Direct oral anticoagulants include two groups of drugs. Factor Xa inhibitors and direct thrombin inhibitors both help to stop clots. Medicine in these categories include:
- Rivaroxaban (Xarelto)
- Apixaban (Eliquis)
- Betrixaban (Bevyxxa)
- Edoxaban (Savaysa)
- Dabigatran (Pradaxa)
There are no studies that look at the direct effect of supplements on this class of drugs. However, certain supplements have shown the ability to affect how blood clots. When combined with this medicine they may increase the risk of bleeding. Let your doctor know about any supplements you are taking or plan to start. Possible interactions can occur with:
Fish oil may increase the risk of bleeding when combined with direct oral anticoagulants. The larger the dose of fish oil, the larger the risk of bleeding. Fish oil includes omega-3 fatty acids and cod liver oil. Talk to your doctor before taking fish oil supplements.1-3
St. John’s wort may reduce the amount of some direct oral anticoagulants in the blood. This can lower the effect of the drugs. Avoid St. John’s wort while taking this medicine.1-2, 4
Other herbs and natural supplements might interfere with the ability of the blood to clot. However, it is not clear if it increases the effect of this class of medication.
References
REF1 Rivaroxaban. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T901914/Rivaroxaban. Updated March 6, 2018. Accessed September 7, 2018.
REF2 Dabigatran. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T901029/Dabigatran#Drug-Interactions. Updated September 6, 2018. Accessed September 7, 2018.
REF3 Apixaban. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T904822/Apixaban#Drug-Interactions. Updated September 6, 2018. Accessed September 7, 2018.
REF4 Edoxaban. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T908365/Edoxaban#Drug-Interactions. Updated September 6, 2018. Accessed September 7, 2018.
REF5 Rivaroxaban—drug summary. PDR—Prescribers’ Digital Reference website. Available at: http://www.pdr.net/drug-summary/Xarelto-rivaroxaban-278#13. Accessed April 11, 2018.