stroke prevention
2 interactions related to stroke prevention
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.
dabigatran + st. john's wort
St. John's wort can modestly induce the P-glycoprotein (P-gp) transporter that dabigatran depends on for absorption. With repeated use this may lower dabigatran blood levels somewhat, in theory reducing clot protection. The measured effect in human studies is weak and there are no reported thrombosis cases from the pairing, but because dabigatran is given for serious clotting conditions and the herb's effect lingers after stopping, the combination is best avoided.