Apixaban and supplements: 6 sourced interactions
Anticoagulant (factor Xa inhibitor), also sold as Eliquis. Of these, 6 named by an FDA label or NIH page. Plus 1 predicted from how each works (not established). Plus 1 food and drink line. Each links its source and the date it was checked.
From the Interaction Map Sources checked Oct 25, 2026
A combination missing here is not on our list; that does not mean it is safe together.
Apixaban with supplements
Most serious first. Open a row for the mechanism, the source's words and the date checked.
Educational only. Check with your pharmacist or prescriber before changing anything you take.
Major
1St John's wortLabel or NIHThe FDA label names this pair (breakdown by liver enzymes).
major · Named by an FDA label or NIH page · Breakdown by liver enzymes
In the source’s own words; rated major from that wording, not from a study of the pair.
“Avoid concomitant use of ELIQUIS with combined P-gp and strong CYP3A4 inducers (e.g., rifampin, carbamazepine, phenytoin, St. John’s wort) because such drugs will decrease exposure to apixaban”
“Avoid concomitant use of ELIQUIS with combined P-gp and strong CYP3A4 inducers (e.g., rifampin, carbamazepine, phenytoin, St. John’s wort) because such drugs will decrease exposure to apixaban [see Clinical Pharmacology (12.3)].”
“As a result, St. John’s wort has major drug interactions, particularly with birth control pills, transplant rejection agents, antiretroviral agents, digoxin, platelet inhibitors, anticoagulants and psychotropic agents.”
- FDA drug label (DailyMed) · ELIQUIS (APIXABAN) TABLET, FILM COATED ELIQUIS 30-DAY STARTER PACK (APIXABAN) KIT [E.R. SQUIBB & SONS, L.L.C.], section 7.2
- LiverTox (NIH) · St. John's Wort. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury (NIDDK), Background
- Checked Oct 23, 2026
Moderate
6Fish oil (omega-3)Label or NIHAn NIH page names this pair (platelets and bleeding).
moderate · Named by an FDA label or NIH page · Platelets and bleeding
In the source’s own words; rated moderate from that wording, not from a study of the pair.
“However, these package inserts also state that patients taking these products with anticoagulants should be monitored periodically for changes in INR.”
- NIH Office of Dietary Supplements · Office of Dietary Supplements · Omega-3 Fatty Acids: Fact Sheet for Health Professionals, Interactions with Medications > Warfarin (Coumadin) and similar anticoagulants
- Checked Oct 23, 2026
GarlicLabel or NIHAn NIH page names this pair (platelets and bleeding).
moderate · Named by an FDA label or NIH page · Platelets and bleeding
In the source’s own words; rated moderate from that wording, not from a study of the pair.
“This is especially important if you are going to have surgery or if you take medicines, such as anticoagulants or aspirin, that may also affect bleeding.”
- NIH National Center for Complementary and Integrative Health · Garlic: Usefulness and Safety, What Do We Know About Safety?
- Checked Oct 23, 2026
Ginkgo bilobaLabel or NIHAn NIH page names this pair (platelets and bleeding).
moderate · Named by an FDA label or NIH page · Platelets and bleeding
In the source’s own words; rated moderate from that wording, not from a study of the pair.
“Ginkgo may increase the risk of bleeding in people who are taking anticoagulant drugs, such as warfarin.”
“Several instances of excessive bleeding during therapy with ginkgo have been attributed to drug interactions with antiplatelet medications or anticoagulants.”
- NIH National Center for Complementary and Integrative Health · Ginkgo: Usefulness and Safety, What Do We Know About Safety?
- LiverTox (NIH) · Ginkgo. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury (NIDDK), Hepatotoxicity
- Checked Oct 23, 2026
MelatoninLabel or NIHAn NIH page names this pair (cause not established).
moderate · Named by an FDA label or NIH page · Cause not established
In the source’s own words; rated moderate from that wording, not from a study of the pair.
“In particular, people with epilepsy and those taking blood thinner medications need to be under medical supervision when taking melatonin supplements.”
- NIH National Center for Complementary and Integrative Health · Melatonin: What You Need To Know, Is it safe to take melatonin? > Interactions with medicines
- Checked Oct 23, 2026
Vitamin ELabel or NIHAn NIH page names this pair (platelets and bleeding).
moderate · Named by an FDA label or NIH page · Platelets and bleeding
In the source’s own words; rated moderate from that wording, not from a study of the pair.
“Vitamin E supplements can interact with certain medications, including anticoagulants, antiplatelets, simvastatin, and niacin.”
“As a result, taking large doses of vitamin E with anticoagulant or antiplatelet medications, such as warfarin (Coumadin), can increase the risk of bleeding, especially in conjunction with low vitamin K intake.”
- NIH Office of Dietary Supplements · Office of Dietary Supplements · Vitamin E, Interactions with Medications · Anticoagulant and antiplatelet medications
- Checked Oct 25, 2026
Asian ginsengPredictedBoth can affect clotting or platelets, so bleeding risk may add up.
moderate · Predicted from how each works, not established · Platelets and bleeding
Predicted from what each is known to do, not studied as a pair and not established.
Both can affect clotting or platelets, so bleeding risk may add up.
- FDA drug label (DailyMed) · Apixaban: affects clotting or platelets (ELIQUIS (APIXABAN) TABLET, FILM COATED ELIQUIS 30-DAY STARTER PACK (APIXABAN) KIT [E.R. SQUIBB & SONS, L.L.C.], section 5.2)
- NIH National Center for Complementary and Integrative Health · Asian ginseng: affects clotting or platelets (Asian Ginseng: Usefulness and Safety, What Do We Know About Safety?)
- Checked Oct 25, 2026
Apixaban with food and drink
Food and drink
1GrapefruitPredictedGrapefruit may raise Apixaban levels: it slows CYP3A, an enzyme that breaks Apixaban down.
moderate · Predicted from how each works, not established · Breakdown by liver enzymes
Predicted from what each is known to do, not studied as a pair and not established.
Grapefruit may raise Apixaban levels: it slows CYP3A, an enzyme that breaks Apixaban down.
- FDA table of drugs that interact with CYP enzymes · Grapefruit: CYP3A moderate inhibitor (Table 1, row "grapefruit juice", column "CYP Mod INH" (footnote 9: The effect of grapefruit juice varies widely among brands and is concentration-, dose-, and preparation-dependent. Studies have shown that it can be classified as a “strong CYP3A inhibitor” when a certain preparation was used (e.g., high dose, double strength) or more commonly as a “moderate CYP3A inhibitor” when another preparation was used (e.g., low dose, single strength).))
- FDA drug label (DailyMed) · Apixaban: CYP3A substrate (ELIQUIS (APIXABAN) TABLET, FILM COATED ELIQUIS 30-DAY STARTER PACK (APIXABAN) KIT [E.R. SQUIBB & SONS, L.L.C.], section 12.3 Pharmacokinetics · Metabolism)
- Checked Oct 23, 2026
How these lines are sourced
Three kinds of line
- Studied in people (PubMed): PubMed records that were opened and read, graded A (several controlled studies, or a finding in the dosing guidance), B (at least one controlled human study) or C (case reports, observational data or mechanism only).
- Named by an FDA label or NIH page: quoted word for word from that page. Its severity comes from the source’s wording, not from a study of the pair.
- Predicted from how each works, not established: built from sourced facts about each substance, such as the FDA’s table of enzyme roles. Never rated major.
Interaction MapCheck Apixaban with everything else you take, together
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- Interaction MapCheck several medicines and supplements at once, each interaction sourced to PubMed, FDA labels or NIH; a pair we have no source for reads as not on our list, never as safe.
- St. John's wortSt.