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