Is it safe to take NMN (Nicotinamide Mononucleotide) supplements with apixaban (Eliquis) 5mg twice a day for anticoagulation?

Safety of NMN Supplements with Apixaban

There is no established safety data on the combination of NMN (Nicotinamide Mononucleotide) supplements with apixaban, and this combination should be approached with caution due to potential unknown interactions that could affect bleeding risk.

Understanding Apixaban

Apixaban (Eliquis) is a direct factor Xa inhibitor anticoagulant that is commonly prescribed for:

• Prevention of stroke in nonvalvular atrial fibrillation 1
• Treatment and prevention of venous thromboembolism (VTE) 1

Apixaban has several important characteristics:

• Primarily metabolized via the liver (cytochrome P450 3A4-dependent) 1
• Approximately 27% is eliminated through renal pathways 1
• Half-life of approximately 12 hours 1
• Substrate of P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP) transporters 1

Potential Concerns with NMN and Apixaban

While there are no specific studies evaluating the interaction between NMN and apixaban, several concerns exist:

1. Unknown Drug-Supplement Interactions:

   • NMN is a relatively new supplement with limited research on its interactions with prescription medications
   • Many patients taking apixaban are unaware of potential interactions with supplements 2

2. Bleeding Risk Considerations:

   • Apixaban's main adverse effect is bleeding 3
   • Any substance that might interfere with apixaban metabolism could potentially increase bleeding risk
   • A study found that 33% of patients on apixaban took at least one OTC product with potentially serious interactions daily/most days 2

3. Metabolic Pathway Concerns:

   • If NMN affects CYP3A4 enzymes or P-glycoprotein transporters, it could theoretically alter apixaban levels
   • Supplements that inhibit these pathways can increase apixaban exposure and potentially bleeding risk 1

Clinical Recommendations

Given the lack of specific evidence on NMN-apixaban interactions:

1. Discuss with Healthcare Provider:

   • Before starting NMN supplements, patients should consult with their prescribing physician
   • Disclose all supplements during medication reviews

2. Monitor for Bleeding Signs:

   • If taking both substances, watch for unusual bruising, nosebleeds, bleeding gums, or blood in urine/stool
   • Seek immediate medical attention if these occur

3. Consider Alternatives:

   • Until more safety data is available, consider whether the theoretical benefits of NMN outweigh potential risks
   • Patients at higher bleeding risk (elderly, history of bleeding, renal impairment) should be particularly cautious

4. Timing Considerations:

   • If both must be taken, consider separating administration times to potentially minimize interaction
   • This approach is used with other known P-gp substrate interactions 1

Conclusion

The safety of combining NMN supplements with apixaban remains unknown due to lack of clinical studies. Given apixaban's narrow therapeutic window and the serious consequences of altered anticoagulation (either increased bleeding or reduced efficacy), a cautious approach is warranted until more evidence becomes available.