What Foods To Eat And Avoid While Taking Eliquis (Apixaban)

The ability of your blood to clot is necessary for survival. 

You’d experience severe blood loss from minor cuts and scrapes if your blood didn’t clot. 

However, if your blood clots too much, it can form a blood clot that blocks blood flow in your arteries and veins.

Eliquis is a medication that helps prevent harmful blood clots. 

We’ll discuss Eliquis in depth in this article, as well as what foods to eat and avoid while taking Eliquis (Apixaban).

What is Eliquis (Apixaban)?

Eliquis is the brand name for apixaban, a prescription blood thinner. Blood thinning medications are also called anticoagulants.

The Food and Drug Administration (FDA) first approved Eliquis in 2012 to help reduce the risk of stroke and blood clots in patients with non-valvular atrial fibrillation (an abnormal heart rhythm not caused by an abnormal heart valve). 

The FDA approved Eliquis again in March 2014 to help reduce blood clots following hip and knee replacement surgeries. In September 2014, they approved it to help treat deep vein thrombosis (DVT) and pulmonary embolism (PE), which occur from blood clots.

Eliquis is manufactured by Bristol-Myers Squibb Company and comes in 2.5 milligram- and 5-milligram tablets. Patients can take Eliquis with or without food, and it is taken twice daily. The maximum daily dosage of Eliquis is typically 10 milligrams twice daily.

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What is Eliquis used for?

Eliquis can be used in patients with atrial fibrillation, a type of irregular heart rhythm. Atrial fibrillation causes blood to collect in chambers of your heart due to the irregular beats, which increases the risk of blood clots.

If the blood clot travels to your legs, it can lodge in a vein and cause deep vein thrombosis (DVT). Signs of a DVT usually include throbbing or cramping in your leg, leg swelling, warm skin around the painful area, and/or red and darkened skin near the site of the pain. DVTs sometimes don’t have any symptoms.

One of the dangers of a DVT is that the blood clot can break off and travel to your lungs, causing a pulmonary embolism (PE). 

A pulmonary embolism is when a blood clot blocks the arteries carrying blood to your lungs. Some signs of a pulmonary embolism include sudden onset shortness of breath, chest pain that worsens while breathing, anxiety, dizziness, irregular heartbeat, coughing (sometimes coughing up blood), and sweating.

Blood clots can also form blockages in your brain, causing a stroke, or in your heart, which is what causes a heart attack.

Eliquis is also used in post-surgical patients to help prevent blood clots after surgery. If you’ve never needed blood thinners before, you’ll likely only take a blood thinner temporarily after surgery.

How does Eliquis work?

Eliquis is an anticoagulant, which means it helps prevent blood clots from forming as quickly as they normally do. Blood clotting is necessary for survival, but too much clotting can be problematic.

Eliquis works by blocking a specific clotting factor called factor Xa. Your blood can still clot while taking Eliquis, but it will happen more slowly, which means you’re at a greater risk of excessive bleeding if you have an injury. 

Foods to avoid while on Eliquis (Apixaban)

One of the benefits of Eliquis compared to other types of anticoagulants is that it doesn’t have any known food interactions. On the other hand, a popular blood thinner, warfarin has dietary restrictions because it interacts with vitamin K, a nutrient primarily found in green leafy vegetables.

While Eliquis isn’t known to interact with any foods, you may want to avoid or limit the following:

Ginger and other herbs (high doses/supplements)

Ginger might act as an anticoagulant, which could put you at a greater risk of developing blood clots while taking Eliquis. A review of ten scientific studies was done to determine ginger’s potential role in blood clotting (1). 

Four of the clinical trials showed a correlation between ginger and decreased platelet aggregation, meaning it slowed blood clotting and acted as a blood thinner. The rest of the studies didn’t find a correlation between ginger and blood clotting factors.

While it’s likely safe to enjoy ginger in small amounts, such as in cooked dishes, you should probably avoid taking large doses, such as in the form of ginger supplements.

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Other herbs

Other herbs with potential anticoagulant effects include ginkgo biloba, turmeric, and white willow. You should let your healthcare provider know if you’re taking these before starting Eliquis or any other anticoagulant medication.

Foods high in saturated fat

Blood clots can block the blood flow in your arteries and veins. Blockages can also form from fatty plaque buildup, known as atherosclerosis. Diets high in saturated fats might increase your risk of plaque buildup and could eventually lead to a heart attack or stroke.

You can typically find saturated fat in animal foods like high-fat meat and whole-fat dairy products. But you can also find it in some plant foods, such as coconut and palm fruit.

Eating some saturated fat is okay, but aim to keep your total saturated fat intake to less than 10% of your total calories (less than 22 grams for a 2,000-calorie diet). 

You should be especially mindful of your saturated fat intake if you have heart disease, high cholesterol, or other risk factors for heart disease.

Below is a list of foods high in saturated fat you may want to limit or avoid while taking Eliquis:

  • Beef (especially non-lean cuts)
  • Lamb
  • Pork
  • Poultry with the skin on
  • Lard and cream
  • Butter
  • Cheese
  • Ice Cream
  • Coconut (including coconut oil)
  • Palm oil and palm kernel oil
  • Some baked and fried foods

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Foods to eat while taking Eliquis

Now you know what foods to avoid while taking Eliquis (Apixaban), what foods should you include in your diet?

Eating a healthy diet can optimize your cardiovascular and overall health while taking Eliquis. A diet rich in plant-based foods, such as a Mediterranean eating style, is a great plan to follow while taking Eliquis.

A healthy diet while taking Eliquis should include:

Fruits and vegetables

Fruits and vegetables provide dietary fiber and important vitamins and minerals like folate, vitamin C, and potassium. They also contain antioxidants which help fight inflammation

Fruits and vegetables can help fight plaque buildup in your arteries, therefore helping to reduce your risk of heart attack and stroke (2). 

low glycemic fruits

Lean protein

Instead of high-saturated fat meat, try eating lean protein such as lean beef and pork, skinless poultry, and fish.

Legumes

Legumes like lentils and beans are packed with dietary fiber. Dietary fiber is a nutrient that can help lower high levels of LDL cholesterol and reduce fatty plaque buildup that can lead to blockages.

Heart-healthy fats (omega-3 fatty acids)

Omega-3 fatty acids can help prevent blood platelets from sticking together and forming blood clots. 

Some of the best sources of omega-3s include:

  • Oily fish like salmon, sardines, and mackerel
  • Oysters
  • Cod liver oil
  • Walnuts
  • Flaxseeds
  • Chia seeds

Taking high doses of omega-3s while on Eliquis might increase your risk of severe bleeding. You should avoid taking omega-3 or other fish oil supplements while taking Eliquis unless your healthcare provider approves it. 

omega-3

What foods are natural blood thinners?

Some foods act as natural blood thinners, but they aren’t nearly as potent as prescription anticoagulants. Below are some examples of foods that have blood thinning properties.

High-salicylate foods

Salicylates are compounds found in some plant foods. Salicylates can block the action of vitamin K, which promotes blood clotting by producing certain clotting factors (3). 

Derivatives of salicylates such as salicylic acid are used to make aspirin, a medication that can be used as a blood thinner.

Some foods and drinks particularly high in salicylates include:

  • Vegetables like broccoli, cauliflower, cucumber, mushrooms, radishes, spinach, and zucchini 
  • Tomatoes
  • Fruit juice (apple, grape, orange, and grapefruit juices)
  • Fruits like apples, avocado, berries, cherries, grapes, peaches, and plums
  • Spices like thyme, rosemary, curry powder, paprika, and garam masala
  • Black, green, and herbal teas

Vitamin D-rich foods

Vitamin D has an anticoagulant effect, which means it can act as a blood thinner. Low vitamin D levels are associated with an increased prevalence of deep vein thrombosis (DVT) (4).

There aren’t many foods that are naturally rich in vitamin D. Some foods that contain vitamin D include:

  • Cod liver oil
  • Salmon
  • Swordfish
  • Tuna fish
  • Orange juice fortified with vitamin D
  • Dairy and plant milk fortified with vitamin D
  • Sardines
  • Beef liver
  • Egg yolk
  • Fortified cereals

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Vitamin E

According to a study, vitamin E may significantly lower your risk of blood clots if you have a history of blood clots.

Taking too much vitamin E can cause excessive bleeding, so you shouldn’t take vitamin E supplements while on Eliquis unless you speak with your healthcare provider. 

The risk of bleeding from vitamin E toxicity is more prevalent with doses above 1,000 milligrams per day.

You can find vitamin E naturally in foods like:

  • Wheat germ oil
  • Sunflower, safflower, and soybean oil
  • Sunflower seeds
  • Almonds
  • Peanuts, peanut butter
  • Beet greens, collard greens, spinach
  • Pumpkin
  • Red bell pepper
  • Asparagus
  • Mango
  • Avocado

Other things to avoid while taking Eliquis

Besides some foods, is there anything else you might need to avoid when taking Eliquis?

  • Taking Eliquis with other anticoagulants or antiplatelet drugs can cause severe interactions and increase your risk of bleeding. Always ensure your healthcare providers know the medications you’re taking to avoid taking multiple anticoagulant drugs.
  • Be careful when using knives and other sharp objects while taking Eliquis. If you accidentally cut yourself, you might bleed more than normal. 
  • There aren’t any known interactions between Eliquis and alcohol. However, alcohol can act as a blood thinner, so drinking excessive alcohol while taking Eliquis might increase your risk of severe bleeding even more.

Should Eliquis be taken with food?

You can take Eliquis with or without food. If you experience nausea from taking Eliquis, try to take it with a meal.

What is the best time to take Eliquis?

Eliquis is usually prescribed for twice daily use, once in the morning and once in the evening, or every 12 hours.

Any other safety concerns? 

Eliquis has a black box warning from the FDA, which is the highest level of caution. Stopping Eliquis can increase your risk of having a problematic blood clot. If you need to discontinue Eliquis, it should be done carefully and under the guidance of a healthcare provider.

Eliquis has potential side effects and warnings. 

The most common side effects while taking Eliquis include:

  • Bleeding from cuts that take longer to stop
  • Bleeding from your nose or gums
  • Dizziness
  • Bruising easily
  • Excessively heavy menstrual bleeding
  • Minor bleeding
  • Nausea

Most of the time, bleeding from Eliquis is considered minor. In rare cases, it can be serious and may lead to death from blood loss. 

Your risk of bleeding is higher if you take other anticoagulant drugs like warfarin, heparin, aspirin, and non-steroidal anti-inflammatories (NSAIDs) like naproxen (Aleve) and ibuprofen (Advil). SSRIs used to treat depression may also increase the risk of bleeding while taking Eliquis.

Eliquis is not to be used if you have an artificial heart valve, have certain clotting disorders or abnormal bleeding, or are allergic to its active ingredients. 

Eliquis also isn’t recommended if you have antiphospholipid syndrome, a condition when your body mistakenly attacks tissue in your body and can lead to blood clots.

There isn’t enough research on taking Eliquis while pregnant, so you should only use it during pregnancy if the potential benefits outweigh the potential risks to both mother and baby. Eliquis isn’t recommended during lactation.

How to reduce the side effects of Eliquis

If you have gastrointestinal symptoms like nausea from taking Eliquis, you can try taking it with food or milk to reduce the side effects.

The most effective way to reduce side effects like excessive bleeding is to take Eliquis as prescribed. Taking too much or too little Eliquis can result in abnormal bleeding or blood clots, which can be serious and even fatal.

A pill organizer can be helpful if you have difficulty remembering to take medications regularly. You can choose a pill organizer with AM and PM designations so you’ll always remember if you took your dose, which can prevent accidental extra doses.

If you have surgery planned, your healthcare provider can guide you on how to adjust Eliquis before and after surgery to minimize complications.

Conclusion

There are no known food interactions with Eliquis, which means you can essentially eat a normal diet. Try to eat a heart-healthy diet while on Eliquis to further help boost your cardiovascular and overall health. 

Avoid taking certain supplements while taking Eliquis (or at least speak to your healthcare provider about them), such as omega-3/fish oil, ginger, and any other potentially anticoagulant herbs in high doses. You may also want to avoid foods high in saturated fat while taking Eliquis.

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Sources

  1. Marx W, McKavanagh D, McCarthy AL, Bird R, Ried K, Chan A, Isenring L. The Effect of Ginger (Zingiber officinale) on Platelet Aggregation: A Systematic Literature Review. PLoS One. 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4619316/
  2. Blekkenhorst LC, Bondonno CP, Lewis JR, Woodman RJ, Devine A, Bondonno NP, Lim WH, Zhu K, Beilin LJ, Thompson PL, Prince RL, Hodgson JM. Cruciferous and Total Vegetable Intakes Are Inversely Associated With Subclinical Atherosclerosis in Older Adult Women. J Am Heart Assoc. 2018. https://www.ahajournals.org/doi/10.1161/jaha.117.008391
  3. Roncaglioni MC, Reyers I, Cerletti C, Donati MB, de Gaetano G. Moderate anticoagulation by salicylate prevents thrombosis without bleeding complications. An experimental study in rats. Biochem Pharmacol. 1988 Dec 15;37(24):4743-5. https://pubmed.ncbi.nlm.nih.gov/3202906/
  4. Mohammad S, Mishra A, Ashraf MZ. Emerging Role of Vitamin D and its Associated Molecules in Pathways Related to Pathogenesis of Thrombosis. Biomolecules. 2019 . https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6920963/

 

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