Does Xarelto interact with cranberry juice? (3+ facts)

This article will answer the question, “Does Xarelto interact with cranberry juice?” We will also discuss the foods, drinks and herbal medications to avoid during Xarelto treatment. Additionally, we will discuss the precautionary measures to take while on Xarelto treatment. 

Does Xarelto interact with cranberry juice? 

No, Xarelto does not interact with cranberry juice, but it does interact with grapefruit and its juice. Taking grapefruit juice along with Xarelto can increase the risk of bleeding. (1)

Xarelto is an anticoagulant/blood-thinning agent which is used as a prophylaxis to prevent clot formation in the system, which can lead to potentially life-threatening conditions. Unlike warfarin, Xarelto does not interact with many fruits or foods that contain vitamins K and C. However, the foods or drugs which inhibit the action of the CYP3A4/5 enzyme can fluctuate the levels of Xarelto in the body and increase the risk of bleeding. (1,2,3)

It is important to consult a physician before consuming any over-the-counter medication. Have knowledge about the food which can interact with Xarelto and consume it in a small amount or avoid it completely. 

What does the research suggest? 

A study by Wanwimolruk et al. demonstrated the effect of cranberry dietary supplements on the CYP3A4 enzyme. They found that cranberry has minimal or no inhibitory effect on the CYP3A4 enzyme. (3)

CYP3A4 enzyme is necessary in the metabolism of the drug. It belongs to the family of Cytochrome P450 isoenzyme which metabolised almost 90% of drugs used clinically. Metabolism of the drug is essential in order to eliminate the drug from the body. (3)

Xarelto is primarily metabolised by CYP3A4/5 and CYP2J2 enzymes. Since Cranberry does not inhibit the action of CYP3A4 enzymes, it is safe along with Xarelto. (1) When it comes to grapefruit, it inhibits CYP3A4 enzymes to a greater extent and, in turn, increases the concentration of Xarelto in the system, leading to toxicity and risk of bleeding. (4)

What are the foods, drinks and herbs that interact with Xarelto? 

Some foods, drinks and herbs can increase or decrease the plasma concentration of the drug in the system; here are some foods, drinks and herbs that can interact with Xarelto along with their mechanism. 

What are the things you need to avoid while taking Xarelto? 

It’s important to avoid certain fruits, beverages, and herbal medications while taking Xarelto to minimize the risk of adverse effects, such as oats, ginkgo, red clover, capsicum, cinnamon, saffron, turmeric, ginger, and many more. These dietary substances increase the risk of bleeding and other complications by increasing the concentration of Xarelto in the system. (5)

Drugs such as antidepressants (sertraline, fluoxetine), antifungals (ketoconazole, itraconazole), seizure drugs (phenytoin), antibiotics (clarithromycin, erythromycin, rifampicin), antiplatelet (clopidogrel), NSAIDs (ibuprofen, naproxen), aspirin, etc. can interact with Xarelto and affect its mechanism of action leading to complications. (6)

It is important to consult a physician and a dietitian before taking OTC medication or selecting any diet if you are consuming Xarelto.

What are the precautionary measures to take while on Xarelto? 

It is important to follow certain measures while taking Xarelto to avoid adverse effects. 

• Take Xarelto as prescribed by your physician, and do not change the course of your treatment without first consulting your physician. 
• Avoid taking any over-the-counter medication without consulting your physician. Some of the drugs, such as NSAIDs (ibuprofen, naproxen), aspirin, etc., can interact with Xarelto and increase the risk of bleeding. 
• Xarelto also interacts with antidepressants (sertraline, fluoxetine), antifungals (ketoconazole, itraconazole), seizure drugs (phenytoin), etc. 
• Avoid taking herbal supplements without a physician’s guidance because herbal drugs such as St. John’s wort, ginkgo, etc, can interact with Xarelto and increase the risk of bleeding. 
• Avoid eating grapefruit. Ginger, cinnamon, etc., as it can increase the risk of bleeding. Avoid activities that pose a risk of injury and bleeding. 
• Avoid taking a double dose of Xarelto, as it can increase the risk of bleeding. 
• If you missed a dose of Xarelto, take it as soon as possible on the same day. 
• If you experience any discomfort while taking Xarelto or have uncontrolled bleeding, seek medical help immediately. 
• It is important to attend all follow-up appointments to monitor treatment and adverse effects. 

In my experience

As per my knowledge, Xarelto does not interact with cranberry. However, there is a possible interaction between grapefruit and Xarelto. Have knowledge about the foods and drugs that may interact with Xarelto. Consult a healthcare physician if you are experiencing any unwanted side effects. I recommend you seek immediate medical help if you notice too much bruising, increased bleeding, severe headache, dizziness, etc.  

References