Can I take Flecainide and Rivaroxaban together?

Why this happens

Flecainide is primarily processed by a liver enzyme called CYP2D6, while rivaroxaban is processed by different pathways (CYP3A4 and P-gp). Because they use different 'routes' for metabolism and have different targets in the body (one affects electrical signals, the other affects blood clotting), they do not interfere with each other.

What you should do

You can safely take these two medicines together as prescribed by your doctor. Ensure you attend your regular heart check-ups and blood tests. If you notice any unusual bruising or bleeding (common with rivaroxaban) or feel new heart palpitations (related to the condition flecainide treats), contact your healthcare provider.

Important precautions

Bleeding risk and surgery

You must inform any doctor, dentist, or surgeon that you are taking rivaroxaban before any procedure, as it significantly increases the risk of serious bleeding. You may need to stop it temporarily. Carry your patient alert card at all times.

Pregnancy and breastfeeding

Rivaroxaban must not be used during pregnancy or while breastfeeding as it may cause serious bleeding in the fetus or baby.

Heart failure or previous heart attack

Flecainide must not be used if you have heart failure or have previously suffered a heart attack, as it can increase the risk of life-threatening heart rhythm problems.

Permanent atrial fibrillation

This medicine should not be used if you have long-standing (permanent) atrial fibrillation that has not been corrected, as it can paradoxically cause the heart rate to become dangerously fast.

Severe Kidney or Liver Disease

Both medicines require careful monitoring or dose adjustments if you have significant kidney or liver problems. Rivaroxaban, in particular, must be avoided if you have a high risk of bleeding due to liver disease.

Food and drink warnings

Alcohol

It is best to avoid or strictly limit alcohol while taking these medicines. Alcohol can increase the risk of heart rhythm issues (affecting flecainide) and can increase the risk of bleeding in the stomach or gut (affecting rivaroxaban).

Caffeine (Coffee, tea, energy drinks, cola)

Caffeine is a stimulant that can increase your heart rate or cause irregular heart rhythms. Since flecainide is used to treat heart rhythm problems (arrhythmias), consuming high amounts of caffeine may counteract the effects of your medicine or make your condition worse. It is best to limit your intake of caffeine.

Dairy products (Milk)

In some cases, particularly in children or patients on a milk-based diet, high intake of milk can affect how flecainide is absorbed. However, for most adults, normal amounts of dairy are fine. If you are making a significant change to your dairy intake, discuss this with your doctor.

Low-salt (low-sodium) diets

A sudden change to a very low-salt diet or using salt substitutes can increase the levels of flecainide in your blood, which may lead to toxicity. Do not make major changes to your salt intake without consulting your doctor.

Food (General)

The 15mg and 20mg doses of rivaroxaban must be taken with food to ensure the medicine is absorbed properly into your body. Taking them on an empty stomach makes them much less effective. The 2.5mg and 10mg doses can be taken with or without food.

Using other medicines

Taking multiple medicines? Our Medicines Interaction Checker helps you check whether your prescriptions, over-the-counter medicines, and supplements are safe to take together. Simply search for your medicines to see potential interactions and what to do about them.

Disclaimer

This information is for general educational purposes only and should not be relied upon as a substitute for professional medical advice. Always consult your GP, pharmacist, or another qualified healthcare professional before making decisions about your medications. Individual circumstances may vary, and only a healthcare professional who knows your medical history can provide personalised guidance.