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Vitamin D helps the gut absorb calcium and maintains normal bone turnover. Many people over age 60, the group most commonly prescribed Eliquis (apixaban), are also at increased risk of osteoporosis. It’s estimated that 20% of apixaban users regularly take nutritional supplements, and vitamin D, calcium, and fish oil supplements are among the most common choices.

To add, vitamin D deficiency is common. Studies suggest that about 60% of people in the US and Europe have low vitamin D levels.

In this guide, we’ll explain what current evidence says about Eliquis and vitamin D supplements, whether there are any interaction concerns, warning signs you should never ignore, and practical tips for taking both safely.

Key Takeaways

  • No direct interaction has been found between apixaban (Eliquis) and vitamin D supplements. Surveys of apixaban users categorize vitamin D and calcium as non-interacting supplements, and drug-interaction checkers report no drug-drug interactions.
  • Vitamin D has modest anticoagulant properties. Low vitamin D levels are associated with an increased risk of venous thromboembolism, and raising vitamin D may reduce clot risk.
  • Most people on Eliquis can safely take vitamin D at recommended doses. Stick to the RDA (600-800 IU/day) unless directed otherwise by a healthcare professional. Very high doses can cause hypercalcemia and other health problems.

Do vitamin D supplements interact with Eliquis?

Based on current evidence, no direct drug-drug interaction between vitamin D supplements and apixaban has been identified.

In a large survey of apixaban users, researchers classified numerous herbal products and vitamins according to whether they should be avoided, dose-modified, or monitored. Vitamin D was explicitly listed among products with no identified interactions.

In other words, vitamin D did not make apixaban less effective or increase bleeding risk in this study.

Can you take vitamin D with Eliquis?

Vitamin D Supplement Pills Forming Sun and Letter

You can generally take vitamin D supplements at recommended doses while on Eliquis or apixaban. Vitamin D may actually complement the anticoagulant effects of Eliquis.

Vitamin D is both a vitamin and a prohormone. There are two main forms:

    • vitamin D2 (ergocalciferol)
    • vitamin D3 (cholecalciferol)

After absorption, vitamin D undergoes two chemical changes. It is first converted in the liver to 25-hydroxyvitamin D (calcidiol) and then in the kidneys to 1,25-dihydroxyvitamin D (calcitriol), the active hormone.

The active form, calcitriol, has been shown in leukemia-related studies to have mild anticoagulant effects. It may do this by increasing thrombomodulin, a protein that helps limit clotting, and decreasing tissue factor, which can trigger clot formation, in certain blood and immune cells. Some research also suggests that the vitamin D receptor may be involved in how blood clots form.

One study suggests that low vitamin D levels are associated with a higher likelihood of unexplained (idiopathic) lower-extremity deep vein thrombosis (DVT). Vitamin D deficiency was also more common among people with DVT. In the DVT group, 68.3% had deficient vitamin D levels, compared with 49.4% of the control group.

Another study found that using calcitriol lowered the incidence of DVT in prostate cancer patients.

These findings suggest that vitamin D deficiency might predispose people to clots and that adequate vitamin D could support overall anticoagulation. Still, it’s best to ask your doctor before adding vitamin D, since the right dose depends on your blood levels, kidney health, and overall medication plan.

Recommended vitamin D dosage and monitoring

The National Institutes of Health recommends the following intake levels:

Age / Life Stage

Suggested Daily Vitamin D Intake
Infants up to 12 months

10 mcg (400 IU)
Children ages 1-13

15 mcg (600 IU)
Teens ages 14-18

15 mcg (600 IU)
Adults ages 19-70

15 mcg (600 IU)
Adults over 70

20 mcg (800 IU)
Pregnant or breastfeeding teens and adults

15 mcg (600 IU)

These recommendations are designed to help maintain healthy vitamin D levels for bone, muscle, and immune health. However, you might require different amounts depending on your medical condition, medications, lab results, or risk of deficiency.

Also, vitamin D toxicity is possible at very high doses, exceeding 4,000 IU per day. Signs of vitamin D toxicity include:

    • fatigue
    • nausea
    • constipation
    • frequent urination
    • heart rhythm changes
    • deposition of calcium in blood vessels and organs (hypercalcemia), if prolonged

Safety considerations when combining Eliquis and vitamin D

If you are considering vitamin D supplements while on Eliquis:

  • Check your baseline vitamin D level. A simple blood test (25-hydroxyvitamin D) tells you whether you need supplementation. Many people maintain adequate levels with sunlight and diet and may not require supplements.
  • Stick to recommended doses unless instructed otherwise. High-dose vitamin D should be taken only under medical supervision.
  • Be mindful of calcium intake. Vitamin D increases calcium absorption. Excessive calcium intake from supplements and fortified foods can contribute to kidney stones and vascular calcification.
  • Avoid grapefruit with vitamin D supplements. Vitamin D3 products sometimes include warnings to limit grapefruit juice, which can increase vitamin D levels. Grapefruit also interacts with many medications, including Eliquis.
  • Report new symptoms. If you develop unusual bruising, bleeding, muscle pain, irregular heartbeat, or gastrointestinal issues, contact your healthcare provider.
  • Limit non-prescription pain relievers like ibuprofen and aspirin unless your doctor directs otherwise. These drugs can increase bleeding when combined with apixaban.
  • Avoid herbal supplements known to affect bleeding or drug metabolism. St John’s wort is a strong inducer of CYP3A4 and P-gp. It can reduce apixaban levels and is classified as “avoid” in the apixaban OTC interaction survey. Herbs like gingko and garlic have antiplatelet properties, and taking them with a DOAC can increase bleeding risk.
  • Adhere to dosing instructions. Take apixaban exactly as prescribed. Do not double up doses if you miss one. Instead, take the missed dose as soon as you remember, unless it’s almost time for your next dose, and resume your regular schedule thereafter.
  • Communicate with your healthcare team. Tell your doctors and pharmacist about every supplement, over-the-counter medication, and herb you use. Pharmacists are trained to identify potential interactions and can provide guidance.
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Bottom line

Vitamin D does not interfere with Eliquis. In fact, adequate vitamin D levels may support cardiovascular health and even modestly reduce clot risk. That said, more is not better. Extremely high doses of vitamin D can cause hypercalcemia and other health problems.

Because Eliquis’ main risk is bleeding, you should still be cautious about adding any new supplement. The safest approach is to know your vitamin D status through a blood test and only use supplements under the guidance of your healthcare provider. If allowed, look out for signs of bleeding or vitamin D toxicity and seek medical advice promptly.

Frequently Asked Questions

Yes, vitamin C is generally considered okay to take with Eliquis at typical daily doses, and it is not known to directly reduce or intensify Eliquis’s effect. Avoid very high doses unless your doctor recommends them, since excess vitamin C can cause side effects like diarrhea, nausea, stomach cramps, and may be a concern for people prone to kidney stones. Because Eliquis is a blood thinner, it is still smart to ask a pharmacist or doctor before adding any supplement.

Use caution with vitamin E while taking Eliquis, especially at high supplement doses. Vitamin E can affect platelet activity and may increase bleeding risk when combined with anticoagulant or antiplatelet medicines. The NIH notes that clinically important effects are more likely with larger supplemental doses, possibly above 400 IU per day, so ask your healthcare provider before using vitamin E supplements with Eliquis.

High-dose vitamin E is the main one to be careful with because of possible bleeding concerns. Vitamin K does not affect Eliquis the same way it affects warfarin, and the Eliquis label notes that vitamin K is not expected to change apixaban’s anticoagulant activity. Still, you should review all vitamins with a pharmacist or doctor, especially if the product contains herbs, high-dose antioxidants, or “blood circulation” blends.

Yes, vitamin B12 is generally fine to take with Eliquis, and it is not known as a major interaction concern with apixaban. B12 is commonly found in multivitamins, B-complex products, and standalone supplements. However, patients taking medicines such as metformin or acid-reducing drugs may need medical guidance because those medications can affect B12 levels.

Patients should avoid St. John’s wort unless their prescriber specifically approves it, because the Eliquis label says it can lower apixaban exposure and may increase the risk of stroke or blood clots. Supplements that may raise bleeding concerns include high-dose vitamin E, omega-3/fish oil products, ginkgo, garlic, and glucosamine, especially in concentrated supplement form. A pharmacist or doctor should review any herbal product or supplement before use with Eliquis.

Yes, many people can take a standard multivitamin with Eliquis, but you should check the label first. The biggest things to watch for are high-dose vitamin E, added herbs, fish oil, or specialty blends marketed for heart, circulation, or inflammation support. When in doubt, bring the bottle or ingredient list to your doctor so they can check whether it is safe with your anticoagulant.

Related Articles

Sources

Tarn DM, Barrientos M, Wang AY, Ramaprasad A, Fang MC, Schwartz JB. Prevalence and Knowledge of Potential Interactions Between Over-the-Counter Products and Apixaban. J Am Geriatr Soc. 2020 Jan;68(1):155-162. doi: 10.1111/jgs.16193. Epub 2019 Oct 28. PMID: 31658372; PMCID: PMC7141171.

Koyama T, Shibakura M, Ohsawa M, Kamiyama R, Hirosawa S. Anticoagulant effects of 1alpha,25-dihydroxyvitamin D3 on human myelogenous leukemia cells and monocytes. Blood. 1998 Jul 1;92(1):160-7. PMID: 9639512.

Wu-Wong, J. R., Nakane, M., & Ma, J. (2006). Vitamin D analogs modulate the expression of plasminogen activator inhibitor-1, thrombospondin-1 and thrombomodulin in human aortic smooth muscle cells. Journal of Vascular Research, 44(1), 11–18. https://doi.org/10.1159/000097812

Rezaei, Y., Khademvatani, K., Seyyed-Mohammadzad, M. H., Akbari, M., Eskandari, R., & Rostamzadeh, A. (2014). The relationship between vitamin D status and idiopathic lower-extremity deep vein thrombosis. International Journal of General Medicine, 7, 303. https://doi.org/10.2147/ijgm.s64812

Beer, T. M., Venner, P. M., Ryan, C. W., Petrylak, D. P., Chatta, G., Ruether, J. D., Chi, K. N., Curd, J. G., & DeLoughery, T. G. (2006). High dose calcitriol may reduce thrombosis in cancer patients. British Journal of Haematology, 135(3), 392–394. https://doi.org/10.1111/j.1365-2141.2006.06322.x

Office of Dietary Supplements – Vitamin D. (n.d.). https://ods.od.nih.gov/factsheets/VitaminD-Consumer/#h2

Vitamin D. (n.d.). Mayo Clinic. https://www.mayoclinic.org/drugs-supplements-vitamin-d/art-20363792

Khademvatani K, Seyyed-Mohammadzad MH, Akbari M, Rezaei Y, Eskandari R, Rostamzadeh A. The relationship between vitamin D status and idiopathic lower-extremity deep vein thrombosis. Int J Gen Med. 2014 Jun 19;7:303-9. doi: 10.2147/IJGM.S64812. PMID: 24971035; PMCID: PMC4069050.

Grze?k G, Rogowicz D, Wo?owiec ?, Ratajczak A, Gilewski W, Chudzi?ska M, Sinkiewicz A, Banach J. The Clinical Significance of Drug-Food Interactions of Direct Oral Anticoagulants. Int J Mol Sci. 2021 Aug 8;22(16):8531. doi: 10.3390/ijms22168531. PMID: 34445237; PMCID: PMC8395160.