No Clinically Significant Drug Interaction Between Prevagen and Eliquis
Prevagen (apoaequorin) does not interact with apixaban (Eliquis) because apoaequorin is a dietary supplement protein that is not metabolized by cytochrome P450 enzymes or P-glycoprotein transporters, the two pathways responsible for apixaban metabolism and elimination. 1
Apixaban Metabolism Pathways
Apixaban is eliminated through three main routes 1, 2:
- 27% renal excretion of unchanged drug 1
- Metabolism via CYP3A4 (major hepatic enzyme) 1
- P-glycoprotein (P-gp) transporter-mediated elimination 1
Why Prevagen Does Not Interact
Prevagen contains apoaequorin, a calcium-binding protein originally derived from jellyfish 3. This protein:
- Does not inhibit or induce CYP3A4 enzymes 1
- Does not affect P-glycoprotein transporters 1
- Is digested as a dietary protein in the gastrointestinal tract rather than undergoing hepatic metabolism 2
Drugs That DO Require Apixaban Dose Adjustment
For context, only combined strong CYP3A4 AND P-gp inhibitors require apixaban dose reduction 1, 4:
- Ketoconazole, itraconazole, ritonavir, clarithromycin → reduce apixaban from 5 mg to 2.5 mg twice daily 1, 4
- Strong CYP3A4 inducers (rifampin, carbamazepine, phenytoin) → avoid apixaban entirely 1, 4
Common Pitfalls to Avoid
Do not confuse dietary supplements with actual drug interactions. The 2020 study examining OTC product use with apixaban found that 20.2% of patients took dietary supplements daily, but the concern was primarily with NSAIDs (ibuprofen, naproxen) and aspirin, not protein-based supplements like Prevagen 3. The bleeding risk comes from antiplatelet effects, not metabolic interactions 3.
Moderate P-gp inhibitors alone (diltiazem, verapamil) cause only a 40% increase in apixaban levels and generally do not require dose adjustment unless combined with other risk factors 4. Prevagen has no such effect 1.
Clinical Management
Continue apixaban 5 mg twice daily (or 2.5 mg twice daily if the patient meets ≥2 dose-reduction criteria: age ≥80 years, weight ≤60 kg, serum creatinine ≥1.5 mg/dL) without modification when Prevagen is added 5, 4. No additional monitoring is required beyond standard annual renal function assessment 5.