Is it safe to consume salmon while taking apixaban (5mg twice a day)?

Salmon Consumption with Apixaban 5mg Twice Daily

It is safe to consume salmon while taking apixaban 5mg twice daily, as there are no known interactions between salmon and apixaban that would affect its efficacy or safety profile. 1

Evidence on Salmon and Apixaban

The 2018 European Heart Rhythm Association (EHRA) practical guide on NOACs specifically addresses this concern, stating that "there are no pharmacokinetic data on fish oil supplements for any of the NOACs, but interaction is unlikely" 1. This guidance provides reassurance that consuming salmon while on apixaban therapy is safe.

Pharmacokinetic Considerations

Apixaban has several characteristics that make it less susceptible to food interactions:

• Bioavailability of approximately 50% 1
• Unlike rivaroxaban, apixaban does not need to be taken with food 1
• Only 27% of apixaban is eliminated through renal excretion, with the remainder through hepatic metabolism and biliary/intestinal excretion 1
• Half-life of approximately 12 hours 1

Potential Benefits of Salmon Consumption

Interestingly, salmon contains omega-3 fatty acids which have been associated with:

• Mild antiplatelet effects 2
• Potential cardiovascular benefits 3

However, clinical trial evidence has not supported increased bleeding with omega-3 fatty acid intake, even when combined with other antithrombotic agents 4.

Important Monitoring Considerations

While salmon consumption is safe with apixaban, patients should be aware of:

1. Dose adherence: Continue taking apixaban 5mg twice daily as prescribed
2. Consistent intake: Maintain relatively consistent salmon consumption rather than dramatically changing intake patterns
3. Monitoring signs: Be alert for any unusual bleeding or bruising, although this would not be expected from salmon consumption alone

Special Populations

For patients with specific conditions, additional considerations may apply:

• Renal impairment: No dose adjustment needed for salmon consumption, but apixaban dosing may need adjustment based on creatinine clearance, age, and weight 1
• Hepatic impairment: Apixaban should be used with caution in mild-moderate hepatic impairment and avoided in severe impairment 1

Conclusion

Patients taking apixaban 5mg twice daily can safely consume salmon as part of their diet without concerns about clinically significant interactions. The EHRA guidelines specifically note that fish oil interactions with NOACs like apixaban are unlikely 1.