MajorAntiepileptics. Carboxamide derivatives×Direct oral anticoagulants (factor Xa inhibitors)
Updated · Methodology
Mechanism
As with apixaban, carbamazepine induces CYP3A4 and P-glycoprotein, and rivaroxaban levels fall. Rifampicin, an inducer of the same strength, lowers rivaroxaban AUC by about 50%. Anticoagulation loses effect, with a higher risk of stroke and recurrent thrombosis.
Symptoms
Ischemic stroke in atrial fibrillation patient or recurrent venous thrombosis on apparently active anticoagulant.
Management
Avoid the combination: this is what the rivaroxaban labels say (AEMPS, FDA), and the carbamazepine label calls for close watch for signs of thrombosis if the pair cannot be avoided. If carbamazepine cannot be replaced, switch to warfarin with a target INR of 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.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- EMA: Xarelto (rivaroxaban) Summary of Product Characteristics (2024)
- FDA: Xarelto (rivaroxaban) prescribing information (2011)– ; DailyMed setid 10db92f9-2300-4a80-836b-673e1ae91610
- AEMPS: Ficha técnica: Rivaroxabán (nº registro 08472018), sección 4.5 (2026)– AEMPS, CIMA, nº registro 08472018, sección 4.5, texto de la EMA publicado en CIMA, consultado en septiembre de 2026
- AEMPS: Ficha técnica: Carbamazepina (nº registro 62621), sección 4.5 (2025)– AEMPS, CIMA, nº registro 62621, sección 4.5
- FDA: Rivaroxaban Tablets – Prescribing Information (2026)– FDA, DailyMed SPL, Micro Labs, разделы 5.6 и 7.3, пересмотр этикетки 09/2026