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 6 documented pairs we have explicitly assessed against Rivaroxaban in the Distil database: 5 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 June 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 Curcumin interact with ?
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: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Additive antiplatelet effect
Amber Does Fisetin interact with ?
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: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Omega-3 EPA interact with ?
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, based on case reports and a known mechanism.
Amber Does Resveratrol interact with ?
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: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Vitamin E interact with ?
Vitamin E at high doses (above 400 IU per day) can raise bleeding risk in its own right, which could add to rivaroxaban. At low supplement doses (100 to 200 IU) the effect is minimal. Rivaroxaban has no INR test to monitor this, so keep vitamin E modest and tell your GP if you take high-dose vitamin E. Stop it six weeks before planned surgery.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Other
Green Does Vitamin K2 interact with ?
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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How we grade severity, choose what's in scope, and what we exclude.
Every call on this page is reasoned. We publish the full rubric for severity tiers, the medication inclusion logic, the evidence grades we accept, and what we deliberately leave out. About three thousand words. Worth reading once if you use this tool more than occasionally.
Read the full methodologyA full supplement review, built around you, not a generic stack.
The free checker answers one interaction question at a time. A Distil report reviews the bigger picture: your goals, diet, medications, current supplements and any blood results you provide, then shows what appears worth keeping, changing, adding or leaving out.
- what your diet already covers, so you are not adding a capsule for something food is already handling
- which evidence-graded compounds are worth considering for your goals, and which were considered but left out
- what to keep, change or stop from what you already take, plus the order to introduce anything new
- how your medications and complete supplement stack fit together, with daily timing and a clear point for reassessment
The interaction check is one section of the full report. You also get the reasoning behind each recommendation and the evidence references used.
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