Fish Oil and Eliquis (Apixaban) Interaction
Fish oil supplements can be safely taken with Eliquis (apixaban) as they do not significantly increase bleeding risk at standard doses up to 5 g/day. 1
Safety Profile of Fish Oil with Anticoagulants
Fish oil supplements containing omega-3 fatty acids (EPA and DHA) have been extensively studied for their potential bleeding risk when combined with anticoagulants:
- The European Food Safety Authority (EFSA) concluded that long-term supplemental intakes of EPA and DHA combined up to about 5 g/day do not increase the risk of spontaneous bleeding episodes or bleeding complications 1
- The 2018 European Heart Rhythm Association practical guide on NOACs specifically states there is no relevant drug-drug interaction anticipated between fish oil and NOACs including apixaban 1
- Clinical evidence shows that fish oil does not significantly increase bleeding risk even when combined with other antithrombotic medications 2, 3
Dosage Considerations
When taking fish oil with Eliquis, consider these dosage guidelines:
- Standard fish oil supplementation (500-1000 mg EPA+DHA daily) is considered safe 4
- Supplemental intakes of EPA and DHA combined at doses up to 5 g/day are generally safe 1
- Supplemental intakes of EPA alone up to 1.8 g/day do not raise safety concerns 1
Special Considerations
While generally safe, there are some important considerations:
- Patients with gastrointestinal or gastroesophageal tumors should exercise caution as they are at increased risk for hemorrhage with direct oral anticoagulants 1
- Fish oil quality matters - select supplements that are free of contaminants such as mercury, dioxins, and polychlorinated biphenyls (PCBs) 1, 5
- Common side effects of fish oil include mild gastrointestinal effects, fishy aftertaste, or fish belching 1
Monitoring Recommendations
Although routine monitoring is not required when combining fish oil with Eliquis, be alert to:
- Any unusual bruising or bleeding
- For patients undergoing surgery, there is no need to discontinue fish oil before procedures based on recent evidence 3
- If taking high doses of fish oil (>3 g/day) with Eliquis, more cautious monitoring may be prudent, although clinical trials have not shown increased bleeding risk 2, 6
Key Contraindications
The only specific contraindication for fish oil with anticoagulants is:
- Patients receiving ibrutinib (for chronic lymphocytic lymphoma) should avoid fish oil supplements due to increased risk of epistaxis 1
Fish oil supplementation has shown cardiovascular benefits and can be safely continued while taking Eliquis without significant concern for increased bleeding risk at standard doses.