What Foods Can I Not Eat with Eliquis?

October 11, 2025 •

5 min read

As one of the most prescribed blood thinners, Eliquis (apixaban) is a cornerstone of modern anticoagulation therapy. Understanding the specific dietary considerations is critical for managing your condition and avoiding dangerous interactions. In contrast to older medications, the list of foods to avoid with Eliquis is surprisingly short, but the items on it are extremely important.

Quick Summary

Taking Eliquis requires avoiding grapefruit and related citrus, limiting certain herbal supplements and alcohol, and being mindful of other substances that increase bleeding risk. Unlike warfarin, Eliquis does not interact with vitamin K from leafy greens.

Key Points

Avoid Grapefruit: Grapefruit, Seville oranges, pomelos, and limes interfere with the breakdown of Eliquis, increasing blood levels and bleeding risk.
Restrict Alcohol: Excessive alcohol consumption increases the risk of bleeding and should be avoided; moderate intake should be cleared with a doctor.
Be Cautious with Herbal Supplements: High-dose supplements like ginger, garlic, turmeric, ginkgo biloba, and fish oil can increase bleeding risk. St. John's wort can reduce Eliquis' effectiveness.
Vitamin K Foods are Safe: Unlike with warfarin, you do not need to limit or consistently monitor your intake of vitamin K-rich foods like kale and spinach while on Eliquis.
Consult Your Provider: Always inform your healthcare provider or pharmacist about any supplements you are taking or planning to take to avoid potential interactions.
Embrace a Healthy Diet: A balanced diet focusing on whole grains, lean proteins, fruits, and vegetables supports overall heart health, which is beneficial for Eliquis users.

The Core Difference: Eliquis vs. Warfarin

When a doctor prescribes an anticoagulant, one of the first questions patients often have is about dietary changes. This is largely due to the reputation of older blood thinners like warfarin (Coumadin®), which famously requires strict, consistent monitoring of vitamin K intake. Warfarin works by interfering with the body's use of vitamin K in the clotting process. However, Eliquis (apixaban) belongs to a newer class of anticoagulants known as Direct Oral Anticoagulants (DOACs) and works through a different mechanism.

Eliquis works by directly blocking a specific clotting factor in the blood called Factor Xa. Because its action is independent of vitamin K, the strict dietary restrictions associated with warfarin simply do not apply. This allows for a much more liberal and heart-healthy diet rich in fruits, vegetables, and whole grains, which is a major advantage for patients.

Foods and Substances to Strictly Avoid or Limit with Eliquis

While Eliquis offers more dietary freedom, certain foods and substances can still interfere with its metabolism and effectiveness. The most significant concern involves interactions that can either increase Eliquis levels in the blood, raising the risk of bleeding, or decrease its effectiveness, increasing the risk of clots.

Grapefruit and Related Citrus

Grapefruit is the most well-documented food interaction with Eliquis. The reason lies with a liver enzyme system known as CYP3A4, which is responsible for breaking down Eliquis and other medications.

How it works: Compounds in grapefruit inhibit the CYP3A4 enzyme, preventing the body from properly metabolizing Eliquis.
The result: When the enzyme is blocked, Eliquis levels in the bloodstream rise higher than intended, amplifying its blood-thinning effect and significantly increasing the risk of dangerous bleeding.
Other culprits: This interaction is not limited to grapefruit alone. Other citrus fruits, including Seville oranges (often used in marmalades), pomelos, and limes, contain similar compounds and should also be avoided or severely limited.

Herbal Supplements and Spices

Many herbal supplements and concentrated spices can interact dangerously with Eliquis. This is primarily due to their inherent blood-thinning properties or their ability to affect the same liver enzymes that process Eliquis.

Increased bleeding risk: Concentrated forms of garlic, ginger, turmeric (curcumin), and ginkgo biloba can enhance the blood-thinning effects of Eliquis, raising the risk of bleeding. While normal amounts used in cooking are generally fine, supplements should be avoided. High-dose fish oil and Vitamin E supplements also increase this risk.
Decreased efficacy: The herbal supplement St. John's wort can decrease the effectiveness of Eliquis by speeding up its breakdown in the liver. This can increase the risk of blood clots, defeating the purpose of the medication.

Alcohol

While alcohol does not have a direct, pharmacological interaction with Eliquis in the same way as grapefruit, its consumption should be monitored closely. Alcohol itself has blood-thinning properties.

Increased bleeding risk: Combining alcohol with Eliquis further increases the risk of excessive bleeding, particularly in the stomach and intestines.
Risk of injury: Heavy alcohol use can impair judgment and coordination, increasing the likelihood of falls or other injuries that could result in dangerous internal bleeding.
Moderation is key: Most healthcare providers advise either abstaining from alcohol or consuming it only in small, occasional amounts. Discussing your alcohol intake with your doctor is essential.

Cranberry Juice

There is conflicting evidence regarding cranberry products and their effect on anticoagulants. While the interaction is more significant with warfarin, some studies suggest that large quantities of cranberry juice could still influence Eliquis, potentially increasing bleeding risk. It is generally safest to be cautious and consume cranberry products in moderation, if at all.

Clarifying Common Myths and Dietary Freedom

Because Eliquis is so different from warfarin, many of the old rules about dietary restrictions no longer apply. This allows patients to enjoy a wider variety of healthy foods without concern.

Vitamin K-rich foods: You do not need to avoid or limit your intake of green leafy vegetables like kale, spinach, broccoli, and Brussels sprouts. These foods are excellent sources of nutrients and can be enjoyed freely as part of a balanced diet while on Eliquis.
Taking with food: Eliquis can be taken with or without food. Some people who experience mild stomach upset find that taking it with a meal helps alleviate this.

Comparison of Dietary Restrictions: Eliquis vs. Warfarin

To highlight the freedom Eliquis provides, the table below compares the dietary restrictions for both medications.


Feature	Eliquis (Apixaban)	Warfarin (Coumadin®)
Mechanism of Action	Directly blocks Factor Xa.	Antagonizes Vitamin K.
Vitamin K Foods	No restrictions. Freely consume leafy greens like kale, spinach, and broccoli.	Requires strict consistency. Sudden changes in intake can affect efficacy.
Grapefruit/Citrus	Strictly avoid grapefruit, Seville oranges, pomelos, and limes.	Interacts with some citrus, but often less critically than Eliquis due to different metabolic pathways.
Herbal Supplements	Caution with supplements containing high doses of ginger, garlic, turmeric, ginkgo biloba, fish oil, and vitamin E. Avoid St. John's wort.	Interactions with many herbal supplements. Consistent diet and disclosure to doctor is crucial.
Alcohol	Heavy consumption increases bleeding risk. Moderate intake should be discussed with a doctor.	Heavy consumption increases bleeding risk. Moderate intake should be discussed with a doctor.

Overall Dietary Advice

For most individuals taking Eliquis, the primary dietary goal is a heart-healthy diet to manage underlying conditions like atrial fibrillation or cardiovascular disease. This includes a diverse intake of fruits, vegetables, whole grains, lean proteins, and healthy fats, with limits on processed foods and saturated fats. Staying well-hydrated is also important to support kidney function.

Conclusion

While Eliquis significantly simplifies dietary management compared to older anticoagulants like warfarin, it is not without important considerations. The most critical step is to avoid grapefruit and related citrus fruits due to the risk of dangerously high drug levels. In addition, caution is warranted with certain herbal supplements, concentrated spices, and excessive alcohol, as these can increase bleeding risk or affect the medication's effectiveness. Unlike warfarin, there is no need to restrict your intake of vitamin K-rich leafy green vegetables. Always consult with your healthcare provider or pharmacist before starting new supplements or making significant changes to your diet to ensure the safest and most effective treatment plan.

This article is for informational purposes only and does not constitute medical advice. Please consult your healthcare provider with any specific questions or concerns about your medication. For additional information on Eliquis and interactions, consult reliable resources like the National Institutes of Health.

Frequently Asked Questions

Yes, you can eat leafy green vegetables like spinach and kale freely while taking Eliquis. This is a common misconception carried over from older blood thinners like warfarin. Eliquis does not interfere with the vitamin K clotting pathway, so there is no need to restrict your intake of these nutritious foods.

Grapefruit and its juice contain compounds that inhibit a liver enzyme called CYP3A4, which is responsible for breaking down Eliquis. This can cause the medication to build up in your bloodstream to dangerously high levels, significantly increasing your risk of bleeding.

Moderate, occasional alcohol consumption may be deemed safe by your doctor, but excessive drinking is not recommended. Alcohol can increase the risk of bleeding and potential falls. It is best to discuss your specific alcohol use with your healthcare provider.

Using small, normal amounts of spices like ginger and turmeric in cooking is generally considered safe. The primary risk comes from taking concentrated supplements of these substances, which can increase bleeding risk. Always consult your doctor before taking any herbal or spice supplements.

While the interaction with cranberry juice is more notable with warfarin, it is still advisable to exercise caution and avoid consuming large quantities while on Eliquis. Discuss this with your healthcare provider for personalized advice.

Eliquis can be taken with or without food, as it does not significantly affect the absorption or efficacy of the medication. If you experience nausea, taking your dose with a snack or meal might help.

Garlic supplements, high-dose fish oil, and high-dose Vitamin E supplements all have blood-thinning properties and should be used with caution or avoided entirely, as they can enhance Eliquis' effects and increase bleeding risk. Always check with your doctor before starting any new supplements.