Does Ketoconazole Interact With Rivaroxaban?

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

Interactions like this one can happen when two medicines have overlapping effects, or when one changes how the other is absorbed, broken down, or cleared from the body. Ketoconazole is a azole antifungal (strong cyp3a4 inhibitor) and Rivaroxaban is a factor xa inhibitor anticoagulant; together they are documented as a major interaction. How much this matters depends on your dose, your other medications, and your overall health.

If you have been prescribed both Ketoconazole and Rivaroxaban, do not start, stop, or change either medication on your own — some medicines are unsafe to stop suddenly. Tell your prescriber and pharmacist that you take both so they can decide whether the combination is right for you, adjust the dose, monitor you more closely, or suggest an alternative.

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).