding Disorder.

Ramucirumab may increase the risk of bleeding. Patients have experienced gastrointestinal hemorrhage, including severe and sometimes fatal hemorrhagic events when using this agent. Permanently discontinue ramucirumab in patients experiencing severe bleeding.

Rivaroxaban has a major potential interaction with Bleeding Disorder.

The use of factor Xa inhibitors is contraindicated in patients with active pathological bleeding as these agents increase the risk of bleeding and can cause serious or fatal hemorrhages. Caution is recommended when prescribing factor Xa inhibitors to patients at increased risk of bleeding, including patients undergoing procedures where bleeding may cause serious complications. Such patients include those undergoing spinal/epidural anesthesia or spinal puncture; these patients are at high risk of an epidural or spinal hematoma, which can result in long-term or permanent paralysis. In general, when using factor Xa inhibitors, the risk of thrombotic events should be weighed against the risk of bleeding.

Ramucirumab has a major potential interaction with Gastrointestinal Obstruction.

Inhibitors of vascular endothelial growth factor receptors (VEGFR) may cause gastrointestinal perforation and fistulae. Avoid use of these agents in patients with ovarian cancer who have evidence of recto-sigmoid involvement by pelvic examination or bowel involvement on CT scan or clinical symptoms of bowel obstruction. Permanently discontinue these agents in patients with gastrointestinal perforation.

Ramucirumab has a major potential interaction with Gastrointestinal Perforation.

Inhibitors of vascular endothelial growth factor receptors (VEGFR) may cause gastrointestinal perforation and fistulae. Avoid use of these agents in patients with ovarian cancer who have evidence of recto-sigmoid involvement by pelvic examination or bowel involvement on CT scan or clinical symptoms of bowel obstruction. Permanently discontinue these agents in patients with gastrointestinal perforation.

Ramucirumab has a major potential interaction with History, Radiation Therapy.

Inhibitors of vascular endothelial growth factor receptors (VEGFR) may cause gastrointestinal perforation and fistulae. Avoid use of these agents in patients with ovarian cancer who have evidence of recto-sigmoid involvement by pelvic examination or bowel involvement on CT scan or clinical symptoms of bowel obstruction. Permanently discontinue these agents in patients with gastrointestinal perforation.

Ramucirumab has a moderate potential interaction with History, Thrombotic/Thromboembolic Disorder.

Venous and arterial thromboembolic events (VTE and ATE), some fatal, have been reported with the use of inhibitors of vascular endothelial growth factor receptors (VEGFR). Caution is recommended when using these agents in patients with a reported history of VTE or ATE. These agents should be discontinued in patients with serious or life-threatening VTE or ATE, including pulmonary embolism.

Ramucirumab has a moderate potential interaction with Hypertensive Encephalopathy.

Inhibitors of vascular endothelial growth factor receptors (VEGFR) have been associated with severe increases in blood pressure. Therapy with these agents should be administered cautiously in patients with preexisting hypertension. Blood pressure should be assessed prior to initiating treatment, regularly during treatment and after discontinuation in patients with bevacizumab -induced or -exacerbated hypertension. Temporarily suspend these agents in patients with severe hypertension that is not controlled with medical management. Discontinue these agents in patients with hypertensive crisis or hypertensive encephalopathy.

Rivaroxaban has a moderate potential interaction with Hypotension.

Initiation of rivaroxaban is not recommended acutely as an alternative to unfractionated heparin in patients with pulmonary embolism who present with hemodynamic instability or who may receive thrombolysis or pulmonary embolectomy.

Ramucirumab has a moderate potential interaction with Liver Disease.

The effect of hepatic impairment on the clearance of ramucirumab was evaluated in patients with mild and moderate hepatic impairment. No clinically important differences in the clearance of ramucirumab were found between patients with mild or moderate hepatic impairment compared to patients with normal hepatic function. No dose adjustment is recommended for patients with mild or moderate hepatic impairment. No PK data are available from patients with severe hepatic dysfunction.

Rivaroxaban has a moderate potential interaction with Liver Disease.

The use of rivaroxaban should be avoided in patients with moderate and severe liver dysfunction (Child-Pugh B and C) or with any liver disease associated with coagulopathy as drug exposure and bleeding risk may be increased.

Rivaroxaban has a moderate potential interaction with Mitral Stenosis.

The use of some factor Xa inhibitors (including apixaban, edoxaban, and rivaroxaban) is not recommended in patients with prosthetic heart valves; safety and efficacy have not been established in such patients.

Ramucirumab has a moderate potential interaction with Posterior Reversible Encephalopathy Syndrome.

Posterior Reversible Encephalopathy Syndrome (PRES) has been reported with the use of inhibitors of vascular endothelial growth factor receptors (VEGFR) in clinical studies. PRES is a neurological disorder which can present with headache, seizure, lethargy, confusion, blindness and other visual and neurologic disturbances. It is recommended to discontinue these agents in patients developing PRES. The safety of restarting therapy is not known. Cation is recommended if therapy is reinitiating in patients previously experiencing PRES.

Rivaroxaban has a moderate potential interaction with Prosthetic Heart Valves - Thrombosis Prophylaxis.

The use of some factor Xa inhibitors (including apixaban, edoxaban, and rivaroxaban) is not recommended in patients with prosthetic heart valves; safety and efficacy have not been established in such patients.

Ramucirumab has a moderate potential interaction with Proteinuria.

The incidence and severity of proteinuria is increased in patients taking inhibitors of vascular endothelial growth factor receptors (VEGFR). Therapy with these agents should be administered cautiously in patients with renal dysfunction. Monitoring for proteinuria and hematuria is recommended and perform baseline and periodic urinalyses during treatment, with follow up measurement as clinically indicated. It is recommended to temporarily suspend these agents in patients with moderate to severe proteinuria and to discontinue therapy in patients with nephrotic syndrome.

Ramucirumab has a moderate potential interaction with Pulmonary Embolism.

Venous and arterial thromboembolic events (VTE and ATE), some fatal, have been reported with the use of inhibitors of vascular endothelial growth factor receptors (VEGFR). Caution is recommended when using these agents in patients with a reported history of VTE or ATE. These agents should be discontinued in patients with serious or life-threatening VTE or ATE, including pulmonary embolism.

Ramucirumab has a moderate potential interaction with Renal Dysfunction.

The incidence and severity of proteinuria is increased in patients taking inhibitors of vascular endothelial growth factor receptors (VEGFR). Therapy with these agents should be administered cautiously in patients with renal dysfunction. Monitoring for proteinuria and hematuria is recommended and perform baseline and periodic urinalyses during treatment, with follow up measurement as clinically indicated. It is recommended to temporarily suspend these agents in patients with moderate to severe proteinuria and to discontinue therapy in patients with nephrotic syndrome.

Rivaroxaban has a moderate potential interaction with Renal Dysfunction.

For most indications, rivaroxaban exposure and pharmacodynamic effects are increased in patients with CrCl less than 30 mL/min compared to patients with normal renal function; these indications include treatment of deep vein thrombosis (DVT), treatment of pulmonary embolism (PE), reduction in the risk of recurrence of DVT and/or PE, prophylaxis of DVT after hip/knee replacement surgery, and prophylaxis of venous thromboembolism in acutely ill medical patients at risk for thromboembolic complications not at high risk of bleeding. Limited clinical data are available in patients with CrCl 15 to less than 30 mL/min, and there are no clinical data in patients with CrCl less than 15 mL/min (including those on dialysis). Patients with CrCl 15 to less than 30 mL/min should be observed closely and any signs/symptoms of blood loss should be evaluated promptly; use of rivaroxaban should be avoided in patients with CrCl less than 15 mL/min (including those on dialysis). This drug should be discontinued in patients who develop acute renal failure while on treatment.

In patients with nonvalvular atrial fibrillation, renal function should be periodically assessed, as clinically indicated (i.e., more often in situations in which renal function may decline), and therapy should be adjusted accordingly; dose adjustment or discontinuation of rivaroxaban should be considered in patients who develop acute renal failure during therapy.

In patients with coronary artery disease or peripheral artery disease, no dose adjustment is needed based on CrCl.

Ramucirumab has a moderate potential interaction with Thrombotic/Thromboembolic Disorder.

Venous and arterial thromboembolic events (VTE and ATE), some fatal, have been reported with the use of inhibitors of vascular endothelial growth factor receptors (VEGFR). Caution is recommended when using these agents in patients with a reported history of VTE or ATE. These agents should be discontinued in patients with serious or life-threatening VTE or ATE, including pulmonary embolism.

Ramucirumab has a moderate potential interaction with Underactive Thyroid.

Hypothyroidism has been reported in patients taking ramucirumab. Therapy with ramucirumab should be administered cautiously to patients with thyroid dysfunction. Baseline laboratory measurement of thyroid function is recommended and if appropriate, treatment per standard medical practice should be given prior to initiation of therapy. Clinical monitoring of thyroid function is recommended during therapy.