MajorNon-steroidal anti-inflammatory drugs (NSAIDs)×Direct oral anticoagulants (factor Xa inhibitors)
Updated · Methodology
Mechanism
Additive GI bleeding risk: anticoagulant (rivaroxaban) + ulcerogenic NSAID (diclofenac). Diclofenac additionally raises cardiovascular risk.
Symptoms
Black or tarry stools (melena), vomiting blood or coffee-ground material, epigastric pain. Risk multiplies in older patients and with prior peptic ulcer disease.
Management
Avoid prolonged combination. If diclofenac is needed for a short course, use the minimum effective dose for 5–7 days under pantoprazole cover. For chronic analgesia: paracetamol, celecoxib (less GI toxicity), or topical NSAIDs.
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
- FDA: Xarelto (rivaroxaban) prescribing information (2011)– ; DailyMed setid 10db92f9-2300-4a80-836b-673e1ae91610
- EMA: Xarelto (rivaroxabán) – ficha técnica en CIMA (2026)– AEMPS CIMA, Xarelto 20 mg comprimidos recubiertos con película, nº registro 08472018 (EU/1/08/472), secciones 4.3, 4.4 y 4.5