Rivaroxaban and St Johns Wort: Drug Interaction Guide

Quick answer: This is a major interaction — avoid combining Rivaroxaban and St Johns Wort unless specifically directed by your doctor.

Interaction severity: Major — avoid combination

How Rivaroxaban interacts with St Johns Wort

St John's wort induces CYP3A4 and P-glycoprotein, increasing rivaroxaban metabolism and efflux. Anticoagulant exposure may fall, increasing thrombotic risk.

What you should do

Avoid the combination. Advise patients not to use St John's wort while taking rivaroxaban.

Key facts

Severity

Major — avoid combination

Mechanism

St John's wort induces CYP3A4 and P-glycoprotein, increasing rivaroxaban metabolism and efflux. Anticoagulant exposure m...

Action

Avoid the combination. Advise patients not to use St John's wort while taking rivaroxaban.

Important medical disclaimer: This page provides educational information about drug interactions for general reference. It is not a substitute for professional medical advice, diagnosis, or treatment. Always discuss your specific medications with a qualified healthcare provider before starting, stopping, or changing any treatment. About our editorial team.

Frequently asked questions

Can I take Rivaroxaban and St Johns Wort together?

No — this combination should generally be avoided. Avoid the combination. Advise patients not to use St John's wort while taking rivaroxaban.

What is the severity of this interaction?

The interaction between Rivaroxaban and St Johns Wort is classified as Major — avoid combination. St John's wort induces CYP3A4 and P-glycoprotein, increasing rivaroxaban metabolism and efflux. Anticoagulant exposure may fall, increasing thrombotic risk.

What should I do if I'm prescribed both?

Avoid the combination. Advise patients not to use St John's wort while taking rivaroxaban. Always consult your prescribing clinician — do not stop or change medications without medical guidance.

Last reviewed: by iMedic Medical Editorial Team. Our editorial process.