Does Ketoconazole Interact With Rivaroxaban?

7.2 Drugs that Inhibit Cytochrome P450 3A Enzymes and Drug Transport Systems Interaction with Combined P-gp and Strong CYP3A Inhibitors Avoid concomitant administration of XARELTO with known combined P-gp and strong CYP3A inhibitors (e.g., ketoconazole and ritonavir) [see Warnings and Precautions (5.6) and Clinical Pharmacology (12.3) ] .

Severity: Major

Severity basis: drug interactions section (keywords: avoid). Combining Ketoconazole (Azole antifungal (strong CYP3A4 inhibitor)) and Rivaroxaban (Factor Xa inhibitor anticoagulant) is classified as a major interaction.

What to Do

The label advises avoiding this combination or using it only under close medical supervision. Talk to your prescriber or pharmacist before combining them.

From the FDA Label

7.2 Drugs that Inhibit Cytochrome P450 3A Enzymes and Drug Transport Systems Interaction with Combined P-gp and Strong CYP3A Inhibitors Avoid concomitant administration of XARELTO with known combined P-gp and strong CYP3A inhibitors (e.g., ketoconazole and ritonavir) [see Warnings and Precautions (5.6) and Clinical Pharmacology (12.3) ] .

Source: FDA structured product labeling (set_id 10db92f9-2300-4a80-836b-673e1ae91610).

Ketoconazole

Azole antifungal (strong CYP3A4 inhibitor)

Brands: Nizoral

View Ketoconazole safety profile

Rivaroxaban

Factor Xa inhibitor anticoagulant

Brands: Xarelto

View Rivaroxaban safety profile

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This information is educational — not medical advice.

This page is provided for general educational purposes and summarizes publicly available data from sources such as the U.S. Food & Drug Administration. It is not a substitute for the judgment of a licensed clinician and should not be used to start, stop, or change any medication. It may be incomplete or out of date, and individual circumstances vary. Always talk with your prescriber or pharmacist about your specific medications and health conditions. If you think you may have a medical emergency, call 911.

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