Drug & supplement interaction

Tree Of Heaven + Rivaroxaban

Rivaroxaban brand name: Xarelto.

Moderate Interaction
Medically reviewed by · Updated September 2026
The bottom line Moderate

Tree Of Heaven has a moderate interaction with Rivaroxaban. Theoretically, tree of heaven extract might reduce platelet aggregation and increase the risk of bleeding if used with antiplatelet or anticoagulant drugs.

Read the full interaction report
SeverityModerate
LikelihoodPossible
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Tree Of Heaven and Rivaroxaban

Here is the interaction we found between these two, with the evidence behind it.

Moderate

ANTICOAGULANT/ANTIPLATELET DRUGS

Why this applies to Rivaroxaban

Rivaroxaban falls under ANTICOAGULANT/ANTIPLATELET DRUGS — the group Tree Of Heaven interacts with.

Theoretically, tree of heaven extract might reduce platelet aggregation and increase the risk of bleeding if used with antiplatelet or anticoagulant drugs. In vitro evidence shows that tree of heaven crude extract attenuates epinephrine and adenosine diphosphate-induced platelet aggregation. This interaction has not been seen in humans. Until more is known, use with caution in patients taking anticoagulant or antiplatelet drugs.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the simple version for you. Rivaroxaban (Xarelto) is a blood thinner that already lowers your blood's ability to form clots. In lab dish studies, Tree of Heaven extract seemed to make platelets (the cells that help blood clot) a little less sticky. If that effect carried over into the body, stacking it on top of Xarelto could in theory nudge your bleeding risk up a bit.

I want to be honest about how soft this evidence is. This has only been seen in test tubes, never in actual people, so it's a theoretical concern, not a proven one. Still, since Xarelto on its own can cause easy bruising, nosebleeds, or longer bleeding from cuts, it's worth a quick chat with your pharmacist or doctor before adding this supplement.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Rahman HMA, Rasool MF, Imran I. Pharmacological Studies Pertaining to Smooth Muscle Relaxant, Platelet Aggregation Inhibitory and Hypotensive Effects of Ailanthus altissima. Evid Based Complement Alternat Med. 2019;2019:1871696.

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Tree Of Heaven Also Interacts With Other Medications

Tree Of Heaven has 121 moderate known drug interactions in our database — the Rivaroxaban one above is one of them. If you take anything else, check it against the full list below.

Moderate 121 No known interaction 2,709 (incl. Rivaroxaban)
Taking anything else?

Check Another of Your Medications Against Tree Of Heaven

Covers the 2,830 medications we’ve checked against Tree Of Heaven. Pick one to open its full report.

From our Q&A

Questions About Tree Of Heaven or Rivaroxaban

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Tree Of Heaven or Rivaroxaban, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Rivaroxaban

This page covers Tree Of Heaven only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Rivaroxaban page lists 285 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Danshen (major), Grapefruit (major), Piracetam (major) and St. John's Wort (major).

By severity: 5 major · 240 moderate · 40 minor.

From our pharmacist’s overview on the Rivaroxaban page

“Grapefruit is the interaction I would flag first for anyone taking rivaroxaban (Xarelto). It slows how the body clears this blood thinner, and higher levels mean more bleeding risk.”

Reviewed by 2 · Jul 18, 2026

Open the Rivaroxaban interaction page

One more smart check

Taking Tree Of Heaven as Part of a Dietary Supplement Product? Check It for Interactions

We hold 14 real supplement products containing Tree Of Heaven, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Tree Of Heaven. Your product may carry other ingredients that interact with Rivaroxaban too, on top of Tree Of Heaven — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Tree Of Heaven and Rivaroxaban Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Tree Of Heaven
Top half

#499 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Rivaroxaban
Top 1%

#26 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Tree Of Heaven

What is Tree Of Heaven?

  • Diarrhea and dysentery
  • Intestinal parasites
  • Menstrual or vaginal complaints
  • Asthma and cough (traditional use)
  • Skin conditions (topical, traditional use)

Tree of Heaven (Ailanthus altissima) is a fast-growing, invasive tree whose bark has been used in traditional medicine, mostly for digestive complaints and parasites. Modern scientific evidence in humans is very limited, and the plant can cause stomach upset and skin reactions, so it should be used cautiously and not without professional guidance.

Read the full Tree Of Heaven monograph & all interactions
Medication

About Rivaroxaban

What Is Rivaroxaban Used For?

Brand name: Xarelto

Rivaroxaban helps prevent and treat harmful blood clots. Across products, adults use it to lower stroke risk in nonvalvular atrial fibrillation, treat deep vein thrombosis (DVT) and pulmonary embolism (PE), and lower the chance those clots come back.

Rivaroxaban tablets are also used to prevent DVT after hip or knee replacement surgery and to prevent venous thromboembolism (VTE) in acutely ill medical patients. With aspirin, they reduce major cardiovascular events in coronary artery disease (CAD) and major thrombotic vascular events in peripheral artery disease (PAD). Children use it too: rivaroxaban for oral suspension (and Xarelto and Rivaroxaban tablets) is for VTE treatment and recurrence prevention from birth to under 18 years, and for clot prevention in children 2 and older with congenital heart disease after the Fontan procedure.

See full Rivaroxaban drug information
Keep checking

Other Drugs & Tree Of Heaven

Browse every other medication we’ve checked against Tree Of Heaven — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
121Moderate
0Minor
2,708No known interaction
121 Moderate 2,708 No interaction
Moderate

121 interactions

Showing 60 of 121 moderate interactions — see all 121 on the Tree Of Heaven page.

No interaction 2,708 drugs checked — show the list

We also checked Tree Of Heaven against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,708 medications checked with no known interaction — see the full Tree Of Heaven list.

See the full Tree Of Heaven interactions page
See every supplement checked against Rivaroxaban, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Tree Of Heaven monograph › Uses, safety, and every drug interaction in one place Rivaroxaban supplement interactions › Every supplement checked against Rivaroxaban, ranked by severity Rivaroxaban drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Tree Of Heaven and Rivaroxaban Together: Common Questions

Can you take Tree Of Heaven with Rivaroxaban?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Tree Of Heaven and Rivaroxaban interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Rivaroxaban and Tree Of Heaven?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.