MajorAntituberculous antibiotic×Direct oral anticoagulants (factor Xa inhibitors)
Updated · Methodology
Mechanism
Rifampicin is a strong CYP3A4 + P-gp inducer. Rivaroxaban falls 50% – anticoagulation lost.
Symptoms
Stroke or recurrent VTE.
Management
Avoid the combination unless the patient can be closely watched for signs of thrombosis, as the EU SmPC and the FDA label of rivaroxaban state. During the rifampicin course rivaroxaban can be replaced with low molecular weight heparin. Warfarin is affected too: the rifampicin SmPC reports a 74% fall in S-warfarin exposure, so the dose is titrated to INR, checked more often than usual, including after rifampicin is stopped.
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 Rifaldin 300 mg cápsulas (rifampicina) (2026)– AEMPS, CIMA, nº registro 46029, revisión 03/2026, sección 4.5