Does Sertraline interact with Xarelto? (3+ safety measures)

In this article, we will discuss the interaction between Sertraline and Xarelto, along with the risks associated with concurrently taking these medications. This article will also include some of the safety measures that can be observed to prevent possible complications.

Does Sertraline interact with Xarelto?

Yes, Sertraline (Zoloft) can interact with Xarelto (Rivaroxaban). Although indicated for treating different health conditions, the interaction of these medications may cause certain risks and potential complications.

What is the interaction between Sertraline and Xarelto?

The interaction between Sertraline and Xarelto is the increased risk of bleeding. When used individually, both medications can be well tolerated. However, using these two together can cause some severe side effects (1).

Xarelto is a blood thinner which works by inhibiting the blood’s ability to clot easily, thereby preventing the formation of blood clots (2). Sertraline, on the other hand, is an antidepressant used to treat various mental health conditions, such as depression and anxiety, by increasing serotonin in the brain which can help improve mood and reduce symptoms of the said conditions (3).

Despite being used as an antidepressant, Sertraline can cause thinning of blood by inhibiting the clumping of the platelets (4), which is a vital process for blood clotting.

Due to this, the use of Sertraline, along with other antidepressants including Fluoxetine, Paroxetine, and Fluvoxamine, is generally avoided when taking Xarelto.

In some cases, your healthcare provider will prescribe and recommend the use of these medications together only if it is beneficial for your condition despite the risk that it imposes.

What to do if you’re bleeding while on Sertraline and Xarelto?

If you experience unusual bleeding, such as nosebleeds, vomiting of blood, and heavy menstrual flow (6), you should get in touch with your doctor immediately.

The degree of severity may differ for each person, your doctor will assess you and will observe safety measures that can be applied to manage your condition.

What to do if you have taken Sertraline and Xarelto together?

If you have taken Sertraline and Xarelto together, you should immediately contact your healthcare provider. Upon consultation, the following precautions and safety measures may be observed and recommended by your physician:

  • Dosage Adjustment. Your physician may need to adjust the dose of either of these medications to prevent or minimize the risk of bleeding while ensuring that both conditions being treated are appropriately managed.
  • Adjustment of Dosing Schedule. To reduce the risk of bleeding, your healthcare provider may recommend that you take these medications at a different time of day.
  • Regular Monitoring. Close monitoring of your symptoms through regular check-ups and laboratory tests may be performed by your physician to assess the safety and effectiveness of the medication treatment.
  • Adherence to Medication Regimen. Make sure to take your medications as prescribed by your healthcare provider – do not skip doses or make any adjustments to your regimen without consulting them.

What are the alternatives to Sertraline when taking Xarelto?

To avoid the risk of the interaction between Sertraline and Xarelto, your healthcare provider may consider the use of other antidepressants such as Citalopram, Venlafaxine, and Mirtazapine that have less interaction and are deemed safer (5).

However, make sure you do not make any changes to your prescription without talking to your doctor first.


This article discussed the drug interaction between Sertraline and Xarelto – how taking these two medications concomitantly can impose an increased risk of bleeding.

Precautions and safety measures that can be employed to ensure the safety of the medication therapy were also stated, as well as the alternative antidepressants that can be considered to lessen the risk of bleeding.

It is important to assess both the benefits and risks of taking these medications simultaneously – always consult your healthcare provider regarding the medications that you are taking to prevent further health complications.

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Bruni-Montero MÁ, Caro-Teller JM, Hernández-Ramos JA, Rosas-Espinoza C, Canales-Siguero D, Ferrari-Piquero JM. Rivaroxaban and selective serotonin reuptake inhibitors: Bleeding risk resulting from their concomitant use. Farm Hosp [Internet]. 2021 December 1 [cited 2023 October 4]; 46 (1): 10-14. Available from:


Medline Plus. Rivaroxaban: MedlinePlus drug information [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2023 April 15; cited 2023 October 4]. Available from:


Medline Plus. Sertraline: MedlinePlus drug information [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2022 January 15; cited 2023 October 4]. Available from:


Eslami Shahrbabki M, Eslami Shahrbabaki A. Sertraline-Related Bleeding Tendency: Could It Be Dose-Dependent? Iran J Psychiatry Behav Sci [Internet]. 2014 [cited 2023 October 4]; 8 (3):81-3. Available from:


Aguilar C. Treatment of Depression in Patients on Anticoagulation Therapy: Antidepressant-Rivaroxaban Drug Interactions. Drug Metab Toxicol [Internet]. 2016 October 15 [cited 2023 October 4]; 7: 215. Available from:


1.      Halperin D, Reber G. Influence of antidepressants on hemostasis. Dialogues Clin Neurosci [Internet]. 2007 March [cited 2023 October 4]; 9 (1): 47-59. Available from:

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