Can I take beet supplements with Eliquis (apixaban)?

Beet Supplements and Eliquis (Apixaban) Interaction

Taking beet supplements with Eliquis (apixaban) is generally not recommended due to potential interactions that could affect bleeding risk, although direct evidence for this specific interaction is limited.

Understanding the Concern

Apixaban (Eliquis) is a direct oral anticoagulant (DOAC) that works as a direct factor Xa inhibitor to prevent blood clots. When considering combining it with supplements, several important factors must be considered:

Mechanism of Potential Interaction

• Beet supplements and nitrates: Beets are rich in nitrates which convert to nitric oxide in the body 1
• Nitric oxide effects: Nitric oxide can cause vasodilation and may have antiplatelet properties
• Combined anticoagulant effects: Taking beet supplements with Eliquis could theoretically enhance the anticoagulant effect, potentially increasing bleeding risk

Evidence-Based Assessment

While no guidelines specifically address beet supplements with apixaban, we can draw conclusions from related evidence:

1. Natural products with anticoagulant properties: Many natural supplements have antiplatelet or anticoagulant effects that can interact with prescription anticoagulants 2

2. Blood pressure effects: Beet juice concentrate has been shown to lower systolic blood pressure in older, overweight subjects 3, which demonstrates its biological activity and potential for drug interactions

3. Apixaban sensitivity: Patients with high apixaban levels are at increased risk of bleeding complications, and factors that increase drug levels should be avoided 4

4. Bleeding risk management: Guidelines emphasize careful management of bleeding risk in patients on DOACs like apixaban 5

Clinical Recommendation

Based on the available evidence:

• Avoid concurrent use: It's safest to avoid combining beet supplements with Eliquis due to the theoretical risk of increased bleeding
• Timing separation: If you must take both, separate them by at least 2-3 hours to minimize potential interactions
• Monitor for bleeding signs: Watch for unusual bruising, nosebleeds, bleeding gums, or blood in urine/stool
• Consult healthcare provider: Discuss with your doctor before starting any supplement while on Eliquis

Important Considerations

• Variability in supplement content: Beet supplements vary widely in their nitrate content (up to 50-fold difference between products) 1, making it difficult to predict interactions
• Disclosure to healthcare providers: Always inform all healthcare providers about all supplements you take, as many patients don't disclose supplement use 6
• Perioperative management: If you're scheduled for any surgical or dental procedures, beet supplements should be discontinued at least 2 weeks prior 6

Alternative Approaches

If you're taking beet supplements for blood pressure management:

• Discuss with your doctor about other evidence-based approaches to blood pressure control
• Consider dietary modifications that don't carry potential interaction risks
• Explore prescription medications specifically designed for blood pressure management if needed

Remember that maintaining proper anticoagulation with Eliquis is critical for preventing serious thromboembolic events, and any supplement that might interfere with this should be approached with caution.