Interaction Between Eliquis (Apixaban) and Quercetin

Mechanism of Potential Interaction

Apixaban is a substrate for P-glycoprotein and breast cancer resistance protein transport systems, as well as cytochrome P450 3A4, which can be affected by quercetin inhibition 1
Inhibition of P-gp and BCRP transport systems can lead to increased plasma concentrations of apixaban, potentially increasing the risk of bleeding complications 1, 2

The European Heart Rhythm Association guidelines classify substances that inhibit P-gp as having potential interactions with direct oral anticoagulants like apixaban 1

The interaction between quercetin and apixaban would likely be classified as "yellow" (caution needed) according to the European Heart Rhythm Association's color-coding system for drug interactions 1, 2
The risk may be higher in patients with renal impairment, as apixaban is partially eliminated by the kidneys 3
The risk may also be higher in patients with advanced age (>80 years) 1, 3
The risk may be higher in patients with low body weight (<60 kg) 1
The risk may be higher with concomitant use of other medications that affect P-gp or CYP3A4 1, 2

Consider avoiding the combination of high-dose quercetin supplements with apixaban when possible, as recommended by the European Heart Journal 1
Monitor for signs of increased anticoagulant effect, such as bruising or bleeding gums, when quercetin is used with apixaban 1
Consider spacing the administration times of quercetin and apixaban to minimize potential interactions 1, 2
For patients requiring anticoagulation who wish to continue quercetin supplementation, alternative anticoagulants less dependent on P-gp transport, such as warfarin, could be considered, according to the Journal of Thrombosis and Haemostasis 5

No specific laboratory monitoring is routinely recommended for apixaban, which complicates detection of increased drug levels, as noted in the journal Chest 6
Be vigilant for signs of bleeding, particularly with high-dose quercetin supplementation, and consider patient education about potential supplement-drug interactions 1, 2