Supplements and Rivaroxaban.
Rivaroxaban, sold under the brand name Xarelto, is a direct oral anticoagulant (DOAC): it inhibits factor Xa or thrombin directly, without routine INR monitoring.
Rivaroxaban is a direct oral anticoagulant (DOAC) and a direct factor Xa inhibitor. UK prescribing covers atrial fibrillation stroke prevention and venous thromboembolism treatment. Among DOACs it sits second in England behind apixaban. Dosing is once daily, where apixaban is twice daily; that timing advantage is the main reason for its use over apixaban in some patients. On supplements, the surface is similar to apixaban. Rivaroxaban is metabolised by CYP3A4 and is a P-glycoprotein substrate, so strong dual 3A4 plus P-gp inhibitors raise plasma levels. Additive antiplatelet or fibrinolytic supplements (fish oil at high doses, ginkgo, garlic extract, curcumin, bromelain, andrographis, nattokinase) add to bleeding risk without changing plasma rivaroxaban. One clinically important contrast with warfarin. Vitamin K does not reverse rivaroxaban. And the antidote (andexanet alfa) is not routinely available, so excess anticoagulation has fewer rescue options. Washout before surgery is 24 to 48 hours depending on renal function and bleeding risk. Supplement washout should align with it.
Below are the 9 documented pairs we have explicitly assessed against Rivaroxaban in the Distil database: 8 amber and 1 green. The pairs cluster around 2 mechanisms: Additive anticoagulation and Additive antiplatelet effect. Every call is cited to either a clinical reference (PMID) or the British National Formulary. Anything not on this list is either still to be assessed or beyond our database scope. The checker beneath surfaces assessments by supplement, and the missing-item form at the bottom of the page routes any uncatalogued supplement into our next curation pass.
Documented interactions
Last reviewed 14 September 2026. Each interaction below lists the evidence its assessment drew on: some rest on studies of the exact pair, others on mechanism evidence, where a citation may support one part of the reasoning rather than the exact combination. The evidence line on each entry says which.
Additive anticoagulation
Amber Does Andrographis interact with Rivaroxaban?
Andrographis may raise rivaroxaban levels by slowing the gut enzymes and pumps that clear it, and it has a mild blood-thinning action of its own, so the concern is added bleeding risk. Studies of andrographis with rivaroxaban have not been done, so this is a judgement from mechanism rather than a measured effect. If you take rivaroxaban, tell your doctor or pharmacist before starting andrographis and watch for unusual bruising, nosebleeds, or blood in your urine or stool.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Bromelain interact with Rivaroxaban?
Bromelain may add to rivaroxaban's bleeding risk. Its effect on blood clotting has been seen mainly in laboratory tests, though in one small 1972 study bromelain tablets reduced platelet clumping in volunteers. The only data on bromelain alongside a blood thinner, from surgical patients on a preventive dose of heparin, found their clotting tests little changed, but no study has tested bromelain with rivaroxaban or in anyone taking a full-dose blood thinner for months. Tell whoever prescribes your rivaroxaban before starting bromelain, watch for unusual bruising, nosebleeds or bleeding gums, and stop it about two weeks before any planned surgery or dental work.
Evidence: Limited human data, from small studies or case reports.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Curcumin interact with Rivaroxaban?
Curcumin has a mild blood-thinning effect of its own, so combining it with rivaroxaban may add slightly to the bleeding risk. There is no strong human evidence either way, so the sensible step is to tell your GP you take it and stop curcumin before any planned surgery or dental work.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Additive antiplatelet effect
Amber Does Fisetin interact with Rivaroxaban?
Fisetin may mildly thin the blood by reducing platelet clumping, which could add to rivaroxaban. Rivaroxaban has no routine blood test to track this, so keep any fisetin course modest and tell your GP if you take both. The amount in food is not the concern.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Ginkgo Biloba interact with Rivaroxaban?
Ginkgo may add to rivaroxaban's bleeding risk, so we would not start it alongside rivaroxaban without your prescriber agreeing, and there is no INR blood test on rivaroxaban to pick up a problem early the way there is on warfarin. Rivaroxaban is usually taken once a day with food, which gives a higher peak level than a twice-daily tablet, so anything that nudges absorption upward lands on an already higher peak. Trials in people have not measured a change in clotting from ginkgo at the 120 to 240mg doses sold in the UK, so the caution rests on published reports of bleeding in ginkgo users, and if you continue both you should watch for unusual bruising, nosebleeds or black stools and stop the ginkgo at least two weeks before planned surgery or dental work.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Omega-3 EPA interact with Rivaroxaban?
At supplement doses below 1 gram of EPA+DHA per day, fish oil adds little to rivaroxaban's bleeding risk. At higher cardiology doses (3 grams per day and above) the antiplatelet effect is more meaningful and the combined bleeding risk rises. Rivaroxaban has no INR test to monitor this, so tell your GP what dose of fish oil you take.
Evidence: Limited human data, from small studies or case reports.
Amber Does Resveratrol interact with Rivaroxaban?
Resveratrol can mildly thin the blood by reducing platelet clumping, which could add to rivaroxaban. Rivaroxaban has no routine blood test to track this, so keep any resveratrol dose modest and tell your GP if you take both. Food amounts are not the concern.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Vitamin E interact with Rivaroxaban?
Vitamin E at high doses (above 400 IU per day) can raise bleeding risk in its own right, which could add to rivaroxaban. Lower doses have not been studied with rivaroxaban, and a pooled analysis of the trials behind vitamin E's own bleeding signal did not find that the dose explained it, so a low dose cannot be assumed to be free of it. Rivaroxaban has no INR test to monitor this, so tell whoever prescribes your rivaroxaban before taking vitamin E at any dose, and stop vitamin E at least two weeks before planned surgery.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Other
Green Does Vitamin K2 interact with Rivaroxaban?
Rivaroxaban is not a warfarin-type blood thinner, so vitamin K does not work against it the way it works against warfarin. Vitamin K2 does not reduce rivaroxaban's effect. If you are on rivaroxaban rather than warfarin, this is a common worry that does not apply to you.
Evidence: Well established across multiple human studies or interaction references.
What this list does not say. Pairs not flagged here are not implicitly safe. They are either not yet in our database, or fall outside our inclusion scope (food-supplement interactions only; for drug-drug interactions, the BNF is authoritative). Use the checker below to surface any supplement, and submit a missing item if you take something we have not catalogued.
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