From the Guidelines
There is no significant interaction between Xarelto (rivaroxaban) and saw palmetto based on current evidence, and you can generally take both medications together without concern for a clinically important drug interaction. Saw palmetto is an herbal supplement commonly used for benign prostatic hyperplasia (BPH) symptoms, while Xarelto is an anticoagulant medication that prevents blood clots. Unlike some herbal supplements that can affect blood clotting (such as ginkgo biloba or garlic supplements), saw palmetto has not been shown to significantly alter the anticoagulant effects of Xarelto or increase bleeding risk when used together, as supported by the lack of mention in recent guidelines and studies 1.
Some key points to consider when taking Xarelto and saw palmetto together include:
- Informing your healthcare provider about all supplements you're taking, including saw palmetto, as individual responses can vary and new information about interactions may emerge.
- Monitoring for any unusual bleeding or bruising while taking these together, and contacting your healthcare provider promptly if such symptoms occur.
- Being aware that Xarelto's metabolism and clearance can be affected by strong inhibitors or inducers of CYP3A4 and P-glycoprotein, but saw palmetto is not known to significantly interact with these pathways 1.
- Understanding that the current evidence base does not support a significant interaction between Xarelto and saw palmetto, but ongoing research and updates to clinical guidelines may provide further clarification in the future.
From the Research
Interaction between Xarelto and Saw Palmetto
- The interaction between Xarelto (rivaroxaban) and saw palmetto is not well-studied, but there are some reports and studies that provide insight into potential interactions.
- A study published in 2022 found that saw palmetto is not associated with bleeding risk when used alone 2.
- However, a case report published in 2014 suggests that saw palmetto may have contributed to a bleeding event in a patient taking rivaroxaban, although the exact mechanism is unclear 3.
- Another study published in 2009 found no reported interactions between saw palmetto and conventional drugs, including anticoagulants like rivaroxaban 4.
- It is essential to note that herbal products, including saw palmetto, can interact with anticoagulants like rivaroxaban by inhibiting P-glycoprotein and cytochrome P450 3A4 activity, which can increase the risk of bleeding 3.
Bleeding Risk with Anticoagulants
- The use of anticoagulants like rivaroxaban can increase the risk of bleeding, and concomitant use with other medications or herbal products can further increase this risk.
- A study published in 2022 found that concomitant use of diltiazem with direct oral anticoagulants, including rivaroxaban, was associated with an increased risk of bleeding-related hospitalization 5.
- Another study published in 2020 found that the use of warfarin with nonsteroidal anti-inflammatory drugs (NSAIDs) increased the risk of gastrointestinal bleeding and general bleeding 6.
Clinical Implications
- Clinicians should be aware of the potential interactions between rivaroxaban and saw palmetto, as well as other herbal products, and monitor patients closely for signs of bleeding.
- Patients taking rivaroxaban should report any use of herbal products, including saw palmetto, to their physicians to minimize the risk of bleeding complications.