Major
Ibuprofen × Rivaroxaban
Non-steroidal anti-inflammatory drugs (NSAIDs)×Direct oral anticoagulants (factor Xa inhibitors)
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.