MajorNon-steroidal anti-inflammatory drugs (NSAIDs)×Direct oral anticoagulants (factor Xa inhibitors)
Updated · Methodology
Mechanism
Additive GI bleeding risk: anticoagulant (rivaroxaban) + ulcerogenic NSAID with antiplatelet effect (ibuprofen).
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 ibuprofen is needed for a short course, use the minimum effective dose for 5–7 days under pantoprazole cover. For chronic analgesia: paracetamol, celecoxib, 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
- AEMPS: Ficha técnica: Ibuprofeno (nº registro 63597), sección 4.4 (2025)– AEMPS, CIMA, nº registro 63597, revisión 04/2025, sección 4.4