Which supplements should not be taken with Eliquis? A vital guide

October 12, 2025 •

3 min read

According to a 2019 article in Healio, approximately one in three older Eliquis users are at risk for potentially serious interactions. This risk often stems from combining the anticoagulant medication with seemingly harmless over-the-counter supplements. Understanding which supplements should not be taken with Eliquis? is crucial for managing your health and preventing dangerous side effects.

Quick Summary

Taking certain supplements with Eliquis can lead to two major complications: a heightened risk of bleeding or a reduction in the medication's efficacy. Dangerous interactions can occur with herbal products like garlic, ginger, and St. John's wort, as well as with fish oil and vitamin E. Always consult a doctor or pharmacist to screen for potential interactions.

Key Points

Bleeding Risk: Numerous herbal supplements and vitamins, such as garlic, ginkgo biloba, turmeric, ginger, fish oil, and vitamin E, significantly increase the risk of bleeding when taken with Eliquis.
Reduced Efficacy: St. John's wort interacts with liver enzymes to make Eliquis less effective, which increases the risk of dangerous blood clots.
Food Interactions: Consuming grapefruit or grapefruit juice can raise Eliquis levels in the bloodstream, increasing bleeding risk.
Hidden Dangers: Many over-the-counter products, including herbal supplements and certain foods, are not as benign as they seem and require careful consideration when on anticoagulant therapy.
Consultation is Key: Always inform your healthcare provider about all supplements, vitamins, and other medications you are taking to prevent harmful interactions and ensure your safety.
Not all Supplements Are Bad: Some supplements, like acetaminophen for pain or certain multivitamins, may be safe, but consultation with a healthcare professional is mandatory to confirm.

Eliquis (apixaban) is a prescription blood thinner used to prevent and treat blood clots in conditions such as atrial fibrillation, DVT, and PE. It works by blocking clotting factor Xa. Due to this function, combining Eliquis with other substances that affect blood clotting can lead to serious complications, primarily an increased risk of bleeding. While Eliquis doesn't require specific dietary changes regarding vitamin K like warfarin, interactions with supplements, vitamins, and certain foods can still significantly impact its safety and effectiveness. These interactions generally either increase the risk of bleeding or decrease Eliquis's efficacy.

Supplements That Increase Bleeding Risk with Eliquis

Many natural supplements have anticoagulant or antiplatelet properties. Combining these with Eliquis, a blood thinner, can dangerously amplify the effect and increase the risk of hemorrhage.

Herbal and Botanical Supplements

Garlic: Concentrated garlic supplements have antiplatelet effects that can increase bleeding risk with Eliquis. Culinary use is typically safe.
Ginkgo Biloba: This herb can significantly affect platelet function and increase the likelihood of bleeding. It has been linked to cerebral bleeding in some cases.
Turmeric and Curcumin: High-dose supplements of the active compound in turmeric, curcumin, can increase bleeding risk due to anti-inflammatory and blood-thinning effects. Moderate culinary use is generally safe.
Ginger: High doses of ginger supplements can also have a blood-thinning effect and should be avoided.
Dong Quai: This herb has anticoagulant properties and should not be used with blood thinners.
Feverfew: This herbal supplement is known to interact with various blood thinners and should be avoided.

Vitamin and Oil Supplements

Fish Oil (Omega-3 Fatty Acids): High-dose fish oil supplements have antiplatelet properties and can increase bleeding risk with Eliquis. Consult your doctor before taking them.
Vitamin E: High doses of vitamin E supplements can inhibit platelet aggregation, increasing bleeding risk.

Food-Based Interactions

Grapefruit: Grapefruit and grapefruit juice can interfere with the enzyme that breaks down Eliquis, leading to increased drug levels and a significantly higher risk of bleeding. Pomelos and Seville oranges have similar effects.
Cranberry: While evidence is mixed, some studies suggest cranberry may increase Eliquis levels or excessive anticoagulation. Caution is advised, and consultation with a healthcare provider is recommended.

Supplements That Decrease Eliquis Effectiveness

Some supplements can make Eliquis less effective, increasing the risk of blood clot formation.

St. John's Wort: This herbal supplement can significantly reduce Eliquis effectiveness by inducing liver enzymes that metabolize the drug, clearing it more quickly from the body. This increases the risk of blood clots.
American Ginseng: Some sources indicate American ginseng may interfere with drug metabolism and could reduce the efficacy of anticoagulants. Consult your doctor before use.

Comparison Table of Eliquis-Supplement Interactions


Supplement	Type of Interaction	Reason for Interaction	Risk Level	What to Do
Fish Oil (Omega-3)	Increased Bleeding	Antiplatelet properties, reduces clotting ability	High	Do not take high-dose supplements without medical supervision.
St. John's Wort	Decreased Effectiveness	Induces enzymes (CYP3A4, P-gp) that break down Eliquis	High	Avoid completely. Inform your doctor if you have been taking it.
Garlic	Increased Bleeding	Antiplatelet properties, reduces clotting	High	Avoid concentrated supplements; small culinary amounts are usually acceptable.
Ginkgo Biloba	Increased Bleeding	Antiplatelet effect, inhibits clotting	High	Avoid completely.
Turmeric/Curcumin	Increased Bleeding	Anti-inflammatory and antiplatelet effects	High	Avoid high-dose supplements. Small amounts in cooking are usually acceptable.
Grapefruit	Increased Bleeding	Inhibits enzyme (CYP3A4) that metabolizes Eliquis	High	Avoid fruit and juice entirely.
Vitamin E	Increased Bleeding	Antiplatelet effect at high doses	High	Avoid high-dose supplements.

A Crucial Step: The Importance of Professional Guidance

Maintaining open communication with your healthcare providers is essential when taking Eliquis. Always inform your doctor and pharmacist about all supplements, vitamins, and over-the-counter medications you use. They can assess potential risks and guide you safely. Never start or stop any supplement without consulting a medical professional while on Eliquis.

Conclusion

When taking Eliquis, being aware of potential supplement interactions is vital. Interactions with supplements like St. John's wort, garlic, and fish oil can increase bleeding risk or reduce Eliquis's effectiveness, potentially leading to dangerous health consequences. By understanding these risks and making informed choices in consultation with your doctor and pharmacist, you can help ensure your medication works safely and effectively for your health needs.

FDA drug label for Eliquis

Frequently Asked Questions

The primary danger is either an increased risk of bleeding, which can be severe, or a reduction in Eliquis's effectiveness, which can increase the risk of a blood clot.

No, you should not take high-dose fish oil (omega-3) supplements with Eliquis without consulting your doctor. Fish oil has antiplatelet properties that can increase your bleeding risk.

St. John's wort can decrease Eliquis levels in your blood by speeding up the drug's metabolism in the liver. This can make Eliquis less effective at preventing blood clots, putting you at risk for a stroke or other cardiovascular event.

While small, culinary amounts of herbs and spices like ginger or garlic are generally safe, you should avoid high-dose or concentrated herbal supplements, as these can have significant blood-thinning effects. Always check with your doctor.

No, you should avoid grapefruit, grapefruit juice, and related citrus fruits (like pomelos and Seville oranges). These can inhibit an enzyme that breaks down Eliquis, causing drug levels to rise and increasing bleeding risk.

No, interactions can vary based on individual health factors, metabolism, and other medications. That's why personalized advice from a healthcare provider is essential.

Most standard multivitamins are safe, but it is important to check the ingredients. High doses of certain components, especially vitamin E, should be avoided. Always discuss your multivitamin with your doctor.