Key takeaways
Eliquis (apixaban) does not require dietary restrictions related to vitamin K intake and does not have known harmful interactions with any foods, unlike warfarin.
Patients on Eliquis are advised to limit caffeine intake and avoid high-fat foods due to their potential to exacerbate underlying heart conditions, not because of direct interactions with the medication.
Certain citrus fruits, including grapefruit, are safe to consume on Eliquis but should be consumed in moderation.
A diet rich in fruits, vegetables, nuts, and soluble fiber is recommended for those on Eliquis to promote heart health and reduce the risk of atherosclerosis.
Eliquis (apixaban) is a blood thinner that belongs to a class of medications called direct oral anticoagulants (DOACs). It is used to prevent and treat blood clots in patients with deep vein thrombosis (DVT), pulmonary embolism (PE), and nonvalvular atrial fibrillation (AFib), which is a type of irregular heartbeat that’s not caused by a heart valve problem. Many people are aware of the blood thinner Coumadin (warfarin) and how certain foods need to be avoided while taking it. But what about the newer anticoagulants? Let’s take a closer look at what foods to avoid while on Eliquis.
RELATED: DVT treatments and medications
How Eliquis works
Eliquis works by blocking factor Xa (pronounced “ten-A”), a factor in our blood that helps clots form. This is sometimes referred to as a factor Xa inhibitor. There are many clotting factors in our blood, and factor Xa is one of the main ones.
Unlike the older blood thinner Coumadin (warfarin), Eliquis doesn’t require monitoring of the international normalized ratio (INR), which is a process of regularly checking a person’s blood to ensure that it’s clotting within the desired range. Warfarin also belongs to a different class of medications called vitamin K antagonists, which work differently than DOACs like Eliquis.
Eliquis is prescribed in doses of 2.5 or 5 milligrams to be taken twice a day.
Save up to 80% on Eliquis with SingleCare
Different pharmacies offer different prices for the same medication. SingleCare helps find the best price for you.
Foods to avoid while on blood thinners
Eliquis doesn’t work like other blood thinners, which have various food restrictions. For example, if you’re taking warfarin, you need to be conscientious of how much vitamin K-containing foods you consume since warfarin and Vitamin K work against each other: Warfarin is a blood thinner, while Vitamin K helps blood clot. But that doesn’t mean you should avoid foods rich in vitamin K entirely while on warfarin. It just means you need to consume a consistent amount of vitamin K-rich foods on a day-to-day basis so the body can maintain a healthy balance of both warfarin and Vitamin K. Examples of vitamin K-rich foods include spinach, broccoli, kale, and Brussels sprouts.
In contrast, apixaban (the active ingredient in Eliquis) does not rely on the vitamin K-dependent clotting pathway. Eliquis acts on clotting factor Xa and is unaffected by vitamin K intake. In fact, Eliquis has not been shown to have a bad interaction with any foods. The usual culprits when it comes to food-drug interactions, such as leafy green vegetables, grapefruit juice, cranberry juice, coffee, and peppermint tea, are safe to enjoy while taking Eliquis—although some should be enjoyed in moderation.
Foods to avoid or limit while taking Eliquis
Unlike other anticoagulants, Eliquis doesn’t require you to avoid leafy greens. In fact, Eliquis doesn’t have any dietary contraindications. However, certain citrus fruits prevent the breakdown of apixaban, meaning the drug stays in the body longer than it should and can increase the risk of bleeding and other side effects. While small amounts are generally okay, you should limit your intake of the following:
- Grapefruit and grapefruit juice
- Limes
- Pomelos
- Orange marmalade and Seville oranges (which are often used in marmalades)
Herbs and supplements to avoid with Eliquis
Since the Food and Drug Administration does not regulate herbals and supplements like other prescription medications, verifying potential interactions between herbal medications and prescription meds can be more difficult. It’s always a good idea to seek medical advice from your healthcare provider before taking herbal or vitamin supplements. Not only can herbal medications interact with prescription meds, but they can also be dangerous if you have any liver or kidney problems.
There is some data that ginger, ginkgo biloba, turmeric, and some Chinese herbs can result in an increased risk of bleeding when combined with a blood-thinning medication such as apixaban. Additionally, St. John’s wort may decrease the effectiveness of apixaban.
Medications to avoid with Eliquis
It is also very important to be careful when taking medications like ibuprofen (Advil, Motrin), naproxen (Naprosyn), and diclofenac (Voltaren), which are collectively referred to as nonsteroidal anti-inflammatory drugs (NSAIDs), while taking Eliquis. NSAIDs and aspirin will result in a higher risk of bleeding when combined with anticoagulants.
Other dietary considerations while taking Eliquis
Many patients placed on Eliquis for the first time have underlying heart disease. As such, it is important to avoid red meat, fast foods, and refined sugars and instead choose heart-healthy foods such as fruits and vegetables, whole grains, low-fat or nonfat dairy, healthy proteins, unsaturated fats and oils, and soluble fiber. Soluble fiber has been shown to decrease blood cholesterol levels, which can decrease the risk of atherosclerosis (fatty deposits) in the blood vessels. Your healthcare provider can refer you to a dietitian if you need extra help planning a heart-healthy diet.
RELATED: The best diet for heart health
You should also avoid alcohol while taking Eliquis. Although alcohol doesn’t directly interact with Eliquis, it may act as a blood thinner, potentially increasing the risk of bleeding, especially when consumed with Eliquis. It can also increase the risk of falls and injury.
Caffeine is also something to be mindful of when taking Eliquis, even though there is no direct interaction between Eliquis and caffeine. However, many patients taking Eliquis also have coronary artery disease and high blood pressure, so their healthcare providers may advise them to limit their caffeine intake. In addition, patients with AFib are often told to avoid caffeine altogether. Consult with your healthcare provider if you have concerns about caffeine and Eliquis.
Eliquis bleeding risk
As with any of the blood thinners, Eliquis can increase the risk of bleeding. Signs of bleeding to watch out for include black, tarry stools, or bright red blood in the stool. Nose bleeds and bleeding from the gums may also occur while taking Eliquis. Be sure to alert your healthcare provider if you notice any of these signs.
Bottom line
DOACs like Eliquis are generally safer than other anticoagulants, such as warfarin, since they don’t require INR monitoring and have fewer dietary restrictions. You can eat leafy greens while taking Eliquis, and you only need to limit certain citrus fruits. However, it’s important to watch out for signs of gastrointestinal blood loss, which is a serious side effect of Eliquis and potentially life-threatening. Contact your healthcare provider immediately if you notice dark black or bloody stool.
Eliquis FAQs
Can I eat broccoli while taking Eliquis?
Yes. You can eat broccoli and other leafy greens rich in vitamin K while taking Eliquis. In contrast, patients taking blood thinners such as warfarin need to be mindful of how much vitamin K is in their diet and ensure they avoid consuming too much one day and too little the next.
Is Eliquis better than warfarin?
In clinical trials, Eliquis was found to be more effective than warfarin in lowering the risk of stroke, systemic embolism, and bleeding episodes. But warfarin is a common drug that’s highly effective itself. In addition, insurance companies may not always cover Eliquis, as warfarin is much cheaper. The best drug for you can only be determined by your healthcare provider, who can consider your medical conditions, medical history, and other medications and supplements you’re taking that could interact with Eliquis or warfarin.
Lea este artículo en español aquí.
- The truth about blood thinners, leafy greens, and vitamin K, Penn Medicine (2022)
- Grapefruit–medication interactions: Forbidden fruit or avoidable consequences?, Canadian Medical Association Journal (2013)
- Heart-healthy foods: What to eat and what to avoid, Harvard Health Publishing (2023)
- Direct oral anticoagulants (DOACs) vs. warfarin: Key differences, North American Thrombosis Forum (2022)
- Apixaban for reduction in stroke and other thromboembolic events in atrial fibrillation – ARISTOTLE, American College of Cardiology (2020)