Is there an interaction between apixaban (anticoagulant) 5mg twice a day and ubiquinol (coenzyme Q10) 200mg?

Apixaban and Ubiquinol Interaction: Clinical Assessment

There is no clinically significant interaction between apixaban 5mg twice daily and ubiquinol (coenzyme Q10) 200mg. Based on the available evidence, these medications can be safely taken together without dose adjustments.

Pharmacological Basis

Apixaban is a direct factor Xa inhibitor with the following pharmacokinetic properties:

• Metabolized primarily through CYP3A4 1
• Substrate of P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP) transporters 1
• 27% renal excretion and 73% biliary/intestinal excretion 1

Clinically significant interactions with apixaban occur primarily with:

1. Strong dual inhibitors of CYP3A4 and P-gp (which can increase apixaban levels)
2. Strong inducers of CYP3A4 or P-gp (which can decrease apixaban levels)

Why No Significant Interaction Exists

Ubiquinol (the reduced form of Coenzyme Q10) is not known to:

• Inhibit or induce CYP3A4 enzymes
• Affect P-gp or BCRP transporter function
• Alter the pharmacokinetics of anticoagulants

None of the guidelines or drug interaction databases reviewed identify ubiquinol as having a clinically significant interaction with apixaban 1.

Medications That DO Interact with Apixaban

For context, medications that DO have significant interactions with apixaban include:

• Strong CYP3A4 and P-gp inhibitors (require 50% dose reduction of apixaban):

  • Ketoconazole
  • Itraconazole
  • Ritonavir
  • Clarithromycin 1

• Strong CYP3A4 and P-gp inducers (avoid combination):

  • Rifampin
  • Carbamazepine
  • Phenytoin
  • St. John's wort 1

Bleeding Risk Considerations

While ubiquinol itself does not interact with apixaban, it's important to note that patients taking apixaban should be cautious with other over-the-counter products that may increase bleeding risk, such as:

• NSAIDs (ibuprofen, naproxen)
• Aspirin 2

A study found that 33% of patients on apixaban took at least one OTC product with potentially serious interactions daily/most days, with many lacking knowledge about these potential interactions 2.

Monitoring Recommendations

When taking apixaban with ubiquinol:

• No special monitoring is required
• No dose adjustments are necessary
• Regular follow-up as normally scheduled for patients on anticoagulation therapy

Conclusion

Patients can safely take apixaban 5mg twice daily together with ubiquinol 200mg without concerns about drug interactions. However, patients should always inform their healthcare providers about all medications and supplements they are taking, including over-the-counter products and supplements.