Ginger Root Interaction with Eliquis (Apixaban)
Yes, ginger root can interact with Eliquis (apixaban) by potentially increasing bleeding risk, and patients should avoid this combination.
Mechanism of Interaction
- Ginger contains constituents that have antiplatelet effects, with 5 of 20 constituents shown to inhibit platelet aggregation in vitro 1
- Ginger may slow blood clotting, creating potential drug-drug interactions with anticoagulants like apixaban 1
- Case reports have documented elevated INR and epistaxis (nosebleeds) when ginger was combined with anticoagulants 1, 2
Clinical Evidence
- The Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus statement recommends holding ginger supplements for 2 weeks before surgery due to laboratory evidence of inhibition of thromboxane synthetase with decreased platelet aggregation 1
- A case report documented ginger-associated overanticoagulation when combined with phenprocoumon (another vitamin K antagonist), resulting in an INR of 10 and epistaxis 2
- While most studies on herb-anticoagulant interactions involve warfarin rather than apixaban specifically, the bleeding risk mechanism is relevant to all anticoagulants 3
Recommendations for Patients on Eliquis
- Patients taking Eliquis should avoid ginger supplements due to the increased risk of bleeding complications 1
- If a patient has been taking both ginger and Eliquis, they should be monitored for signs of increased bleeding such as:
- Unusual bruising or petechiae
- Prolonged bleeding from cuts
- Nosebleeds or gum bleeding
- Dark urine or blood in stool 2
Alternative Pain Management Options
- Acetaminophen is generally considered a safe pain reliever option for patients on anticoagulants like Eliquis, as it does not have antiplatelet effects 4
- Patients should limit daily acetaminophen intake to a maximum of 4 g per day to prevent liver toxicity 4
Important Considerations
- Many patients lack knowledge about potential interactions between over-the-counter supplements and direct oral anticoagulants like apixaban 5
- A survey found that 20.2% of patients on apixaban were taking dietary supplements with potentially serious interactions daily or most days 5
- Healthcare providers should specifically ask about ginger consumption, including ginger tea, supplements, and foods with high ginger content 1
Monitoring and Management
- If a patient has been taking both ginger and Eliquis and cannot immediately discontinue ginger, closer monitoring for bleeding complications is warranted 2
- In case of significant bleeding, temporary discontinuation of Eliquis and supportive care may be necessary 1
- Patients should always inform healthcare providers about all supplements they are taking before any surgical or dental procedures 4