Can I consume hemp hearts while taking clopidogrel (Plavix) and apixaban (Eliquis)?

Hemp Hearts with Clopidogrel and Apixaban: Safety Assessment

Hemp hearts (hulled hemp seeds) can be consumed while taking clopidogrel and apixaban, as they do not contain pharmacologically significant amounts of substances that interact with these anticoagulant or antiplatelet medications.

Understanding the Combination Therapy Context

Your current medication regimen—combining an antiplatelet agent (clopidogrel) with an anticoagulant (apixaban)—already carries substantial bleeding risk that requires careful management:

• The combination of clopidogrel and apixaban increases major bleeding risk 3.4-fold compared to monotherapy 1
• This dual antithrombotic therapy should only be used in specific high-risk scenarios, such as atrial fibrillation patients with recent acute coronary syndrome or recent coronary stent placement 1
• Triple therapy (apixaban + aspirin + clopidogrel) causes more bleeding events than dual therapy and should be limited to a maximum of 1 week after acute coronary syndrome 2, 1

Hemp Hearts: Composition and Safety Profile

Hemp hearts are primarily composed of:

• Protein (approximately 25-30%)
• Healthy fats including omega-3 and omega-6 fatty acids
• Fiber, vitamins, and minerals

Critically, hemp hearts do not contain:

• Vitamin K in clinically significant amounts (unlike warfarin, DOACs like apixaban are not affected by dietary vitamin K) 3, 4
• St. John's Wort (a strong CYP3A4 and P-glycoprotein inducer that is contraindicated with apixaban) 4
• Pharmacologically active cannabinoids (THC or CBD in meaningful concentrations, as these are found in other parts of the hemp plant, not the seeds)

Substances That DO Interact with Your Medications

You must avoid or use extreme caution with the following, which hemp hearts do not contain:

For Apixaban:

• Strong CYP3A4 and P-glycoprotein inhibitors (azole antifungals like ketoconazole) are contraindicated 3
• Strong CYP3A4 and P-glycoprotein inducers (rifampicin, St. John's Wort) significantly reduce apixaban efficacy 3, 4

For Clopidogrel:

• Strong CYP2C19 inhibitors (omeprazole, esomeprazole) reduce clopidogrel's antiplatelet activity 1
• NSAIDs (ibuprofen, naproxen) taken daily/most days significantly increase bleeding risk when combined with antiplatelet and anticoagulant therapy 3, 5

For Both Medications:

• Aspirin increases bleeding risk when added to dual therapy outside the brief triple therapy period 2, 1
• Other antiplatelet agents (prasugrel, ticagrelor) should not be added to this regimen 1

Critical Bleeding Risk Management

While hemp hearts are safe, you must implement these protective measures given your high-risk medication combination:

• A proton pump inhibitor (PPI) should be prescribed to reduce gastrointestinal bleeding risk, with preferred PPIs being pantoprazole, dexlansoprazole, or lansoprazole 1
• Avoid omeprazole and esomeprazole as they reduce clopidogrel efficacy 1
• Patients aged ≥75 years or with history of GI bleeding are at particularly high risk and require mandatory PPI prophylaxis 6
• Monitor for bleeding complications, especially during the first 2 weeks of treatment 7

Over-the-Counter Products to Avoid

Research shows that 33% of patients on apixaban take at least one OTC product with potentially serious interactions daily 5:

• Aspirin was taken daily by 14.7% of apixaban patients, with 64.7% of those also consuming other potentially interacting OTC products 5
• Ibuprofen and naproxen were taken occasionally by 28.5% of patients 5
• Dietary supplements with potentially serious interactions were taken daily by 20.2% of patients 5
• Approximately 66% of patients were uncertain or incorrect about the potential for increased bleeding from combining NSAIDs and apixaban 5

Duration and Discontinuation Guidance

• Clopidogrel should be stopped at 12 months and apixaban monotherapy continued, unless you require elective surgery with major bleeding risk or experience major bleeding 1
• If discontinuation is needed for surgery, clopidogrel should be stopped at least 5 days before the procedure 7
• Do not abruptly discontinue clopidogrel if you have coronary stents, as this dramatically increases the risk of stent thrombosis, MI, and death 7

Bottom Line

Hemp hearts pose no pharmacological interaction risk with clopidogrel or apixaban and can be safely consumed. However, your medication combination itself carries substantial bleeding risk that requires vigilant management, mandatory PPI prophylaxis, and strict avoidance of NSAIDs, additional antiplatelet agents, and herbal supplements like St. John's Wort.