Is it safe to take Neuriva with Xarelto (rivaroxaban)?

Safety of Taking Neuriva with Xarelto (Rivaroxaban)

Taking Neuriva with Xarelto (rivaroxaban) is likely safe as there are no documented significant interactions between these products, but caution is warranted due to limited specific research on this combination.

Understanding Rivaroxaban (Xarelto) Interactions

Known Drug Interactions with Rivaroxaban

• Rivaroxaban is metabolized primarily via CYP3A4 and is a substrate of P-glycoprotein, making it susceptible to specific drug interactions 1
• Strong inhibitors of both CYP3A4 and P-glycoprotein (such as ketoconazole, itraconazole, voriconazole, posaconazole, and HIV protease inhibitors) can significantly increase rivaroxaban plasma concentrations and are not recommended for concomitant use 1
• Medications that strongly inhibit only CYP3A4 or only P-glycoprotein (like clarithromycin and erythromycin) should be used with caution with rivaroxaban 1
• Strong CYP3A4 inducers (rifampicin, phenytoin, carbamazepine, phenobarbital, St. John's wort) can reduce rivaroxaban plasma concentrations 1

Herbal Products and Supplements with Rivaroxaban

• Herbal products may potentially increase rivaroxaban levels by inhibiting P-glycoprotein and CYP3A4 activity 2
• St. John's wort specifically has been identified as a strong CYP3A4 inducer that can reduce rivaroxaban plasma concentrations 1
• There are documented cases where herbal supplements may have contributed to bleeding complications in patients taking rivaroxaban 2

Neuriva and Anticoagulants

• Neuriva is a brain health supplement containing primarily plant-derived ingredients (typically coffee fruit extract and phosphatidylserine)
• There are no specific guidelines or studies addressing interactions between Neuriva and rivaroxaban 1
• Unlike St. John's wort, Neuriva ingredients are not widely recognized as significant CYP3A4 or P-glycoprotein modulators 1

Risk Assessment and Recommendations

Bleeding Risk Considerations

• Rivaroxaban already carries a risk of bleeding complications, with a 5.6% chance of major bleeding reported 2
• Combining medications or supplements that might affect coagulation pathways requires careful consideration 1
• The addition of antiplatelet medications (like aspirin) to rivaroxaban has been shown to significantly increase bleeding time 1

Monitoring Recommendations

• Be vigilant for any signs of unusual bleeding or bruising when starting any new supplement while on rivaroxaban 1
• If taking both products, monitor for potential signs of increased anticoagulant effect such as:
  • Unusual bleeding or bruising 1
  • Blood in urine or stool 1
  • Severe headache or dizziness 1

Precautionary Measures

• Consult with your healthcare provider before starting Neuriva or any supplement while on rivaroxaban 1
• If you experience any signs of bleeding while taking this combination, seek medical attention promptly 1
• When discussing medications with healthcare providers, always mention all supplements being taken, including Neuriva 2

Conclusion

While there is no direct evidence suggesting a harmful interaction between Neuriva and rivaroxaban, the general principle of caution applies when combining any supplement with anticoagulant medications. The absence of specific interaction data does not guarantee safety, particularly since supplements are not regulated as strictly as prescription medications.