Supplements and Apixaban.
Apixaban, sold under the brand name Eliquis, is a direct oral anticoagulant (DOAC): it inhibits factor Xa or thrombin directly, without routine INR monitoring.
Apixaban is a direct oral anticoagulant (DOAC), a direct factor Xa inhibitor, and the most prescribed DOAC in England at around 11 million items per year per NHSBSA. It is the standard alternative to warfarin for atrial fibrillation stroke prevention and for treatment of venous thromboembolism, with no routine INR monitoring required. The tradeoff. No antidote for most clinical situations (andexanet alfa exists but is not routinely available), and reduced flexibility around excess anticoagulation. The supplement surface is real but quieter than warfarin's. Apixaban is metabolised by CYP3A4 and is a P-glycoprotein substrate, so strong dual 3A4 plus P-gp inhibitors raise plasma levels. Some supplements at high concentrations show this in vitro. Additive antiplatelet or fibrinolytic supplements (fish oil at high doses, ginkgo, garlic extract, curcumin, bromelain, nattokinase) add to bleeding risk mostly through platelets or clotting rather than through the apixaban level. The washout window before surgery is 24 to 48 hours depending on renal function and bleeding risk. Supplement washout should align with it.
Below are the 11 documented pairs we have explicitly assessed against Apixaban in the Distil database: 1 severe, 9 caution, and 1 good to know. The pairs cluster around 4 mechanisms: CYP induction, Additive anticoagulation, Additive antiplatelet effect, and CYP3A4 inhibition. Every call is cited to either a clinical reference (PMID) or the British National Formulary. Anything not on this list is either still to be assessed or beyond our database scope. The checker beneath surfaces assessments by supplement, and the missing-item form at the bottom of the page routes any uncatalogued supplement into our next curation pass.
Documented interactions
Last reviewed 12 November 2026. Each interaction below lists the evidence its assessment drew on: some rest on studies of the exact pair, others on mechanism evidence, where a citation may support one part of the reasoning rather than the exact combination. The evidence line on each entry says which.
CYP induction
Severe Does St John's Wort interact with Apixaban?
Avoid taking St John's Wort with apixaban: it may make your body clear apixaban faster, which could lower its level and leave you less protected against clots or stroke. The UK product information for Eliquis names St John's Wort among the medicines that may lower apixaban levels. How large the effect is has not been measured with apixaban itself. Apixaban has no routine blood test that would show a drop, so tell your GP or pharmacist if you take or have recently taken St John's Wort.
Evidence: Supported by human study data.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Additive anticoagulation
Caution Does Andrographis interact with Apixaban?
Andrographis may slow how the body clears apixaban and could also have a mild blood-thinning action of its own, so in theory it might raise apixaban levels and bleeding risk. This has not been studied in people, so it is a cautious flag. If you take apixaban, tell your doctor or pharmacist before starting andrographis and watch for unusual bruising or bleeding.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Caution Does Bromelain interact with Apixaban?
Bromelain may add to apixaban's bleeding risk. Its effect on blood clotting has been seen mainly in laboratory tests, though in one small 1972 study bromelain tablets reduced platelet clumping in volunteers. The only data on bromelain alongside a blood thinner, from surgical patients on a preventive dose of heparin, found their clotting tests little changed, but no study has tested bromelain with apixaban or in anyone taking a full-dose blood thinner for months. Tell whoever prescribes your apixaban before starting bromelain, watch for unusual bruising, nosebleeds or bleeding gums, and stop it about two weeks before any planned surgery or dental work.
Evidence: Limited human data, from small studies or case reports.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Caution Does Curcumin interact with Apixaban?
Curcumin has a mild blood-thinning effect of its own, so combining it with apixaban may add slightly to the bleeding risk. There is no strong human evidence either way, so the sensible step is to tell your GP you take it and stop curcumin before any planned surgery or dental work.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Additive antiplatelet effect
Caution Does Fisetin interact with Apixaban?
Fisetin may mildly thin the blood by reducing platelet clumping, which could add to apixaban. Apixaban has no routine blood test to track this, so keep any fisetin course modest and tell your GP if you take both. The amount in food is not the concern.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Caution Does Ginkgo Biloba interact with Apixaban?
Ginkgo may add to apixaban's bleeding risk, so we would not start it alongside apixaban without your prescriber agreeing, and there is no INR blood test on apixaban to pick up a problem early the way there is on warfarin. In trials in people, ginkgo at the 120 to 240mg doses sold in the UK has not shown a meaningful effect on standard clotting tests, so the caution rests on published reports of bleeding in ginkgo users rather than on a proven blood-thinning effect. If you and your prescriber decide to continue both, watch for unusual bruising, nosebleeds, or black or bloody stools, and stop the ginkgo at least two weeks before any planned surgery or dental work.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Caution Does Omega-3 EPA interact with Apixaban?
Across large trials, omega-3 supplements were not linked to more bleeding overall, but high-dose purified EPA was, and bleeding risk rose with the daily dose of EPA. Fish oil may add a mild blood-thinning effect to apixaban, more so at high doses. Apixaban has no INR test to monitor this, so tell your GP what dose of fish oil you take.
Evidence: Limited human data, from small studies or case reports.
Caution Does Resveratrol interact with Apixaban?
Resveratrol can mildly thin the blood by reducing platelet clumping, which could add to apixaban. Apixaban has no routine blood test to track this, so keep any resveratrol dose modest and tell your GP if you take both. The amount in food is not the concern.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Caution Does Vitamin E interact with Apixaban?
Vitamin E at high doses (above 400 IU per day) can raise bleeding risk in its own right, which could add to apixaban. Lower doses have not been studied with apixaban, and a pooled analysis of the trials behind vitamin E's own bleeding signal did not find that the dose explained it, so a low dose cannot be assumed to be free of it. Apixaban has no INR test to monitor this, so tell whoever prescribes your apixaban before taking vitamin E at any dose, and stop vitamin E at least two weeks before planned surgery.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
CYP3A4 inhibition
Caution Does Schisandra interact with Apixaban?
Schisandra may raise the level of apixaban in your blood a little, which could add to its bleeding risk. Schisandra has been shown in people to slow a gut transporter that helps clear apixaban, and a related schisandra species slows the liver enzyme that clears it, but the two have never been tested together. Tell your prescriber or pharmacist before you start, and watch for unusual bruising, nosebleeds or black stools, because there is no routine blood test for apixaban to catch a change.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Other
Good to know Does Vitamin K2 interact with Apixaban?
Apixaban is not a warfarin-type blood thinner, so vitamin K does not work against it the way it works against warfarin. Vitamin K2 is not expected to reduce apixaban's effect. If you are on apixaban rather than warfarin, this common worry is unlikely to apply to you.
Evidence: Limited human data, from small studies or case reports.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
What this list does not say. Pairs not flagged here are not implicitly safe. They are either not yet in our database, or fall outside our inclusion scope (food-supplement interactions only; for drug-drug interactions, the BNF is authoritative). Use the checker below to surface any supplement, and submit a missing item if you take something we have not catalogued.
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How the checker decides
Every result has a source
Each pair we have assessed is cited to a published study (PMID) or the British National Formulary, so you can read the source yourself.
Four kinds of answer
Severe, caution, no known interaction, and not yet assessed. A pair we have not assessed is never shown as clear.
- Severe
- Caution
- No known interaction
- Not yet assessed
Nothing in our data is not a clearance
When nothing in our data records a problem with a pair, the result says no known interaction at typical doses, which is not a clearance: your pharmacist or GP can check the pair against your full medical history.
A full supplement review, built around you, not a generic stack.
The free checker answers one interaction question at a time. A Distil report reviews the bigger picture: your goals, diet, medications, current supplements and any blood results you provide, then shows what appears worth keeping, changing, adding or leaving out.
- what your diet already covers, so you are not adding a capsule for something food is already handling
- which evidence-graded compounds are worth considering for your goals, and which were considered but left out
- what to keep, change or stop from what you already take, plus the order to introduce anything new
- how your medications and complete supplement stack fit together, with daily timing and a clear point for reassessment
The interaction check is one section of the full report. You also get the reasoning behind each recommendation and the evidence references used.
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