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Probiotic Use with Eliquis: Drug Interactions and Blood Clot Risk


Probiotics are live microorganisms that provide health benefits when consumed. They help restore the natural balance of bacteria in the gut and support the immune system. Some common probiotic strains include lactobacillus and bifidobacterium. Probiotics are generally considered safe, with few side effects. They can be purchased over-the-counter as supplements.

Eliquis (apixaban) is an anticoagulant medication, commonly called a blood thinner. It is used to treat and prevent blood clots, such as deep vein thrombosis (DVT) and pulmonary embolism (PE). Eliquis works by blocking Factor Xa, which prevents the formation of blood clots. It is prescribed to reduce the risk of stroke in people with atrial fibrillation.

Currently, there are no known interactions between probiotics and Eliquis. However, this does not mean the potential for an interaction does not exist. There is often limited data on probiotic interactions, so it’s important to use caution and consult a healthcare provider.

Key Takeaways

  • Probiotics are generally safe to take with the blood thinner Eliquis, but more research is needed on potential interactions.
  • Start new probiotics at low doses and avoid systemic, spore-forming, or very high CFU products.
  • Monitor closely for any increased bleeding or changes in anticoagulation.
  • Consult your doctor for guidance on appropriate strains, dosing, timing and safety measures.
  • Probiotic foods like kefir and kimchi are lower risk options than supplements.
  • Never stop taking Eliquis or alter dosage without doctor approval.

Assessing Potential Interactions

When determining potential interactions between medications and supplements, healthcare providers evaluate a few key factors:

  • Mechanism of action – How the drug or supplement works in the body, which can inform if any processes might overlap. Eliquis prevents clotting via Factor Xa inhibition, while probiotics work locally in the gut. Their mechanisms do not appear to overlap significantly.
  • Metabolism – Whether the drug or supplement is broken down by the same liver enzymes. Eliquis is metabolized by CYP3A4 enzymes, while probiotics are not systemic and do not require liver metabolism. This makes an interaction unlikely.
  • Existing research – Any studies that have directly evaluated the combination. Currently, no studies have specifically looked at co-administration of probiotics and Eliquis in humans. But the lack of metabolism overlap and systemic effect from probiotics provides reassurance.
  • Anecdotal reports – Documented cases of interactions or side effects. There are no case reports of probiotics interacting with Eliquis or causing bleeding problems. But due to limited research overall, risk cannot be completely ruled out.

While these factors suggest a low probability of interaction, healthcare providers still recommend using caution when combining probiotics and Eliquis due to the blood-thinning effects of Eliquis and the lack of definitive research.

Safety Precautions with Probiotics and Anticoagulants

Probiotics are generally considered very safe, with minimal side effects in most people. But there are a few general precautions to consider for people taking blood thinners like Eliquis:

  • Start low, go slow – When starting a new probiotic, begin with low doses and gradually increase over time. This allows the body to adjust and reduces risk of side effects.
  • Take at separate times – Take the probiotic and Eliquis at least 2-3 hours apart. This may help prevent any localized interaction in the gut.
  • Monitor for changes – Be aware of any new symptoms, especially increased bruising or bleeding. Promptly report any changes to your healthcare provider.
  • Avoid combining systemic probiotics – Probiotics confined to the gut are safer than systemic versions with whole-body effects. For example, avoid probiotics like Florastor that contain Saccharomyces boulardii, which can reach the bloodstream.

Using probiotics with caution and care can help minimize any risks when combining them with blood thinners. However, due to the lack of research, close medical supervision is still recommended.

Probiotic Strains and Formulations to Avoid

While most probiotics likely pose minimal risk, a few specific strains and formulations may be more likely to interact and are best avoided:

  • Yeast-based probiotics – Saccharomyces probiotics like Saccharomyces boulardii are yeast-based and can reach systemic circulation. These may pose higher bleeding risk when combined with blood thinners.
  • Spore-forming probiotics – Bacterial spores from strains like Bacillus coagulans are more hardy and survive stomach acid better. Their systemic absorption may be increased.
  • Enteric-coated probiotics – Probiotics coated to withstand stomach acid and dissolve in intestines may be more likely to interact systemically.
  • High CFU doses – Very high doses of colony forming units (CFUs) could increase gut disruption and systemic absorption. Doses over 50 billion CFUs may pose more risk.

Choosing traditional capsules with lactobacillus and bifidobacterium strains, while avoiding higher risk formulations, can help minimize any potential interactions with Eliquis.

Signs of Bleeding to Monitor

Due to the blood-thinning effect of Eliquis, bleeding is a potential side effect to monitor closely when adding an additional supplement like probiotics. Signs of bleeding to be aware of include:

  • Prolonged bleeding from cuts
  • Bleeding gums when brushing teeth
  • Frequent or severe nosebleeds
  • Unexplained bruising
  • Dark stools from gastrointestinal bleeding
  • Coughing up blood
  • Blood in the urine
  • Unusually heavy menstrual bleeding

If you experience any bleeding symptoms when taking Eliquis and probiotics, discontinue use and notify your healthcare provider immediately. Prompt medical attention is needed to address potential over-anticoagulation.

Who Should Avoid Probiotics with Eliquis?

While probiotics are likely safe for most people taking Eliquis, the following groups may have higher bleeding risks and should exercise more caution or avoid probiotics:

  • People with bleeding disorders – Those with hemophilia, von Willebrand disease, or other conditions increasing bleeding risk.
  • People with renal impairment – Reduced kidney function may prevent efficient clearance of Eliquis, increasing blood thinner levels.
  • People with upcoming surgeries – High bleeding risk procedures like spinal anesthesia may have complications if coagulation is impaired.
  • Elderly patients – Older adults may be more susceptible to bleeding problems when additional anticoagulation precautions are needed.

Have an honest discussion with your healthcare provider about your specific bleeding risks before taking probiotics with Eliquis. Certain patient populations need to take extra precautions.

Potential Health Risks of Taking Probiotics With Eliquis

Consuming probiotics supplements and foods in moderation does not pose high risk when taking Eliquis for most people. However, a few health considerations to be aware of include:

  • Increased bleeding risk – Both probiotics and Eliquis can thin the blood and affect coagulation. Combined effects may increase the chance of bruising, nosebleeds, bleeding gums, or other bleeding concerns.
  • Reduced effectiveness of Eliquis – Very high doses of certain probiotic strains could potentially have anticoagulant effects. This might counteract the clot-preventing action of Eliquis.
  • Gastrointestinal damage – Occasionally probiotics could disrupt the gut lining allowing bacteria to enter the bloodstream. This may increase systemic effects.
  • Infection risk – In immune-compromised people, probiotic strains could potentially cause infection or sepsis in rare cases. Lactobacilli are generally safe, but risk can never be fully excluded.

However, these risks remain theoretical and unproven, as no clinical studies have demonstrated increased adverse events with co-administration. By using probiotics prudently and monitoring closely, any risks appear minimal. Speak with your doctor about your situation.

Signs of Probiotic Overdose to Watch For

Probiotic supplements are very safe, even at high doses. But if excessive probiotics are consumed while taking Eliquis, monitor for these signs of overdose:

  • Severe gastrointestinal upset – Cramping, bloating, diarrhea
  • Skin reactions – Rashes, hives, itchiness
  • Respiratory concerns – Shortness of breath, wheezing
  • Neurological changes – Anxiety, confusion, dizziness
  • Drop in blood pressure
  • Fever or chills

Symptoms are most likely with very high CFU doses over 100 billion. Discontinue use and seek medical care if you experience multiple severe symptoms potentially from a probiotic overdose.

Interactions Between Probiotics and Other Drugs

Below are some other known medication interactions involving probiotics to be aware of:

  • Antibiotics – Should be separated by 2-3 hours to prevent antibiotic destruction of probiotic bacteria before they reach the gut.
  • Immunosuppressants – Probiotics may increase infection risk in people taking immunosuppressive drugs like chemotherapy.
  • Proton pump inhibitors – May alter gut pH and impact probiotic growth; separate doses by several hours.
  • Antifungals – Antifungal medications may kill off helpful yeast strains. Avoid combining with antifungals.
  • Oral contraceptives – One small study found probiotics may reduce oral contraceptive effectiveness. Monitor closely if combining.

Always read medication labels carefully and speak to your pharmacist about potential probiotic drug interactions.

Safe Dietary Sources of Probiotics with Eliquis

To get beneficial probiotics through food instead of supplements, try incorporating these probiotic-rich items into your diet while taking Eliquis:

  • Kefir – Fermented milk beverage with up to 50 strains of probiotics. Limit to 4 ounces per day. Choose plain, low-fat varieties.
  • Sauerkraut – Naturally fermented cabbage product high in Lactobacillus. Eat up to 1/2 cup daily. Opt for fresh sauerkraut without vinegar.
  • Kimchi – Spicy fermented cabbage common in Korean cuisine. Contains Lactobacillus species. Have a few spoonfuls once or twice per week.
  • Miso – Fermented soybean paste used in Japanese cooking. Holds probiotic Lactobacillus and yeast strains. Use minimally as a salty seasoning.
  • Sourdough bread – The fermentation process creates naturally probiotic bread. Look for authentic sourdough, not just sourdough-flavored.

Probiotic foods are a safer bet than supplements when taking Eliquis or other blood thinners. Enjoy mild to moderate amounts of probiotic foods as part of your regular diet under medical guidance.

The Role of a Doctor in Overseeing Probiotic Use

A physician can play an important role when using probiotics alongside medication like Eliquis:

  • Review your full medication/supplement list to identify potential interactions
  • Assess your bleeding and clotting risk to determine if probiotics are advisable
  • Recommend appropriate probiotic strains, doses, and formats for your needs
  • Suggest optimal timing and administration guidelines for taking probiotics with Eliquis
  • Monitor through follow-up appointments to detect any issues early
  • Provide guidance on dietary probiotic intake and any necessary restrictions
  • Evaluate any symptoms and make dosage adjustments if necessary
  • Manage any adverse effects and provide appropriate medical intervention as needed

Close involvement of your doctor allows safer probiotic use with Eliquis through all stages – from consideration to initiation to follow-up monitoring. Seeking medical advice is recommended when combining probiotics with any blood thinner medication.

Read Also – 5 Foods to Avoid While on Eliquis in 2024: What to Eat Instead?

Summary: Key Points on Probiotics and Eliquis

  • Probiotics may be safe with Eliquis for most people, but limited research is available on this combination
  • Monitor closely for signs of bleeding or increased anticoagulation
  • Start probiotics at low doses and avoid systemic, spore-forming, or high CFU products
  • Watch for symptoms of probiotic overdose like severe GI upset
  • Get guidance from your doctor about strain selection, dosing, timing and safety precautions
  • Probiotic foods are lower risk options; eat kefir, kimchi, sauerkraut in moderation
  • Never alter Eliquis dosage or stop taking it without your doctor’s approval

With careful use under medical supervision, probiotics can likely be combined with Eliquis without issues for most individuals. However, certain higher risk groups need to take extra precautions. Discuss your specific situation with your healthcare provider.

There were no interactions found between Apixaban and Probiotics. This does not mean the potential for an interaction does not exist, however. There is often a lack of studies and data surrounding traditional medicine, especially concerning drug interactions, so it is important to always consult your provider before making any changes to your medication regimen.

Frequently Asked Questions

Is it safe to take probiotics and Eliquis at the same time?

It’s recommended to separate your Eliquis dose and probiotics by at least 2 hours. Take Eliquis with food, then wait at least 2 hours before taking your probiotic. This precaution helps prevent the probiotic from potentially interfering with absorption of Eliquis in the gut.

Should I avoid certain probiotic strains with Eliquis?

Some probiotic strains are considered more risky than others with medications. Avoid SBOs (soil-based organisms) and focus on well-researched strains like Lactobacillus GG and Saccharomyces boulardii. Check with your pharmacist if you’re unsure about a specific probiotic product.

What should I do if I experience side effects when taking probiotics with Eliquis?

Notify your doctor right away if you notice increased bleeding, bruising, rash, severe digestive issues or any other concerning symptoms after starting probiotics. Your doctor can advise if it is safe to continue the probiotic and may make dosage adjustments to Eliquis or other medications you take.

Are there any specific timing instructions for taking probiotics when using Eliquis?

Take your Eliquis dose with food, then wait at least 2 hours before taking your probiotic supplement. This helps prevent the probiotic bacteria from interfering with absorption of Eliquis from the gut into your system. Set a reminder if needed to ensure you separate the doses appropriately.

Can I take a yeast-based probiotic like saccharomyces boulardii with Eliquis?

Yes, saccharomyces probiotics are likely safe with Eliquis but check with your doctor first. Saccharomyces may not be suitable if you have a yeast allergy, central venous catheter or other specific medical conditions. Give yeast probiotics 2 hours separation from your Eliquis dose as a safety precaution.

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