What the FDA labels say about taking them together
Heparin and rivaroxaban
Heparin's FDA label (Heparin Sodium) of May 12, 2026 names rivaroxaban in its drug interactions section, and rivaroxaban's label names heparin too. The heparin label: “Avoid use of heparin after use of andexanet alfa for the reversal of direct Factor Xa inhibitors (apixaban and rivaroxaban).”
Check it at the source: the heparin FDA label on DailyMed (effective November 28, 2025, Fresenius Kabi USA, LLC); the rivaroxaban FDA label on DailyMed (effective September 10, 2026, Janssen Pharmaceuticals, Inc.).
What does the heparin label say about rivaroxaban?
Heparin Sodium label (Hospira, Inc., May 12, 2026), drug interactionsAvoid use of heparin after use of andexanet alfa for the reversal of direct Factor Xa inhibitors (apixaban and rivaroxaban).
Heparin Sodium label (Hospira, Inc., May 12, 2026), warnings and precautionsHeparin with Concomitant Use With Andexanet Alfa Unresponsiveness to unfractionated heparin leading to non-prolongation of activated clotting times and serious thrombotic events has occurred when unfractionated heparin was administered after use of andexanet alfa for the reversal of direct Factor Xa inhibitors (apixaban and rivaroxaban).
Source: FDA drug label (Heparin Sodium, NDA018916), Hospira, Inc., effective May 12, 2026 (SPL set 0413f511-6b34-4c15-e48b-3fad08baacbe), via openFDA
Source: FDA drug label (Heparin Sodium), Fresenius Kabi USA, LLC, effective November 28, 2025 (SPL set d55b4a63-0c04-4874-b74f-9e9b9e8b008c), via openFDA; the full label on DailyMed
What does the rivaroxaban label say about heparin?
Rivaroxaban label, warnings and precautionsPatients or Patients Who Require Thrombolysis or Pulmonary Embolectomy Initiation of XARELTO is not recommended acutely as an alternative to unfractionated heparin in patients with pulmonary embolism who present with hemodynamic instability or who may receive thrombolysis or pulmonary embolectomy.
Source: FDA drug label (Xarelto), Janssen Pharmaceuticals, Inc., effective September 10, 2026 (SPL set 10db92f9-2300-4a80-836b-673e1ae91610), via openFDA; the full label on DailyMed
These are the labels' own sentences. PlainMeds does not grade interactions; a pharmacist or prescriber can say what they mean for one person's medicines.
Both medicines on the record
| Heparin | Rivaroxaban | |
|---|---|---|
| Labeled for | Blood clots (DVT and PE), Atrial fibrillation | Atrial fibrillation, Heart attack and coronary artery disease, Blood clots (DVT and PE), Stroke prevention |
| Boxed warning | No | Yes |
| Pharmacy cost (NADAC) | $1.18 per mL 5,000 unit/mL vial | $0.650 per tablet 2.5 mg tablet |
| Shortage now | In shortage | A presentation being discontinued |
Source: FDA NDC Directory, CMS NADAC of October 7, 2026 and the FDA Drug Shortage Database (FDA files October 8, 2026)
What next?
- Check more medicines together
- up to five at once