Is it safe to take apixaban (10mg) with chondroitin?

Safety of Taking Apixaban 10mg with Chondroitin

There is insufficient evidence to support the safety of combining apixaban 10mg with chondroitin, and caution is warranted due to potential interaction risks based on documented interactions between chondroitin-containing supplements and other anticoagulants.

Background on Apixaban

Apixaban is a direct factor Xa inhibitor approved for:

• Prevention of stroke in non-valvular atrial fibrillation
• Treatment and prevention of venous thromboembolism (VTE)
• Thromboprophylaxis after hip or knee replacement surgery

The standard dosing for apixaban varies by indication:

• For VTE treatment: 10mg twice daily for 7 days, followed by 5mg twice daily 1
• For atrial fibrillation: 5mg twice daily (with dose reduction criteria for certain patients) 1

Potential Interaction Concerns

Chondroitin and Anticoagulants

While there is no specific evidence directly addressing apixaban-chondroitin interactions, there are documented cases of interactions between similar supplements and warfarin:

• A case report documented a significant increase in INR (from 2.3 to 3.9 and later 4.7) when a patient on warfarin increased his dosage of glucosamine-chondroitin supplement 2
• The FDA MedWatch database contained 20 reports of altered coagulation (increased INR or bleeding) with glucosamine/chondroitin supplements and warfarin 2
• The WHO adverse drug reactions database documented 21 spontaneous reports of increased INR associated with glucosamine use 2

Apixaban Metabolism and Interaction Potential

Apixaban is primarily metabolized via the liver (cytochrome P450 3A4-dependent) with approximately 27% of total drug clearance occurring through renal elimination 1. The half-life after oral administration is approximately 12 hours 1.

Although apixaban has "low number of drug and food interactions, and relatively wide therapeutic window" 3, the potential for interaction with supplements cannot be ruled out, especially at the higher 10mg dose.

Risk Assessment

The primary concern with any potential interaction would be increased bleeding risk. Apixaban already carries a bleeding risk as its main adverse effect 4, 5, and any substance that might enhance this effect should be approached with caution.

Recommendations

1. Consult healthcare provider: Before combining apixaban 10mg with chondroitin, consult with the prescribing physician or pharmacist

2. Consider alternatives: If possible, consider alternative treatments for the condition being treated with chondroitin

3. Monitoring: If both must be taken, monitor for signs of increased bleeding risk:

   • Unusual bruising
   • Prolonged bleeding from minor cuts
   • Nosebleeds
   • Blood in urine or stool
   • Severe headache (potential sign of intracranial bleeding)

4. Timing: If both must be taken, consider separating administration times to minimize potential interactions

Special Considerations

• The 10mg dose of apixaban is typically only used during the initial 7-day treatment period for VTE 1
• Higher doses of apixaban have been associated with increased bleeding risk in clinical trials 1
• Patients with renal impairment or hepatic impairment require special consideration as apixaban should be avoided in severe cases 1

Given the documented interactions between similar supplements and other anticoagulants, and the lack of specific safety data on this combination, a cautious approach is warranted when considering the concurrent use of apixaban 10mg and chondroitin.