Major
Established
الوصف
Cyclosporine, a strong dual inhibitor of CYP3A4 and P-glycoprotein, substantially increases rivaroxaban exposure and bleeding risk.
الآلية
Rivaroxaban depends on CYP3A4 for metabolism and P-gp for intestinal efflux; cyclosporine inhibits both, increasing rivaroxaban AUC by up to 50%.
الأهمية السريرية
This combination is generally contraindicated in post-transplant patients who may also have organ-specific bleeding risks.
التدبير
Avoid combination; consider alternative anticoagulation strategies in transplant recipients requiring anticoagulation.