Is it safe to take amla with apixaban (Eliquis) 5mg twice a day?

Safety of Amla with Apixaban 5mg Twice Daily

Amla should be used with caution when taking apixaban 5mg twice daily due to potential anticoagulant effects that could increase bleeding risk.

Understanding the Potential Interaction

Apixaban (Eliquis) is a direct factor Xa inhibitor used for stroke prevention in non-valvular atrial fibrillation and other thromboembolic conditions 1. Amla (Emblica officinalis) has been shown to have anticoagulant and anti-inflammatory properties that could potentially interact with apixaban's mechanism of action 2.

Mechanism of Potential Interaction

• Amla has demonstrated ability to reduce tissue factor expression and von Willebrand factor release in vascular endothelial cells 2
• These anticoagulant properties could theoretically enhance the anticoagulant effect of apixaban
• The combination might increase the risk of bleeding events, which is the primary safety concern with apixaban therapy 1

Risk Assessment

Factors to Consider:

1. Bleeding risk profile with apixaban alone:

   • Major bleeding with apixaban occurs in approximately 2.1-3.8% of patients 1
   • Intracranial hemorrhage risk is lower with apixaban (0.2-0.4%) compared to warfarin 1

2. Patient-specific factors that increase bleeding risk:

   • Advanced age (≥80 years)
   • Low body weight (≤60 kg)
   • Elevated serum creatinine (≥1.5 mg/dL)
   • Concomitant use of other medications that increase bleeding risk 1

3. Limited clinical evidence:

   • No specific studies have evaluated the interaction between amla and apixaban
   • Research shows 33% of patients on apixaban take at least one over-the-counter product with potentially serious interactions 3

Recommendations

1. Discuss with healthcare provider:

   • Before starting amla supplements while on apixaban therapy
   • Particularly important as many patients lack knowledge about potential interactions between over-the-counter products and DOACs 3

2. Monitor for bleeding signs:

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

3. Consider timing separation:

   • If using both, consider taking amla and apixaban at different times of day to minimize potential interaction
   • Similar to recommendations for other P-gp substrate interactions 1

4. Dose considerations:

   • No specific dose adjustments are established for this combination
   • Standard apixaban dosing (5mg twice daily) should be maintained unless other criteria for dose reduction are present 1

Common Pitfalls to Avoid

1. Self-medication without disclosure:

   • Many patients don't report supplement use to healthcare providers
   • Studies show 97.5% of patients on apixaban use some form of OTC product 3

2. Assuming natural products are always safe:

   • Natural supplements can have significant pharmacological effects
   • Amla's anticoagulant properties are documented in research 2

3. Ignoring early warning signs:

   • Minor bleeding events may precede more serious complications
   • Prompt reporting of any unusual bleeding is essential

The combination of apixaban and amla should be approached with caution due to the theoretical increased risk of bleeding. While there are no specific contraindications in guidelines, the known pharmacological effects of amla suggest potential for interaction that warrants clinical vigilance.