OBJECT DRUGS

• Rivaroxaban (Xarelto)

PRECIPITANT DRUGS

Calcium Channel Blockers:

• Bepridil (Vascor)
• Diltiazem (Cardizem, etc.)
• Verapamil (Isoptin, etc.)

Comment:

These calcium channel blockers inhibit CYP3A4 and may increase the plasma concentration of rivaroxaban. Precipitant drugs that inhibit both CYP3A4 and P-glycoprotein may produce a larger increase in rivaroxaban concentrations.

Class 3: Assess Risk & Take Action if Necessary

• Consider Alternative: Dihydropyridine calcium channel blockers such as amlodipine (Norvasc), felodipine (Plendil), or nifedipine (Procardia) do not appear to inhibit CYP3A4 or P-glycoprotein and would not be expected to alter the rivaroxaban concentrations.
• Monitor: Monitor for altered rivaroxaban effect if one of these calcium channel blockers is initiated, discontinued or changed in dosage; adjustments of rivaroxaban dosage may be needed. If rivaroxaban is initiated in the presence of therapy with one of these agents, consider conservative doses of rivaroxaban.