Safety of Magnesium Threonate with Clopidogrel and Apixaban
Magnesium threonate can be safely taken with clopidogrel (Plavix) and apixaban (Eliquis) as there are no documented pharmacokinetic or pharmacodynamic interactions between magnesium supplements and these antithrombotic agents.
Mechanism and Drug Interaction Profile
Clopidogrel is metabolized primarily through the CYP2C19 pathway, and magnesium does not inhibit or induce cytochrome P450 enzymes, eliminating concerns about altered clopidogrel activation 1.
Apixaban is not metabolized by the CYP3A4 system in a way that magnesium would interfere with, though p-glycoprotein inhibitors like dronedarone, ketoconazole, and verapamil can affect apixaban levels—magnesium is not a p-glycoprotein inhibitor 1.
The combination of apixaban and clopidogrel itself carries similar bleeding risk to rivaroxaban plus clopidogrel (IPTW hazard ratio 1.13,95% CI 0.78-1.63), with major bleeding rates of approximately 7-8 events per 100 person-years, but this is unrelated to magnesium supplementation 2.
Critical Bleeding Risk Considerations for Your Current Regimen
While magnesium is safe to add, you should be aware of the baseline bleeding risk from your current dual antithrombotic therapy:
Dual therapy with an oral anticoagulant plus clopidogrel (without aspirin) is the preferred strategy when both anticoagulation and antiplatelet therapy are indicated, as triple therapy significantly increases bleeding without reducing thrombotic events 1.
Monitor for signs of bleeding including bruising, petechiae, melena, hematemesis, hematuria, or unexplained anemia, and report any unusual bleeding immediately 3.
If you require gastroprotection, use pantoprazole, dexlansoprazole, or lansoprazole—avoid omeprazole or esomeprazole as these significantly inhibit CYP2C19 and reduce clopidogrel effectiveness 1, 3.
Specific Situations Requiring Caution
If you have a history of gastrointestinal bleeding, peptic ulcer disease, age >75 years, or renal impairment, your baseline bleeding risk is elevated and warrants closer monitoring, though this does not contraindicate magnesium 3.
The combination of antiplatelet and anticoagulant therapy significantly increases bleeding time (from 7.6 minutes to 17.5-24.9 minutes in studies), which is relevant for any surgical procedures but unaffected by magnesium supplementation 4.
For elective surgery, clopidogrel should be held for 5 days and apixaban for 48 hours (with normal renal function) to allow complete hemostasis, but magnesium can be continued 1, 5.
Common Pitfall to Avoid
Do not assume that adding any supplement to dual antithrombotic therapy increases bleeding risk—only agents that affect platelet function (like NSAIDs, SSRIs/SNRIs) or anticoagulation pathways create additive bleeding risk. Magnesium threonate has no such mechanism 1.