rivaroxaban and acetylsalicylic acid

B01AF51

Forms & Strengths

Co-packaged combination: Rivaroxaban 2.5 mg and Acetylsalicylic acid (Aspirin) 100 mg tablets
Co-packaged combination: Rivaroxaban 2.5 mg and Acetylsalicylic acid (Aspirin) 75 mg tablets

Adult Dosing

Reduction of risk of major cardiovascular events in patients with coronary artery disease (CAD) or peripheral artery disease (PAD): 2.5 mg rivaroxaban twice daily plus 75-100 mg aspirin once daily

Pediatric Dosing

Indications

Reduction of the risk of major cardiovascular events (cardiovascular death, myocardial infarction, and stroke) in patients with coronary artery disease (CAD)
Reduction of the risk of major thrombotic vascular events (myocardial infarction, ischemic stroke, acute limb ischemia, and mortality) in patients with peripheral artery disease (PAD), including those after lower extremity revascularization

Mechanism of Action

Rivaroxaban is a selective, direct inhibitor of Factor Xa, interrupting the intrinsic and extrinsic coagulation pathways and inhibiting thrombin formation
Acetylsalicylic acid (aspirin) inhibits cyclooxygenase (COX-1 and COX-2) irreversibly, preventing the synthesis of thromboxane A2 and thereby inhibiting platelet aggregation for the lifespan of the platelet

Contraindications

Active pathological bleeding (such as intracranial hemorrhage or peptic ulcer)
Severe hypersensitivity to rivaroxaban, acetylsalicylic acid, or any component of the formulation
History of asthma, rhinitis, or nasal polyps triggered by salicylate or NSAID administration (due to aspirin component)
Children and teenagers recovering from viral infections due to the risk of Reye's syndrome (due to aspirin component)

Adverse Reactions

Major and minor bleeding events (epistaxis, gastrointestinal hemorrhage, hematuria)
Anemia
Gastrointestinal distress, dyspepsia, nausea, and abdominal pain
Gastric or duodenal ulcers
Bruising and ecchymosis
Hypersensitivity reactions, including rash and pruritus

Drug Interactions

Concomitant use with other anticoagulants, antiplatelet agents, NSAIDs, SSRIs, or SNRIs significantly increases the risk of bleeding
Strong dual inhibitors of CYP3A4 and P-glycoprotein (e.g., ritonavir, ketoconazole) increase rivaroxaban exposure and bleeding risk
Strong dual inducers of CYP3A4 and P-glycoprotein (e.g., rifampin, carbamazepine, St. John's wort) decrease rivaroxaban efficacy
Aspirin may antagonize the natriuretic effect of loop diuretics and interact with ACE inhibitors/ARBs, increasing the risk of renal impairment

Curated Content: Needs Vetting Before Put to Clinical Use