apixaban
3 interactions related to apixaban
apixaban + fish oil
Apixaban is a direct factor Xa inhibitor that raises bleeding risk on its own. Omega-3 fatty acids in fish oil have a mild antiplatelet effect that can theoretically add to that risk. A large 2024 systematic review and meta-analysis found that typical supplement-level omega-3 intake did not significantly raise bleeding risk, with only a small absolute increase seen at very high, prescription-strength doses. Standard fish oil is generally compatible with apixaban when the prescriber is aware, while high-dose omega-3 should be cleared with a clinician.
apixaban + st. john's wort
St. John's wort strongly induces both CYP3A4 (apixaban's main metabolizing enzyme) and P-glycoprotein (its efflux transporter). Taken together, it speeds apixaban's breakdown and clearance, lowering blood levels and weakening clot protection, which raises the risk of stroke or thromboembolism.
chia seeds + blood thinners
Chia seeds contain plant-form omega-3 (alpha-linolenic acid) and soluble fiber. The omega-3 has a mild, mostly theoretical effect on platelets, and the fiber gel could slow a pill's absorption if eaten at the same time. There is no documented case of chia seeds themselves causing bleeding on warfarin, DOACs, aspirin, or antiplatelet drugs, and human studies of dietary omega-3 do not show added bleeding. The anticoagulant caution often cited comes from a different plant (danshen root), not chia.