Can Xarelto (rivaroxaban) be taken with Plavix (clopidogrel)?

From the Guidelines

Xarelto (rivaroxaban) should not be taken with Plavix (clopidogrel) unless specifically prescribed by your doctor, as it significantly increases bleeding risk. The combination of these two blood thinners creates a dangerous "double blood-thinning" effect, as Xarelto is an anticoagulant that prevents blood clots by inhibiting Factor Xa in the clotting cascade, while Plavix is an antiplatelet medication that works by preventing platelets from sticking together 1.

Key Considerations

• The study from the American College of Chest Physicians found that concomitant administration of rivaroxaban with other drugs that affect clotting can lead to increased bleeding risk 1.
• However, the study also found that the concomitant administration of rivaroxaban with aspirin did not alter the pharmacokinetic parameters of rivaroxaban, but did prolong bleeding time 1.
• It is essential to consult your healthcare provider before starting any additional medications, including over-the-counter drugs or supplements, as many can interact with Xarelto 1.

Important Interactions

• Strong inhibitors of CYP3A4 and P-glycoprotein, such as azole antimycotics and HIV protease inhibitors, can increase rivaroxaban plasma concentrations and should be avoided 1.
• Strong CYP3A4 inducers, such as rifampicin, can decrease rivaroxaban plasma concentrations and should be used with caution 1.

Clinical Implications

• If you're currently taking Xarelto, always take it exactly as prescribed, typically once or twice daily with food for the 20mg dose, and report any unusual bleeding or bruising to your doctor immediately.
• The American Heart Association and American Stroke Association recommend rivaroxaban as a reasonable alternative to warfarin for stroke prevention in nonvalvular atrial fibrillation, but emphasize the importance of careful patient selection and monitoring 1.

From the FDA Drug Label

You may have a higher risk of bleeding if you take XARELTO and take other medicines that increase your risk of bleeding, including: ... clopidogrel (Plavix ®) In two drug interaction studies where clopidogrel (300 mg loading dose followed by 75 mg daily maintenance dose) and XARELTO (15 mg single dose) were coadministered in healthy subjects, an increase in bleeding time to 45 minutes was observed in approximately 45% and 30% of subjects in these studies, respectively

The use of Xarelto (rivaroxaban) with Plavix (clopidogrel) may increase the risk of bleeding. Bleeding risk is a concern when these two medications are taken together, as evidenced by the increase in bleeding time observed in drug interaction studies 2 2. Therefore, caution is advised when considering concomitant use of Xarelto and Plavix.

From the Research

Interaction between Xarelto (rivaroxaban) and Plavix (clopidogrel)

• There is no direct evidence in the provided studies that discusses the interaction between Xarelto (rivaroxaban) and Plavix (clopidogrel) 3, 4, 5, 6, 7.
• However, it is known that rivaroxaban is an anticoagulant that works by inhibiting Factor Xa, while clopidogrel is an antiplatelet medication that works by inhibiting platelet activation 6.
• The study 6 discusses the use of rivaroxaban in combination with aspirin for secondary cardiovascular prevention, which suggests that rivaroxaban can be used with antiplatelet therapy, but it does not specifically address the use of rivaroxaban with clopidogrel.
• Another study 5 discusses the management of bleeding risk with rivaroxaban, which may be relevant when considering the use of rivaroxaban with other medications that affect bleeding risk, such as clopidogrel.

Practical Considerations

• When considering the use of Xarelto (rivaroxaban) with Plavix (clopidogrel), it is essential to weigh the potential benefits against the potential risks, including the risk of bleeding 5, 6.
• The decision to use these medications together should be made on a case-by-case basis, taking into account the individual patient's medical history, current medications, and clinical status.
• Close monitoring of the patient's condition and adjustment of the treatment plan as needed is crucial when using rivaroxaban with other medications that affect bleeding risk 5, 6.