What foods and supplements should be avoided while taking clopidogrel (Cloprogel) and apixaban (Eliquis)?

Foods and Supplements to Avoid While Taking Clopidogrel and Apixaban

There are no specific foods that need to be avoided while taking clopidogrel and apixaban together, but you must strictly avoid NSAIDs (including ibuprofen and naproxen), limit alcohol consumption, avoid herbal supplements that increase bleeding risk, and use proton pump inhibitors for gastrointestinal protection if you have risk factors for bleeding. 1, 2

Food Interactions

Apixaban (Eliquis)

• No dietary restrictions are required - apixaban can be taken with or without food, as food intake does not significantly affect its absorption or bioavailability 1
• Unlike rivaroxaban (which requires food intake), apixaban has no clinically relevant food interactions 1

Clopidogrel

• No specific food restrictions - clopidogrel can be taken with or without food 1
• No documented interactions with common foods that would require dietary modifications

Critical Medications and Supplements to Avoid

NSAIDs and Pain Medications (Highest Priority)

• Absolutely avoid all NSAIDs including ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin (unless specifically prescribed by your cardiologist as part of triple therapy) 1, 2
• The combination of apixaban + clopidogrel + NSAIDs increases bleeding risk by at least 60% compared to anticoagulation alone 1
• Use acetaminophen (Tylenol) for pain relief instead, as it does not increase bleeding risk 2

Herbal Supplements with Bleeding Risk

Based on evidence of bleeding when combined with anticoagulants and antiplatelet agents, avoid these supplements 3:

High-risk supplements (strong evidence for bleeding):

• Garlic supplements (strongly associated with surgical bleeding) 3
• Ginkgo biloba (associated with bleeding in anticoagulated patients) 3
• Turmeric/curcumin (increases bleeding risk with anticoagulants) 3
• Ginger (conflicting but concerning evidence) 3

Moderate-risk supplements:

• Chondroitin-glucosamine (bleeding risk with anticoagulants) 3
• Melatonin (associated with bleeding in anticoagulated patients) 3
• Chamomile, fenugreek, milk thistle, peppermint (all associated with bleeding risk) 3

Safe supplements (no evidence of increased bleeding):

• Fish oil/omega-3 fatty acids are safe even at high doses (3+ grams daily) when combined with clopidogrel and does not increase bleeding risk 4
• Ginseng and saw palmetto show no association with bleeding 3

Other Anticoagulants and Antiplatelet Agents

• Never combine with other anticoagulants (warfarin, dabigatran, rivaroxaban, edoxaban) without explicit cardiologist direction 1, 2
• Avoid additional antiplatelet agents beyond what is prescribed (aspirin, prasugrel, ticagrelor) 1

Corticosteroids

• Avoid or minimize steroid use (prednisone, dexamethasone) as they significantly increase gastrointestinal bleeding risk when combined with antiplatelet and anticoagulant therapy 2, 5

Alcohol Consumption Guidelines

Strict alcohol limitations are mandatory 2:

• Limit to one drink per session with abstinent days between drinking occasions 2
• One drink = 12 oz beer, 5 oz wine, or 1.5 oz spirits

Complete alcohol abstinence is required if you have 2:

• Active bleeding or recent major bleeding event
• Planned surgery or invasive procedure
• Concurrent NSAID use
• Any liver disease
• History of gastrointestinal bleeding

Protective Medications You Should Take

Proton Pump Inhibitors (PPIs)

You should be on a PPI if you have any of these risk factors 1, 5:

• Age over 65 years 5
• History of peptic ulcer disease or gastrointestinal bleeding 1, 5
• Concurrent steroid use 5
• Helicobacter pylori infection 5

Preferred PPIs (avoid drug interactions with clopidogrel) 1:

• Pantoprazole (preferred - no interaction with clopidogrel)
• Dexlansoprazole (no interaction)
• Avoid omeprazole and esomeprazole as they interfere with clopidogrel metabolism through cytochrome P450 2C19 1

Monitoring and Safety Considerations

High-Risk Situations Requiring Extra Caution

The combination of clopidogrel + apixaban carries significant bleeding risk, particularly with 6, 7:

• Advanced age (>70 years) 7
• Renal impairment (even mild) 7
• Extremes of body weight 7
• Multiple interacting medications 7

Clinical Pitfall to Avoid

The most common and dangerous mistake is patients taking over-the-counter NSAIDs (ibuprofen, naproxen, aspirin) for headaches, muscle pain, or arthritis without realizing these dramatically increase bleeding risk 1, 2. Always read labels on combination cold/flu medications, as many contain NSAIDs or aspirin.

When to Seek Immediate Medical Attention

Contact your physician immediately if you experience 7:

• Any unusual bleeding (nosebleeds, bleeding gums, blood in urine or stool)
• Severe bruising
• Prolonged bleeding from minor cuts
• Black or tarry stools
• Vomiting blood or coffee-ground material