Can Eliquis (apixaban) be used together with preservison?

Apixaban (Eliquis) and Preservision: Safety of Concurrent Use

Apixaban (Eliquis) can be safely used concurrently with Preservision as there are no significant drug interactions between these medications. 1, 2

Understanding the Medications

• Apixaban (Eliquis) is a direct factor Xa inhibitor anticoagulant that works by inhibiting both free factor Xa and prothrombinase activity 3
• Preservision is an over-the-counter vitamin and mineral supplement containing antioxidants, zinc, and other nutrients primarily used for age-related macular degeneration
• Apixaban is primarily metabolized through CYP3A4 pathways and is a substrate for P-glycoprotein (P-gp) transport 1

Drug Interaction Analysis

Metabolism and Transport Considerations

• Apixaban interacts with drugs that induce or inhibit CYP3A4 or P-glycoprotein (P-gp) 1
• Preservision contains vitamins and minerals that do not significantly affect CYP3A4 or P-gp pathways 2
• Strong CYP3A4 and P-gp inhibitors (such as ketoconazole, itraconazole, clarithromycin, ritonavir) can significantly increase apixaban levels, but Preservision is not in this category 1

Clinical Evidence

• Current guidelines on drug interactions affecting oral anticoagulants do not list vitamin supplements like Preservision as having significant interactions with apixaban 1
• The American College of Cardiology/American Heart Association guidelines on atrial fibrillation management do not identify vitamin supplements as problematic when used with direct oral anticoagulants 1

Important Monitoring Considerations

• While no specific interaction exists between Preservision and apixaban, patients should still be monitored for:
  • Signs of bleeding, which is the primary risk associated with apixaban therapy 1, 2
  • Renal function, as apixaban dosing may need adjustment in patients with impaired kidney function 1
  • Any new medications or supplements added to the regimen that might interact with apixaban 1

Special Populations and Considerations

• Elderly patients (≥80 years) may require dose adjustments of apixaban based on age, weight, and serum creatinine, regardless of Preservision use 1
• Patients with severe hepatic impairment should use apixaban with caution, though this is not related to Preservision use 1
• Patients with a history of gastrointestinal bleeding should be monitored more closely when on apixaban, though Preservision does not increase this risk 2

Clinical Recommendation

• Patients can continue using both apixaban and Preservision together without dose adjustments 1, 2
• Unlike some medications that require separation of dosing times, Preservision and apixaban can be taken at the same time of day 2
• Patients should inform all healthcare providers about all medications and supplements they are taking, including over-the-counter products like Preservision 2