Rivaroxaban with Sulfinpyrazone Interaction Details

Brand Names Associated with Rivaroxaban

Brand Names Associated with Sulfinpyrazone

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 14, 2023

Interaction Effect

Increased risk of bleeding

Interaction Summary

Coadministration of rivaroxaban and antiplatelet agents may increase the risk of bleeding. Coadministration of direct oral anticoagulant (DOAC; including rivaroxaban) and prescription antiplatelet therapy (predominantly clopidogrel) resulted in increased risk of major hemorrhage in a study of elderly patients who received a coronary artery stent compared to antiplatelet therapy alone , but coadministration of a DOAC (including rivaroxaban) and antiplatelet therapy (predominantly low-dose aspirin) did not significantly alter the incidence of major bleeding or clinically relevant non-major bleeding compared to DOAC therapy alone in another study of patients with VTE or atrial fibrillation . Promptly evaluate any signs or symptoms of blood loss that occur in a patient treated concomitantly. Discontinue rivaroxaban in patients with active pathological bleeding .

Severity

Major

Onset

Unspecified

Evidence

Theoretical

How To Manage Interaction

Coadministration of rivaroxaban and antiplatelet agents may increase the risk of bleeding. Promptly evaluate any signs or symptoms of blood loss that occur in a patient treated concomitantly. Discontinue rivaroxaban in patients with active pathological bleeding.

Mechanism Of Interaction

Additive effects on hemostasis

Literature Reports

A) Concomitant use of direct oral anticoagulant (DOAC) and antiplatelet therapy (APT; n=78) compared to DOAC therapy alone (n=329) did not significantly alter the incidence of major bleeding (1.3% vs 1.2%) or clinically relevant non-major bleeding (10.2% vs 6.4%) over 6 months of treatment in a retrospective study. Patients were primarily Caucasian men with a mean age of 63.7 years. Patients receiving concurrent APT had significantly higher mean body mass index (30.7 vs 28.4), mean CHA2DS2-VASc score (4.28 vs 3.85), and were more likely to have diabetes (26.9% vs 17.3%) compared with those prescribed DOAC monotherapy. DOACs were prescribed for VTE treatment or atrial fibrillation, and included apixaban (58.5%), rivaroxaban (38.1%), and dabigatran (3.4%). Single antiplatelet therapy was utilized in 94.9% (74 patients), with aspirin 81 mg once daily as the most common regimen (69 patients). Other APT regimens included aspirin 81 mg twice daily (3 patients), aspirin 325 mg daily (1 patient), clopidogrel 75 mg daily (1 patient), and dual APT with aspirin 81 mg and clopidogrel 75 mg daily (4 patients) .

B) In a retrospective study of patients 65 years or older who received a coronary artery stent (N=70,900), coadministration of direct oral anticoagulant (DOAC; dabigatran or rivaroxaban) and prescription antiplatelet therapy (predominantly clopidogrel) significantly increased the risk of major hemorrhagic events compared with antiplatelet therapy alone (HR, 2.36; 95% CI, 1.91 to 2.93) over 12 months following stent placement; this risk was similar to coadministration of warfarin and antiplatelets (HR, 2; 95% CI, 1.83 to 2.18). When patients were stratified by index atrial fibrillation (AF) status, the risk of major hemorrhagic events was also significantly increased with coadministration of DOAC and antiplatelet therapy for both AF (HR, 1.94; 95% CI, 1.48 to 2.54; n=10,238) and non-AF groups (HR, 3.09; 95% CI, 2.15 to 4.46; n=60,662). Hemorrhages in the first 30 days after stenting were considered periprocedural morbidity and excluded. The average observation period was 11.5 months, with 24.470,270 person-days of exposure; antiplatelet only therapy accounted for 73.8% of person-days of exposure, antiplatelets plus DOACs for 0.6%, and antiplatelets plus warfarin for 4.7% .

Rivaroxaban Overview

• 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.

Sulfinpyrazone Overview

• Sulfinpyrazone is used to treat gouty arthritis. It works by lowering the amount of uric acid in your blood, preventing gout attacks. The drug helps prevent attacks but will not treat an attack once it has started.

• This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

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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:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

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.