Can I take a multivitamin with vitamin K while on Eliquis (apixaban) and Lexapro (escitalopram)?

Can You Take a Multivitamin with Vitamin K While on Eliquis and Lexapro?

Yes, you can safely take a multivitamin containing vitamin K while on Eliquis (apixaban) and Lexapro (escitalopram), as apixaban does not interact with vitamin K supplementation. 1

Why Vitamin K Is Safe with Eliquis

• Apixaban works independently of the vitamin K pathway, unlike warfarin which directly antagonizes vitamin K-dependent clotting factors. 1

• The American Heart Association confirms that calcium supplements with or without vitamin K can be safely taken with Eliquis, as there is no clinically significant drug interaction between them. 1

• Apixaban's major drug interactions involve CYP3A4 and P-gp inhibitors or inducers, not vitamin K or calcium supplements. 1

• Comprehensive guidelines on direct oral anticoagulant (DOAC) drug interactions do not list vitamin K supplements as concerning agents when used with apixaban or other DOACs. 1

Critical Distinction: Warfarin vs. Eliquis

• Vitamin K supplementation is only a significant concern with warfarin, where it can reduce anticoagulant effectiveness by overcoming the vitamin K antagonism in a dose-dependent manner. 2

• The American College of Cardiology extensively discusses vitamin K interactions with warfarin but makes no such warnings for apixaban or other DOACs. 1

• Even small amounts of vitamin K (25 mcg daily) in multivitamins can affect warfarin patients who are vitamin K-depleted, causing subtherapeutic INRs. 3, 4 However, this mechanism does not apply to apixaban.

Lexapro Considerations

• Lexapro (escitalopram) has no known interaction with vitamin K supplementation and does not affect the safety of taking a multivitamin with your current medications.

Medications to Actually Avoid with Eliquis

While vitamin K is safe, you should be aware of genuinely problematic interactions:

• NSAIDs (ibuprofen, naproxen) significantly increase bleeding risk when combined with apixaban and should be avoided or used with extreme caution. 1

• Strong dual CYP3A4 and P-gp inhibitors (ketoconazole, ritonavir) are contraindicated as they can dangerously increase apixaban levels. 1

• Strong dual CYP3A4 and P-gp inducers (rifampin, carbamazepine, St. John's wort) should not be used as they reduce apixaban effectiveness. 1

• Acetaminophen is the preferred analgesic for patients on apixaban, as it does not have antiplatelet effects and does not significantly interact with the medication. 1

Important Safety Monitoring

• Report any unusual bleeding or bruising while taking any combination of medications with apixaban, as this requires immediate medical evaluation. 1

• Inform healthcare providers about apixaban use before any surgical or dental procedures, as temporary discontinuation may be needed. 1