Ketoconazole and Rivaroxaban: Drug Interaction Guide
Quick answer: This is a major interaction — avoid combining Ketoconazole and Rivaroxaban unless specifically directed by your doctor.
How Ketoconazole interacts with Rivaroxaban
Ketoconazole is a strong dual inhibitor of CYP3A4 and P-glycoprotein, more than doubling rivaroxaban exposure and bleeding risk.
What you should do
Avoid concomitant use of rivaroxaban with systemic ketoconazole, itraconazole, voriconazole, or posaconazole. Use a different anticoagulant or antifungal.
Key facts
Severity
Major — avoid combination
Mechanism
Ketoconazole is a strong dual inhibitor of CYP3A4 and P-glycoprotein, more than doubling rivaroxaban exposure and bleedi...
Action
Avoid concomitant use of rivaroxaban with systemic ketoconazole, itraconazole, voriconazole, or posaconazole. Use a diff...
Frequently asked questions
Can I take Ketoconazole and Rivaroxaban together?
No — this combination should generally be avoided. Avoid concomitant use of rivaroxaban with systemic ketoconazole, itraconazole, voriconazole, or posaconazole. Use a different anticoagulant or antifungal.
What is the severity of this interaction?
The interaction between Ketoconazole and Rivaroxaban is classified as Major — avoid combination. Ketoconazole is a strong dual inhibitor of CYP3A4 and P-glycoprotein, more than doubling rivaroxaban exposure and bleeding risk.
What should I do if I'm prescribed both?
Avoid concomitant use of rivaroxaban with systemic ketoconazole, itraconazole, voriconazole, or posaconazole. Use a different anticoagulant or antifungal. Always consult your prescribing clinician — do not stop or change medications without medical guidance.
Last reviewed: by iMedic Medical Editorial Team. Our editorial process.