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Drug Interactions between voriconazole and Xarelto

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

voriconazole rivaroxaban

Applies to: voriconazole and Xarelto (rivaroxaban)

GENERALLY AVOID: Coadministration with potent inhibitors of CYP450 3A4 that can also inhibit P-glycoprotein (P-gp) may significantly increase the plasma concentrations of rivaroxaban, which is a substrate of both the isoenzyme and efflux transporter. The risk of bleeding associated with rivaroxaban may be increased. When rivaroxaban was coadministered with the dual P-gp and potent CYP450 3A4 inhibitor, ketoconazole (400 mg once daily), mean steady-state rivaroxaban peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 1.7- and 2.6-fold, respectively. Likewise, coadministration with ritonavir 600 mg twice a day increased the mean steady-state rivaroxaban Cmax by 1.6-fold and AUC by 2.5-fold. Significant increases in pharmacodynamic effects of rivaroxaban were observed with both drugs.

MANAGEMENT: Concomitant use of rivaroxaban with dual P-gp and potent CYP450 3A4 inhibitors should generally be avoided. Some authorities recommend avoiding concomitant use of rivaroxaban during and for 2 weeks after treatment with itraconazole.

References (5)
  1. (2002) "Product Information. Sporanox (itraconazole)." Janssen Pharmaceuticals
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  3. Cerner Multum, Inc. "Australian Product Information."
  4. (2008) "Product Information. Xarelto (rivaroxaban)." Bayer Inc
  5. (2015) "Product Information. Evotaz (atazanavir-cobicistat)." Bristol-Myers Squibb

Drug and food interactions

Moderate

voriconazole food

Applies to: voriconazole

ADJUST DOSING INTERVAL: Food reduces the oral absorption and bioavailability of voriconazole. According to the product labeling, administration of multiple doses of voriconazole with high-fat meals decreased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) by 34% and 24%, respectively, when the drug is administered as a tablet, and by 58% and 37%, respectively, when administered as the oral suspension.

MANAGEMENT: To ensure maximal oral absorption, voriconazole tablets and oral suspension should be taken at least one hour before or after a meal.

References (2)
  1. (2002) "Product Information. VFEND (voriconazole)." Pfizer U.S. Pharmaceuticals
  2. Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT (2009) "Recommendations for the use of medications with continuous enteral nutrition." Am J Health Syst Pharm, 66, p. 1438-67

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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