Is there a dietary interaction between apixaban (apixaban) 5mg twice a day and daily consumption of garlic cloves?

Apixaban and Garlic: No Known Significant Dietary Interaction

There is no documented significant dietary interaction between apixaban 5mg twice daily and daily consumption of garlic cloves that would require dose adjustment or medication changes.

Understanding Apixaban's Interaction Profile

Apixaban is a direct oral anticoagulant (DOAC) that works as a factor Xa inhibitor. Its metabolism and potential for interactions are well characterized:

• Apixaban is primarily metabolized via CYP3A4 in the liver 1
• It is a substrate for P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP) transporters 1
• Approximately 27% of apixaban is eliminated renally, with the remainder through biliary and intestinal routes 1

Known Drug Interactions with Apixaban

Significant interactions with apixaban typically occur through two main mechanisms:

• Strong inhibitors of both CYP3A4 and P-gp can significantly increase apixaban plasma levels, increasing bleeding risk 1
• Strong inducers of CYP3A4 or P-gp can decrease apixaban levels, potentially reducing efficacy 1

Garlic and Anticoagulants

While garlic has been historically associated with potential antiplatelet properties, research specifically examining garlic with DOACs like apixaban is limited. The most relevant evidence comes from studies with warfarin:

• A randomized controlled trial examining aged garlic extract with warfarin found no evidence of increased hemorrhage risk when these were used together 2
• The study concluded that aged garlic extract posed no serious hemorrhagic risk for closely monitored patients on warfarin 2

Clinical Recommendation for Apixaban and Garlic

Based on the available evidence:

1. There is no specific contraindication or warning regarding garlic consumption in patients taking apixaban in current guidelines 1

2. Unlike some medications that have documented interactions with apixaban requiring dose adjustments, garlic is not listed among substances requiring special precautions 1

3. Food interactions with apixaban are minimal - unlike rivaroxaban which should be taken with food, apixaban can be taken with or without food 1

Important Considerations and Monitoring

While no significant interaction is documented, prudent clinical practice suggests:

• Patients should inform healthcare providers about all supplements they take, including garlic
• Monitoring for any unusual bleeding or bruising is always recommended for patients on any anticoagulant
• If a patient notices any changes after starting garlic supplementation, they should report this to their healthcare provider

Conclusion

Daily consumption of garlic cloves appears to be compatible with apixaban therapy based on current evidence. Unlike strong CYP3A4/P-gp inhibitors or inducers that require dose adjustments or avoidance, garlic has not been identified as having a clinically significant interaction with apixaban that would affect morbidity, mortality, or quality of life outcomes.