Rivaroxaban Interactions

Ginkgo biloba has antiplatelet properties and may theoretically add to the bleeding risk of rivaroxaban, although a controlled pharmacokinetic study with EGb 761 found no change in rivaroxaban plasma levels or anti-Factor Xa activity. The risk is primarily additive rather than pharmacokinetic.

Omega-3 fatty acids in fish oil have mild antiplatelet and anticoagulant effects, reducing thromboxane A2 and prolonging bleeding time. Combined with rivaroxaban's Factor Xa inhibition, this can additively increase bleeding risk, particularly at fish oil doses above 3 g per day.