Rivaroxaban and Nevirapine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Nevirapine
Rivaroxaban
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Reduced plasma concentrations of rivaroxaban
Interaction Deep Dive
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 rivaroxaban1.
Why it happens (mechanism)
Induction of CYP3A4-mediated rivaroxaban metabolism by nevirapine
Literature reports
1 report — tap to read
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 1.
Common questions
Can I take Rivaroxaban and Nevirapine together?
Reduced plasma concentrations of rivaroxaban Always confirm with your pharmacist or prescriber before making any change.
How serious is the Rivaroxaban and Nevirapine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Rivaroxaban or Nevirapine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Bates D, Dalton B, Gilmour J, et al: Venous thromboembolism due to suspected interaction between rivaroxaban and nevirapine. Can J Hosp Pharm 2013; 66(2):125-129.
Keep reading about Nevirapine
Keep reading about Rivaroxaban
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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