Drug General Information (ID: DDID6SX5P2)
Drug Name			Diclofenac		Drug Info		Rivaroxaban		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Nsaids/Analgesics				Anticoagulants/Factor Xa Inhibitors
Structure

Mechanism of Diclofenac-Rivaroxaban Interaction (Severity Level: Major)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Diclofenac				Rivaroxaban
Mechanism		Risk of bleeding Antiplatelet effects				Risk of bleeding Anticoagulant
Key Mechanism Factor 1
		Factor Name		Bleeding
		Factor Description		Patients may be at risk for bleeding when the outcome of a disease or disease treatment confounds the standard mechanisms for maintaining hemostasis. Signs or symptoms of abnormal bleeding include: bleeding that takes a long time to stop (including nosebleeds, bleeding gums, bleeding from cuts and abrasions, and menstrual bleeding); severe unexplained bruising, or bruising that becomes larger; blood in the urine or stool, etc.
Mechanism Description		Increased risk of bleeding by the combination of Diclofenac and Rivaroxaban

Recommended Action
Management		Caution is recommended if rivaroxaban must be used with other agents that alter hemostasis. Patients should be monitored for increased anticoagulant effects and bleeding complications. In patients undergoing neuraxial intervention, coadministration of these agents should be approached with caution and only after thorough assessment of risks and benefits. Besides bleeding complications, patients should also be monitored frequently for signs and symptoms of neurologic impairment such as midline back pain, sensory and motor deficits (numbness or weakness in lower limbs), and bowel or bladder dysfunction.

References
1	Product Information. Xarelto (rivaroxaban). Bayer Inc, Toronto, IA.