Critical
Carbamazepine × Rivaroxaban
Antiepileptics. Carboxamide derivatives×Direct oral anticoagulants (factor Xa inhibitors)
Mechanism
Same mechanism as with apixaban: CYP3A4 and P-gp induction by carbamazepine drops rivaroxaban levels by 50%. Anticoagulation fails with stroke and recurrent thrombosis risk. EMA Xarelto SmPC Section 4.5 – combination not recommended.
Symptoms
Ischemic stroke in atrial fibrillation patient or recurrent venous thrombosis on apparently active anticoagulant.
Management
Combination contraindicated. If carbamazepine cannot be replaced, switch to warfarin with target INR 2.0–3.0. Alternative anticonvulsant: levetiracetam.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.