Many patients prescribed Eliquis (apixaban) wonder whether they can safely take Coenzyme Q10 (CoQ10) supplements alongside their anticoagulant therapy. Eliquis is a direct oral anticoagulant used to reduce stroke risk in atrial fibrillation and to treat venous thromboembolism. CoQ10 is a popular dietary supplement taken for cardiovascular health and energy production. Unlike warfarin, which has numerous documented supplement interactions, Eliquis has a more predictable profile with fewer known dietary restrictions. However, all patients on anticoagulants should discuss supplement use with their GP or pharmacist before starting new products, as individual circumstances vary and safety monitoring remains essential.

Can You Take CoQ10 with Eliquis?

There is no known clinically significant interaction between Coenzyme Q10 (CoQ10) and Eliquis (apixaban), though evidence is limited and patients should always discuss supplement use with their healthcare team. Eliquis is a direct oral anticoagulant (DOAC) prescribed to reduce the risk of stroke in atrial fibrillation and to treat or prevent venous thromboembolism. CoQ10 is a naturally occurring antioxidant compound that many people take as a dietary supplement for cardiovascular health, energy production, or to counteract statin-related muscle symptoms.

Unlike warfarin—an older anticoagulant that interacts significantly with vitamin K and numerous supplements—Eliquis has a more predictable pharmacological profile with fewer documented dietary and supplement interactions. CoQ10 is not listed as a contraindication in the Eliquis Summary of Product Characteristics (SmPC), but this does not mean the combination has been extensively studied in clinical trials.

Patients taking Eliquis should adopt a cautious approach to all supplements. The Medicines and Healthcare products Regulatory Agency (MHRA) and the NHS advise that anyone on anticoagulant therapy should discuss supplement use with their GP or pharmacist before starting new products. It is particularly important to avoid St John's wort, which significantly reduces apixaban levels and effectiveness. Transparency about supplement use is a key component of safe anticoagulation management.

How CoQ10 May Affect Eliquis (Apixaban)

Apixaban works by directly inhibiting Factor Xa, a key enzyme in the coagulation cascade. This mechanism is entirely different from warfarin, which affects vitamin K pathways. Apixaban is metabolised primarily through cytochrome P450 enzymes (particularly CYP3A4) and is a substrate for P-glycoprotein (P-gp), an efflux transporter.

There is no robust clinical evidence that CoQ10 significantly inhibits or induces these metabolic pathways at typical supplemental doses (usually 100–200 mg daily). Therefore, CoQ10 is not expected to alter apixaban blood levels or increase bleeding risk through pharmacokinetic interactions, though studies specifically examining this combination are limited.

Some laboratory studies suggest that CoQ10 might have mild effects on platelet function, though the clinical significance remains uncertain. When combined with an anticoagulant like Eliquis, any additional antiplatelet activity could theoretically increase bleeding risk. However, this effect has not been clearly demonstrated in clinical practice, and CoQ10 is not classified as a significant antiplatelet agent in authoritative sources.

Patients should nonetheless remain vigilant for signs of unusual bleeding, particularly if taking multiple supplements or medications that affect blood clotting. Medicines that may increase bleeding risk when taken with Eliquis include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), non-steroidal anti-inflammatory drugs (NSAIDs), and aspirin.

What the Evidence Shows About This Combination

The clinical evidence specifically examining CoQ10 and Eliquis together is limited. Most interaction data for apixaban focuses on potent CYP3A4 inhibitors (such as ketoconazole or clarithromycin) and P-gp inhibitors or inducers, rather than dietary supplements. The absence of published case reports or clinical trials documenting adverse events from the CoQ10-Eliquis combination is reassuring, though it does not constitute proof of absolute safety.

The MHRA's Yellow Card scheme collects reports of suspected adverse drug reactions in the UK. If you experience any side effects or suspect an interaction between CoQ10 and Eliquis, you should report this through the Yellow Card scheme.

NICE guidance on anticoagulation management emphasises the importance of assessing individual bleeding risk factors, including concomitant medications and supplements. While NICE does not specifically address CoQ10, the general principle is that patients on anticoagulants should be educated about recognising bleeding symptoms and maintaining consistent supplement regimens. The European Medicines Agency (EMA) product information for apixaban does not list CoQ10 among clinically significant interactions.

Patients should be aware that supplement quality and content can vary. In the UK, food supplements are regulated as foods rather than medicines, meaning they undergo less rigorous quality control. Consider purchasing supplements from reputable UK or EU suppliers, pharmacies, or brands that meet quality standards.

Safe Use of Supplements While Taking Eliquis

Patients taking Eliquis should follow several key principles when considering any dietary supplement, including CoQ10. First, always inform your GP, anticoagulation clinic, and pharmacist about all supplements you take or plan to start. This allows your healthcare team to review your complete medication profile and assess for potential interactions or cumulative effects on bleeding risk.

Maintain consistency in your supplement routine. If you decide to take CoQ10 with Eliquis, avoid suddenly starting, stopping, or dramatically changing the dose without medical guidance. Choose reputable supplement brands from established UK or EU suppliers or pharmacies.

Be vigilant for signs of bleeding, which is the primary risk with any anticoagulant therapy. For severe bleeding, head injury, or signs of internal bleeding, call 999 or go to A&E immediately. Contact your GP promptly if you experience:

• Unusual bruising or bruises that appear without injury

• Prolonged bleeding from cuts or nosebleeds that won't stop

• Blood in urine (pink, red, or dark brown colour) or stools (black, tarry, or visibly bloody)

• Severe headaches, dizziness, or weakness

• Vomiting blood or material that looks like coffee grounds

• Coughing up blood

Avoid combining multiple supplements that might affect bleeding risk without medical supervision. Products containing high-dose vitamin E, fish oil, ginkgo biloba, garlic supplements, or ginger in concentrated forms may have additive effects. Never take aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen without explicit approval from your doctor, as these significantly increase bleeding risk when combined with Eliquis. Paracetamol is generally the preferred pain reliever for patients on anticoagulants unless advised otherwise by your doctor.

Absolutely avoid St John's wort, as it significantly reduces apixaban's effectiveness by inducing CYP3A4 and P-gp.

When to Speak with Your Doctor or Pharmacist

Schedule a conversation with your GP or pharmacist before starting CoQ10 if you are taking Eliquis, particularly if you have additional risk factors for bleeding. These include older age (over 75), low body weight (under 60 kg), impaired kidney function, history of gastrointestinal bleeding, or concurrent use of antiplatelet agents, SSRIs or SNRIs. Your healthcare team can assess whether CoQ10 is appropriate for your individual circumstances and advise on suitable dosing.

Contact your doctor promptly if you experience any unusual symptoms after starting CoQ10 or any new supplement whilst on Eliquis. Whilst serious interactions are unlikely, individual responses can vary, and early discussion of concerns allows for timely assessment and adjustment of your treatment plan if necessary. Your anticoagulation clinic or GP should be informed at every medication review about all supplements you are taking.

Patients on Eliquis should have monitoring at least annually, including renal and liver function tests and a full blood count. More frequent monitoring may be needed if you are over 75, have reduced kidney function (CrCl <60 mL/min), or develop intercurrent illness.

Seek immediate medical attention by calling 999 or going to A&E if you develop signs of serious bleeding, severe allergic reactions (rash, swelling, difficulty breathing), or experience a head injury. Do not stop taking Eliquis without medical advice, as this could increase your risk of stroke or blood clots. If you require surgery or dental procedures, inform the healthcare professionals involved that you take both Eliquis and CoQ10. Follow your clinician's instructions about stopping and restarting apixaban; do not make these decisions independently.

Pharmacists are an accessible resource for questions about supplement-drug interactions. Your community pharmacist can check for interactions, provide advice on timing of doses, and help you understand which symptoms warrant medical review. The NHS 111 service can provide guidance if you cannot reach your GP and are concerned about potential side effects or interactions. If you suspect an adverse reaction or interaction, report it to the MHRA through the Yellow Card scheme.

Frequently Asked Questions