Can you take Xarelto with Cialis or Viagra? No interaction is listed: the Australian leaflets for Viagra and Cialis do not name rivaroxaban, the medicine in Xarelto, and the rivaroxaban leaflet names no erectile dysfunction medicine. "Not listed" is not the same as "tested", so the doctor who prescribes the ED tablet needs to know you take Xarelto — and why, because the heart condition behind it can matter more than the blood thinner. Nitrates for chest pain are never allowed with either ED medicine.
Does Xarelto interact with Viagra or Cialis?
No interaction is listed in either direction. Xarelto is an anticoagulant, a medicine that prevents blood clotting, and its active substance is rivaroxaban (EMA — Xarelto). The Australian leaflet for rivaroxaban lists the medicines that interfere with it — other blood thinners such as enoxaparin, clopidogrel or warfarin, some antidepressants (SSRIs and SNRIs), and anti-inflammatory painkillers such as naproxen, or aspirin — and no ED medicine is among them (rivaroxaban CMI (Rivaxib)). Neither the Viagra nor the Cialis leaflet names rivaroxaban (Viagra CMI; Cialis CMI), and nor does the European product information for either medicine. Warfarin was studied with both, and no significant interaction was found: can you take Viagra with warfarin or other blood thinners?
Which medicines clash with all three?
A few, and they are worth knowing. The rivaroxaban leaflet says not to take it with antifungals such as ketoconazole or itraconazole (unless applied only to the skin) or with HIV medicines such as ritonavir. The same medicines are on the Viagra and Cialis interaction lists, because they raise the level of sildenafil and tadalafil in the blood: ritonavir raised sildenafil exposure elevenfold in a study, and ketoconazole up to fourfold for tadalafil (EMA — Viagra; EMA — Cialis). The antibiotic rifampicin is on all three lists as well; with rivaroxaban it may reduce the blood thinner's effect. If one of these is prescribed, every doctor involved needs your full list of medicines.
What if you get a nosebleed or a bad headache?
Take it seriously. Like other anticoagulants, rivaroxaban "may cause bleeding, which may potentially be life-threatening", and prolonged or excessive bleeding from the gums or nose is among its serious side effects (rivaroxaban CMI). Bleeding from the nose is also on the Australian Viagra leaflet's list of side effects to report to your doctor straight away, and a bleeding nose is listed for Cialis. Headache is a common side effect of ED medicines (healthdirect), and dizziness is listed in both leaflets, but healthdirect also lists a severe headache or dizziness among the signs of heavy bleeding on a blood thinner, along with bruising, red or brown urine, red or black stools and coughing up or vomiting blood (healthdirect — Blood thinners). On Xarelto, do not put a severe headache down to the ED tablet.
Is it safe for your heart?
That is the question that decides it, because of why Xarelto is prescribed: to prevent stroke in atrial fibrillation, to treat and prevent clots in the legs and lungs, and to lower the risk of heart attack in coronary artery disease (EMA — Xarelto). The Viagra leaflet rules Viagra out after a heart attack or stroke in the last 6 months, or if heart or blood-vessel problems make sex inadvisable. The Cialis leaflet also rules Cialis out if you have "heart problems such as angina, arrhythmias (change in rhythm or rate of heart beat), heart failure", a heart attack in the last 3 months or a stroke in the last 6, and explains that sex "puts extra strain on the heart" (Viagra and Cialis CMIs). If you take Xarelto for an irregular heartbeat, see can Viagra be used with atrial fibrillation? and Viagra after a heart attack or with heart medicines. Whether the ED tablet itself affects clotting is asked in can Viagra cause or worsen blood clots?
What about Eliquis and other blood thinners?
The answer is the same. Eliquis contains apixaban (Eliquis CMI), which, like rivaroxaban and dabigatran, is a direct-acting oral anticoagulant (healthdirect — Blood thinners). Neither the Viagra nor the Cialis leaflet names apixaban, and the Eliquis leaflet carries the same rule against antifungals such as ketoconazole and HIV medicines such as ritonavir. Aspirin has its own page: can aspirin be taken with Viagra?
What must never be taken with Viagra or Cialis?
Nitrates — angina medicines such as glyceryl trinitrate sprays or tablets — and amyl nitrite ("poppers"): with an ED medicine they can cause "a sudden drop in your blood pressure that is hard to treat" (healthdirect — Sildenafil). If you carry a nitrate spray or tablets for chest pain, neither Viagra nor Cialis is for you. More in can nitrates be taken with Viagra?
The short answer
No leaflet lists an interaction between Xarelto and Viagra or Cialis, and no label reports a study of the pair. What changes the answer is the heart condition behind the Xarelto, a nitrate, or a medicine that clashes with all three, such as ketoconazole or ritonavir; a nosebleed or a severe headache is a reason to call your doctor. Every other combination is covered in our guide to taking Viagra or Cialis with other medicines.
