Drug Interaction Report

Theoretically, coadministration with inducers of CYP450 3A4 and/or P-glycoprotein (P-gp) may decrease the plasma concentrations of rivaroxaban, which is a substrate of the isoenzyme as well as the efflux transporter. In a pharmacokinetic study, administration of a single 20 mg dose of rivaroxaban with the potent CYP450 3A4 and P-gp inducer rifampin (titrated up to 600 mg once daily) resulted in approximately 22% and 50% decreases in mean rivaroxaban peak plasma concentration (Cmax) and system exposure (AUC), respectively, with parallel decreases in its pharmacodynamic effects. The effects of less potent inducers of either CYP450 3A4 or P-gp have not been studied.

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.