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Rivaroxaban and azole antifungal — GPhC CRA MCQ

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HardDrug InteractionsRivaroxaban and azole antifungalGPhC CRA

A 67-year-old man takes rivaroxaban 20mg once daily for AF. He asks to buy oral fluconazole for recurrent thrush after antibiotics. He has eGFR 38mL/min/1.73m2 and reports easy bruising over the past week. What is the most important interaction to flag?

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Correct answer: EFluconazole may increase rivaroxaban exposure and bleeding risk

Azole antifungals can increase exposure to some DOACs through metabolic and transporter inhibition, increasing bleeding risk. Reduced renal function and existing bruising increase concern. The patient should be referred for assessment and a safer antifungal approach. The interaction is not loss of anticoagulant effect.

Reference: BNF Rivaroxaban interactions; BNF Fluconazole