Can I take 2 g of vitamin C daily while I am on clopidogrel (Cloprogel) and apixaban (Eliquis)?

Vitamin C Supplementation with Clopidogrel and Apixaban

Taking 2 grams of vitamin C daily while on clopidogrel and apixaban is safe, as there are no clinically significant drug interactions between vitamin C and these anticoagulant/antiplatelet medications, and this dose falls within established safety limits.

Safety Profile of 2g Vitamin C

• Vitamin C supplements up to 2000 mg/day are safe for most adults, with the Food and Nutrition Board establishing this as the tolerable upper intake level 1
• The most common side effects at this dose are occasional gastrointestinal upset or mild diarrhea due to osmotic effects of unabsorbed vitamin C, not bleeding complications 1
• No consistent pattern of adverse effects has occurred in numerous clinical trials involving vitamin C supplementation at or below 2000 mg daily 1

Absence of Drug Interactions

• There is no documented interaction between vitamin C and clopidogrel that would alter platelet inhibition or increase bleeding risk 2, 1
• Vitamin C does not interfere with apixaban's anticoagulant mechanism, as apixaban is a direct Factor Xa inhibitor and vitamin C does not affect this pathway 3
• The combination of clopidogrel and apixaban already carries significant bleeding risk (3.4-fold increase), but this is inherent to the dual antithrombotic therapy itself, not influenced by vitamin C 4

Clinical Context of Your Dual Therapy

• You are on a high-risk medication regimen combining an antiplatelet agent (clopidogrel) with an oral anticoagulant (apixaban), which is typically reserved for specific indications like atrial fibrillation with recent coronary stent placement 4, 5
• Your bleeding risk is already elevated from the medication combination, with major bleeding occurring in 3-12% of patients on dual therapy depending on duration and patient factors 6, 4
• Vitamin C at 2g daily does not add to this bleeding risk, as there is no evidence of vitamin C causing bleeding effects even at higher intakes 1

Specific Precautions Unrelated to Your Medications

• If you have a history of kidney stones, exercise caution with vitamin C supplementation as it may increase oxalate formation 2
• If you have iron overload conditions (hemochromatosis), vitamin C can enhance iron absorption and should be used cautiously 2
• Monitor for gastrointestinal symptoms (diarrhea, nausea) which are the most common side effects at 2g daily, not bleeding 1

What Actually Matters for Your Bleeding Risk

• Ensure you're on appropriate gastroprotection with a proton pump inhibitor (pantoprazole, lansoprazole, or dexlansoprazole—avoid omeprazole/esomeprazole as they reduce clopidogrel efficacy) 5
• Avoid adding aspirin, NSAIDs, or other antiplatelet agents unless specifically directed by your cardiologist, as these dramatically increase bleeding risk 4, 5
• Your age, weight, and kidney function determine your apixaban dose (2.5 mg twice daily if ≥80 years, ≤60 kg, or creatinine ≥1.5 mg/dL; otherwise 5 mg twice daily) 4, 5

Common Pitfall to Avoid

Do not confuse vitamin C with vitamin E or other supplements that may have antiplatelet effects—vitamin C at 2g daily has no documented impact on platelet function or coagulation pathways 1. The safety concern with your regimen is the clopidogrel-apixaban combination itself, which requires careful monitoring for bleeding regardless of vitamin C intake 4, 5.