Can you take Xarelto (rivaroxaban) and Neuriva together?

Compatibility of Xarelto (Rivaroxaban) and Neuriva

Yes, you can take Xarelto (rivaroxaban) and Neuriva together as there are no known drug interactions between these medications.

Understanding Xarelto (Rivaroxaban)

Xarelto is a direct Factor Xa inhibitor anticoagulant used for:

• Prevention of stroke in non-valvular atrial fibrillation 1
• Treatment and prevention of venous thromboembolism 1
• Prevention of major adverse cardiovascular events in patients with coronary or peripheral artery disease 1

Pharmacokinetic Properties of Xarelto

• Absorbed rapidly with maximum plasma concentrations reached in 2-4 hours 2
• Bioavailability is high (80-100%) for the 10 mg tablet regardless of food intake 3
• For 15 mg and 20 mg tablets, should be taken with food to ensure high bioavailability 3
• Eliminated through multiple pathways including:
  • CYP3A4 and CYP2J2 metabolism 1
  • P-glycoprotein (P-gp) transport 1
  • Breast cancer resistance protein (BCRP) transport 1

Neuriva Supplement

Neuriva is a dietary supplement containing ingredients like phosphatidylserine and coffee cherry extract. As a supplement:

• Not regulated as strictly as prescription medications 1
• No documented interactions with rivaroxaban in available guidelines or research 1
• Contains natural ingredients that are not known to significantly affect CYP3A4, P-gp, or BCRP pathways that are important for Xarelto metabolism 1

Drug Interaction Considerations

Known Significant Interactions with Xarelto

Xarelto has documented interactions with:

• Strong CYP3A4 and P-gp inhibitors (contraindicated):

  • Azole antimycotics (ketoconazole, itraconazole, voriconazole, posaconazole) 1
  • HIV protease inhibitors 1

• Moderate CYP3A4 inhibitors (use with caution):

  • Clarithromycin (increases rivaroxaban exposure by 54%) 4
  • Erythromycin (increases rivaroxaban exposure by 34%) 4
  • Fluconazole (increases rivaroxaban exposure by 42%) 4

• Strong CYP3A4 inducers (use with caution):

  • Rifampicin (decreases rivaroxaban AUC by 50%) 1
  • Phenytoin, carbamazepine, phenobarbital, St. John's wort 1

• Antiplatelet agents and NSAIDs:

  • Increased bleeding risk when combined with aspirin or NSAIDs 1
  • Bleeding time significantly increased with combined use 1

Neuriva and Xarelto

• No evidence suggests Neuriva ingredients significantly inhibit or induce CYP3A4, P-gp, or BCRP 1
• Not listed among medications that interact with rivaroxaban in any guidelines 1
• Unlike medications such as ketoconazole that can increase rivaroxaban levels by 158% 4, Neuriva has no documented effect on rivaroxaban pharmacokinetics

Clinical Recommendations

• Neuriva can be taken with Xarelto as there are no documented interactions between these products 1
• Continue taking Xarelto as prescribed with food if using 15 mg or 20 mg tablets 3
• No dose adjustment of Xarelto is needed when taking Neuriva 1

Important Precautions

• Always inform all healthcare providers about all medications and supplements you are taking 1
• Monitor for any unusual bleeding or bruising, which could indicate excessive anticoagulation 5
• If starting any new medication or supplement, consult with your healthcare provider first 1
• Avoid other supplements known to affect blood clotting (such as high-dose vitamin E, ginkgo biloba, garlic supplements) without medical advice 1