From the Guidelines
Patients taking Eliquis (apixaban) should avoid supplements that can interact with the medication, such as St. John's Wort, which can decrease Eliquis levels and reduce its effectiveness at preventing blood clots 1. When considering supplements to avoid with Eliquis, it's essential to look at the potential for dangerous interactions.
- St. John's Wort is a significant concern because it can induce the P-glycoprotein efflux transporter, leading to decreased apixaban levels and reduced efficacy 1.
- Other supplements with anticoagulant or antiplatelet effects, including garlic supplements, ginger supplements, ginkgo biloba, vitamin E supplements, fish oil, and turmeric/curcumin supplements, can increase bleeding risk when combined with Eliquis.
- Cranberry supplements may increase Eliquis levels, potentially causing excessive anticoagulation.
- Green tea supplements containing vitamin K can potentially reduce Eliquis effectiveness. It's crucial to consult healthcare providers before starting any supplement while on Eliquis, as these interactions can occur due to the medication's mechanism as a direct factor Xa inhibitor and the supplements' effects on blood clotting pathways, platelet function, or the metabolism of Eliquis through the CYP3A4 and P-glycoprotein systems 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Supplements Contraindicated with Eliquis (Apixaban)
The following supplements may interact with Eliquis (apixaban) and increase the risk of bleeding:
- Garlic and hawthorn supplementation is strongly associated with surgical bleeding independent of anticoagulants 2
- Ginkgo biloba, chondroitin-glucosamine, melatonin, turmeric, bilberry, chamomile, fenugreek, milk thistle, and peppermint are associated with bleeding risk in patients on anticoagulants 2
- Anise and dong quai have anticoagulant effects 3
- Omega 3-fatty acids in fish oil, ajoene in garlic, ginger, ginko, and vitamin E have antiplatelet properties 3
- Fucus has heparin-like activity, and danshen has antithrombin III-like activity and anticoagulant bioavailability 3
- St. John's Wort and American Ginseng may interfere with drug metabolism 3
- High doses of vitamin E may have vitamin K antagonist activity, and alfalfa has high-vitamin K content 3
- Coenzyme Q10 may have vitamin K-like activity 3
Supplements with Uncertain Interactions
The following supplements have uncertain interactions with Eliquis (apixaban) and may require caution:
- Cordyceps sinensis, echinacea, and aloe vera are loosely associated with surgical bleeding independent of anticoagulants 2
- Fish oil, ginseng, and saw palmetto are not associated with bleeding 2
- Evidence for overall bleeding risk associated with St. John's wort, ginger, ginkgo biloba, or cranberry supplementation is conflicting 2
- Omega-3 fatty acids and garlic may have benefits for triglyceridemia and HDL-C, respectively, but safety concerns persist 4