Is it safe to take glucosamine chondroitin with Eliquis (apixaban) and Celebrex (celecoxib)?

Safety of Glucosamine Chondroitin with Eliquis and Celebrex

Taking glucosamine chondroitin supplements is not recommended in combination with Eliquis (apixaban) and Celebrex (celecoxib) due to potential drug interactions and lack of proven efficacy.

Potential Interactions and Safety Concerns

Interaction with Eliquis (apixaban)

• Glucosamine and chondroitin may interact with anticoagulants like Eliquis
• Evidence from case reports shows that glucosamine-chondroitin can increase INR in patients taking warfarin 1
• While specific studies with apixaban are limited, the potential for similar interactions exists since both are anticoagulants
• The FDA MedWatch database identified 20 reports of altered coagulation (increased INR or increased bleeding/bruising) when glucosamine products were used with warfarin 1
• One severe case resulted in intraventricular bleeding and subdural hematoma 1

Concerns with Celebrex (celecoxib)

• Celebrex is a COX-2 inhibitor used for osteoarthritis pain management 2
• Adding glucosamine-chondroitin provides no additional proven benefit over Celebrex alone for pain relief 3
• The combination may increase the risk of adverse effects without providing additional therapeutic benefit

Efficacy Considerations

Evidence Against Glucosamine and Chondroitin

• The American College of Rheumatology (ACR) strongly recommends against using glucosamine for knee, hip, and hand osteoarthritis 2
• The ACR also strongly recommends against chondroitin sulfate for knee and hip osteoarthritis 2
• The American Academy of Orthopaedic Surgeons (AAOS) strongly recommends against glucosamine and chondroitin for knee osteoarthritis 2
• NICE guidelines specifically state that glucosamine and chondroitin products are not recommended 2

Clinical Trial Evidence

• The Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT) showed that:
  • Over 2 years, neither glucosamine nor chondroitin, alone or in combination, achieved clinically important differences in pain or function compared to placebo 3
  • No significant benefit in preventing joint space narrowing compared to placebo 4

Alternative Approaches

For osteoarthritis management while on Eliquis and Celebrex:

1. First-line non-pharmacological options:

   • Physical activity and exercise focusing on local muscle strengthening and aerobic fitness 2
   • Weight loss if overweight or obese 2
   • Physical therapy and appropriate assistive devices 2

2. Safer pharmacological alternatives:

   • Topical NSAIDs (if appropriate for the affected joint) 2
   • Acetaminophen/paracetamol (with appropriate dosing) 2
   • Intra-articular corticosteroid injections for moderate to severe pain 2

Monitoring Recommendations

If a patient insists on taking glucosamine-chondroitin with Eliquis and Celebrex:

• Monitor for signs of increased bleeding (bruising, prolonged bleeding from cuts, nosebleeds)
• Consider more frequent INR monitoring if applicable
• Watch for changes in pain control or gastrointestinal symptoms
• Discontinue glucosamine-chondroitin immediately if any adverse effects occur

Key Takeaway

The combination of glucosamine-chondroitin with Eliquis and Celebrex presents unnecessary risks without proven benefits. Current guidelines strongly recommend against using these supplements for osteoarthritis, and the potential interaction with anticoagulants raises additional safety concerns. Patients should be encouraged to pursue evidence-based treatments for osteoarthritis management.