Is it safe to take astaxanthin supplements with Eliquis (apixaban)?

Astaxanthin and Eliquis (Apixaban) Interaction

Astaxanthin supplements should be used with caution when taking Eliquis (apixaban) due to potential increased bleeding risk, although there is no direct contraindication.

Mechanism of Potential Interaction

Astaxanthin may have anticoagulant and antiplatelet effects that could theoretically enhance the anticoagulant action of apixaban:

• Astaxanthin has been shown to affect blood coagulation, fibrinolysis, and platelet aggregation in animal studies 1
• It may increase prothrombin time (PT) and activated partial thromboplastin time (APTT) 1
• There is a documented case report of interaction between astaxanthin and warfarin (another anticoagulant) that resulted in significantly elevated INR and bleeding 2

Risk Assessment

While there are no specific guidelines addressing astaxanthin and apixaban interaction, several factors should be considered:

• Apixaban (Eliquis) is a direct oral anticoagulant (DOAC) that works as a factor Xa inhibitor 3
• Unlike warfarin, apixaban does not require routine monitoring of coagulation parameters 4
• Dietary supplements are a common source of potential drug interactions with DOACs 4
• Approximately 20.2% of patients on apixaban take dietary supplements with potentially serious interactions daily or most days 4

Clinical Recommendations

1. Consultation with healthcare provider

   • Discuss astaxanthin supplementation with your healthcare provider before starting
   • If already taking both, inform your provider at your next visit

2. Monitoring for bleeding signs

   • Watch for unusual bruising, nosebleeds, bleeding gums, or blood in urine/stool
   • Seek immediate medical attention if experiencing symptoms of significant bleeding

3. Dosage considerations

   • If astaxanthin is deemed necessary, consider starting with a lower dose
   • Natural astaxanthin has been studied at doses ranging from 2-24 mg daily 5
   • The European Food Safety Authority has proposed an acceptable daily intake of 2 mg 5

Important Precautions

• High-risk situations: Exercise extra caution during periods of increased bleeding risk, such as:

  • Before surgical or invasive procedures 3
  • When taking other medications that increase bleeding risk
  • If you have kidney or liver dysfunction 3

• Drug-drug interactions: Be aware that P-glycoprotein (P-gp) and CYP3A4 inhibitors/inducers can affect apixaban levels 3

Special Considerations

• If you experience any unusual bleeding while taking both medications, discontinue astaxanthin and seek medical advice
• Unlike warfarin, there is no specific reversal agent for apixaban-astaxanthin interaction (andexanet alfa is the reversal agent for apixaban in emergency situations) 3

Bottom Line

While there is no absolute contraindication to taking astaxanthin with apixaban, the potential for increased bleeding risk exists based on the known pharmacological effects of astaxanthin and a documented interaction with another anticoagulant (warfarin). A cautious approach is warranted, with appropriate monitoring for any signs of enhanced anticoagulation.