Is it safe to eat kiwi fruit while taking Eliquis (apixaban)?

Kiwi Fruit and Eliquis (Apixaban): Safety Assessment

Yes, kiwi fruit is safe to eat while taking Eliquis (apixaban), as there is no documented pharmacokinetic or pharmacodynamic interaction between kiwi fruit and this anticoagulant.

Key Evidence

The most comprehensive guideline on oral anticoagulant drug interactions from the American Heart Association specifically addresses fruit interactions with anticoagulants 1. Kiwi fruit is notably absent from the list of fruits that have documented interactions with anticoagulants 1. The guideline only mentions case reports of interactions with pomegranate, avocado, grapefruit, mango, and papaya—primarily with warfarin, not with direct oral anticoagulants (DOACs) like apixaban 1.

Why Kiwi Is Not a Concern with Apixaban

Mechanism of Apixaban Metabolism

• Apixaban is metabolized primarily through CYP3A4 enzymes (25% hepatic metabolism) and is a substrate for P-glycoprotein (P-gp) transport proteins 1
• Clinically significant interactions occur only with strong dual inhibitors or inducers of both CYP3A4 and P-gp 1
• Kiwi fruit does not contain compounds that significantly affect CYP3A4 or P-gp activity 1

Platelet Effects Are Not Clinically Relevant

While research shows kiwi fruit can reduce platelet aggregation by approximately 18% when consuming 2-3 fruits daily 2, this effect:

• Is modest compared to antiplatelet medications 2
• Has not been associated with increased bleeding risk in clinical practice 2, 3
• Does not create a contraindication for use with anticoagulants 1

What Actually Matters for Apixaban Interactions

Focus your attention on these documented interactions instead 1:

Strong Dual CYP3A4 and P-gp Inhibitors (Require Dose Adjustment)

• Ketoconazole, itraconazole, clarithromycin, ritonavir 1, 4
• For patients on apixaban 5 mg twice daily: reduce to 2.5 mg twice daily 1, 4
• For patients already on 2.5 mg twice daily: avoid concomitant use 1, 4

Strong Dual CYP3A4 and P-gp Inducers (Avoid Completely)

• Rifampin, carbamazepine, phenytoin, St. John's wort 1
• These reduce apixaban levels by up to 66%, increasing thrombotic risk 1

Over-the-Counter Products That Actually Matter

• NSAIDs (ibuprofen, naproxen): Increase bleeding risk through platelet inhibition, not drug interaction 5
• Aspirin: 14.7% of apixaban users take this daily, often with inadequate knowledge of bleeding risk 5

Practical Recommendations

You can confidently advise patients that kiwi fruit consumption is safe with Eliquis 1. There is no need for:

• Dietary restrictions on kiwi fruit 1
• Dose adjustments of apixaban 1
• Additional monitoring 1

Instead, educate patients about the actual risks 5:

• 33% of apixaban users take OTC products with potentially serious interactions daily 5
• 66% of patients are uncertain or incorrect about NSAID-apixaban bleeding risk 5
• Focus counseling on avoiding strong CYP3A4/P-gp inhibitors and limiting NSAID use 1, 5