Rivaroxaban with Nevirapine Interaction Details
Brand Names Associated with Rivaroxaban
- Rivaroxaban
- Xarelto®
Brand Names Associated with Nevirapine
- Nevirapine
- Viramune®
- Viramune® XR
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 14, 2023
Interaction Effect
Reduced plasma concentrations of rivaroxaban
Interaction Summary
Use caution when prescribing rivaroxaban to patients who take nevirapine. Concomitant use of nevirapine, an inducer of CYP3A, and rivaroxaban may decrease rivaroxaban exposure resulting in decreased efficacy and increased risk of venous thromboembolism. This risk is especially present in patients with HIV. A case of DVT was reported in a 60-year-old man with HIV who was regularly receiving nevirapine after administered 2 doses or rivaroxaban for DVT prophylaxis. Rivaroxaban was discontinued and the patient switched to and stabilized on warfarin. The Drug interaction Probability scale rated this as a possible drug interaction between nevirapine and rivaroxaban.
Severity
Major
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Use caution when prescribing rivaroxaban to patients who take nevirapine. Concomitant use of nevirapine, an inducer of CYP3A, and rivaroxaban may decrease rivaroxaban exposure resulting in decreased efficacy and increased risk of venous thromboembolism. This risk is especially present in patients with HIV.
Mechanism Of Interaction
Induction of CYP3A4-mediated rivaroxaban metabolism by nevirapine
Literature Reports
A) A 60-year-old man with HIV on a stable antiretroviral regimen, which included nevirapine 400 mg daily, underwent treatment for a total knee replacement and developed DVT after receiving 2 doses of rivaroxaban. Twenty-four hours after initial discharge, the patient presented back to the hospital with dyspnea, electrocardiographic changes, and elevated troponin T, with a contrast-enhanced computed tomography confirming left-sided DVT. Rivaroxaban was discontinued and the patient was switched to and stabilized on warfarin. The Drug Interaction Probability scale rated this as a possible drug interaction between nevirapine and rivaroxaban .
Rivaroxaban Overview
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Rivaroxaban is used to treat deep vein thrombosis (DVT; a blood clot, usually in the leg) and pulmonary embolism (PE; a blood clot in the lung) in adults. Rivaroxaban is also used to prevent DVT and PE from happening again after initial treatment is completed in adults. It is also used to help prevent strokes or serious blood clots in adults who have atrial fibrillation (a condition in which the heart beats irregularly, increasing the chance of clots forming in the body, and possibly causing strokes) that is not caused by heart valve disease. Rivaroxaban is also used to prevent DVT and PE in adults who are having hip replacement or knee replacement surgery or in people who are hospitalized for serious illnesses and are at risk of developing a clot due to decreased ability to move around or other risk factors. It is also used along with aspirin to lower the risk of a heart attack, stroke, or death in adults with coronary artery disease (narrowing of the blood vessels that supply blood to the heart) or peripheral arterial disease (poor circulation in the blood vessels that supply blood to the arms and legs). Rivaroxaban is also used to treat and prevent DVT and PE from happening again in children and certain infants who have received at least 5 days of initial anticoagulation (blood thinner) treatment. It is also used to prevent DVT and PE after heart surgery in children 2 years of age or older who have congenital heart disease (abnormality in the heart that develops before birth). Rivaroxaban is in a class of medications called factor Xa inhibitors. It works by blocking the action of a certain natural substance that helps blood clots to form.
Nevirapine Overview
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Nevirapine is used along with other medications to treat human immunodeficiency virus (HIV) infection in adults and children 15 days of age and older. Nevirapine should not be used to treat healthcare workers or other individuals exposed to HIV infection after contact with HIV-contaminated blood, tissues, or other body fluids. Nevirapine is in a class of medications called non-nucleoside reverse transcriptase inhibitors (NNRTIs). It works by decreasing the amount of HIV in the blood. Although nevirapine does not cure HIV, it may decrease your chance of developing acquired immunodeficiency syndrome (AIDS) and HIV-related illnesses such as serious infections or cancer. Taking these medications along with practicing safer sex and making other life-style changes may decrease the risk of transmitting (spreading) the HIV virus to other people.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.