I have been on Rivaroxaban for a number of years due to Afib. Just had blood test and my ESR is 60 CRP Normal so GP has added Predisolone to my daily intake. I am certainly worried about interactions and wondered if anyone also on this combination or any experience/thoughts.
Thanks
I'm on Pradaxa/dabigatran as an anticoagulant together with pred, have been for at least 6 years and have been fine. If you notice any bad bruising, do see a doctor though in case the blood level of the anticoagulant is a bit high. That isn't necessarily to do with the pred - if you have any other heart tablets to take you should take them a couple of hours away from the anticoagulant just in case. I take the anticoag at 7.30am and the antiarrythmic tablet at 9.30am. Thank goodness for dosette boxes and alarms on phones!
~Curious PMRpro why you take your anti-arrythmic 2 hours away from blood thinner.Assuming its due to possible bleed (intestinal wise) or is it absorption issues?
No one has ever suggested this to me & take all in morning along with my hydrocortisone.
My hydrocort is in an acid resistant capsule + is slow release.
Heavens knows 
Neither - the anti-arrythmic affects the metabolism of the anti-coag so that the blood level rises further than it should. All the dosing is based on normal cases and they claim the levels don't need to be monitored. If something sends the level higher than expected, the excretion of the drug for the rest of the day will mean the level hasn't reached the baseline it was before taking it. So the next dose starts from a higher level. Over time, that climbs slowly and since it isn't being checked, can just keep on going up to dangerous levels. OH's got to 10x what it should be, his bleeding time was so long he was on the verge of bleeding out and was already severely anaemic and very unwell.
I was also put on the "standard" dose, 150mg. That sent my blood level up to about 15% higher than the therapeutic range - switching to the lower dose of 110mg kept my blood level within the therapeutic range.
It is known that if they checked both those factors - i.e. is this the right dose for this patient and are other medications interfering they could cut the number of severe bleeding events by about 20%. But the manufacturers keep quiet about it as that would lose their USP of "no testing" compared with warfarin. The information about separating the doses is in the detailed data sheets - but most doctors don't look at them.
I and the head of the hospital lab, a haematologist, did the tests to establish my blood levels. He reported it to the physicians as a red flag. They just said "Ah so ..." - they obviously didn't quite appreciate the potential problems. The surgeons did - they find most patients on anti-coags coming for surgery need at least double the time off their medication before it is safe to operate and always check before taking a patient to theatre.
~This is great information as always - gracious me & thank goodness for your continued intuitiveness in keeping up with the play..I will take my b/t 2 hours earlier to my other meds. as from tomorrow.
Our DHB's (district health boards) always in the red - wouldn't you think this is one area they could sort ust to save hospital beds being taken up unnecessarily if the data sheet was compulsory reading @ primary care level?
Thank you once more - hope others will see your reply because this is vital information I feel~
An efficient flagging system for such warnings that doctor had to acknowledge would be a good start instead of one that can be overruled. Someone below says "nothing on drugs.com" - there are quite a few drugs not even ON drugs.com as it is a US-based site and doesn't include drugs that are banned in the USA but used elsewhere. I have looked on these warning sites for drug reactions that I know exist but can't find them listed.
~Indeed an efficient flagging system would be ideal - guess its only as good as the Dr/s on duty when one presents at public emergency & 9 times out of 10 they are overstretched, over run & overworked (that was pre covid) so we are always at their mercy in more ways than one. Goodness knows what state the A&E is in now...........Interesting too re drug.com - never knew this sort of thing existed.
What? Interaction checking sites? There are quite a few. I think MrsNails did a list in FAQs but I might be wrong.
~Not a problem - if I need to check I simply use Google - invariably that will lead me somewhere or if not sure I ring my usual Chemist~
👍
I'm on 110mg of Pradaxa Dabigatran and 3x120mg Verapamil per day for arrythmia. I take the first Verapamil (with Omperazole) when I get out of bed, about 30 mins before breakfast and the Dabigatran after breakfast with Pred. I have not been advised about leaving a 2 hour gap between these med. I take the second Verapamil after lunch and the third at bedtime, the second Dabigatran after evening meal. It is a faff taking meds at five different times in the day!
drugs.com/drug-interactions....
Exactly the interaction I mentioned. And I bet YOUR doctor doesn't check the blood levels?
It is a faff, I do it - but infinitely preferable to bleeding to death which my husband came very close to doing. I was still very early days but my blood level with Pradaxa was already raised - and I had noticed even worse bruising.
Thanks for the link, I had not seen that one but a different interaction site which was not so thorough. I'll switch things round a bit for the morning doses.
I have an alarm set for 7.30 for the dabigatran and bisoprolol. Then at 9.30am for the antiarrythmic and again at 4pm. Then dabigatran and bisoprolol again at 7.30pm. Pred and the antiarrythmic at 10pm before bed.
It looks like this for me in the future: Omeprazole to be taken 30 mins before food (on getting out of bed). Dabigatran after food (=breakfast) then first Verapamil 2 hours later (= mid morning). That's meds 7 times a day now as 2nd Verapamil will need to be mid afternoon.
I am on rivaroxiban and pred . My pred dose is 5mg .
Not sure with rivaroxiban if it depends on dosage or not though .
Perhaps email your GP to check if you are concerned at all .
Sure it will be fine though 😊
I've taken pred and rivaroxaban together for years, though the pred is gastro resistant, so I assume gets into my system later than the rivaroxaban.
There seem to be no interactions found on drugs.com
Not for rivaroxaban but on this page they mention other anticoags in section 7:
I'm on pred tapering from 40mg, now on 9mg, and apixaban. I've never had any issues. I didn't even have to stop the apixaban for my GCA biopsy!
I live in Australia but use drugs.com which has an interaction checkerThey also have an App, where you can store your medication list and interactions
They also do FDA Alerts
It’s free but you can upgrade
Hope this helps
It doesn't include drugs that are not approved for use in the USA though - and there are quite a few.
Prednisolone and Omeprazole
Prednisolone and Formication
Prednisolone and diarrhoea 
Aspirin and Prednisolone
