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Natural and Alternative Treatments Index Page | Drug Interactions

Direct Oral Anticoagulants

Fish Oil—Possible Harmful Interaction | St. John's Wort—Possible Harmful Interaction

Direct oral anticoagulants include two groups of drugs. Factor Xa inhibitors and direct thrombin inhibitors both help to stop clots. Medicine in these categories include:

  • Rivaroxaban (Xarelto)
  • Apixaban (Eliquis)
  • Betrixaban (Bevyxxa)
  • Edoxaban (Savaysa)
  • Dabigatran (Pradaxa)

There are no studies that look at the direct effect of supplements on this class of drugs. However, certain supplements have shown the ability to affect how blood clots. When combined with this medicine they may increase the risk of bleeding. Let your doctor know about any supplements you are taking or plan to start. Possible interactions can occur with:


Fish Oil

Possible Harmful Interaction

Fish oil may increase the risk of bleeding when combined with direct oral anticoagulants. The larger the dose of fish oil, the larger the risk of bleeding. Fish oil includes omega-3 fatty acids and cod liver oil. Talk to your doctor before taking fish oil supplements.1-3 


St. John’s Wort

Possible Harmful Interaction

St. John’s wort may reduce the amount of some direct oral anticoagulants in the blood. This can lower the effect of the drugs. Avoid St. John’s wort while taking this medicine.1-2, 4 

Other herbs and natural supplements might interfere with the ability of the blood to clot. However, it is not clear if it increases the effect of this class of medication.

References [ + ]

1. Rivaroxaban. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T901914/Rivaroxaban. Updated March 6, 2018. Accessed September 7, 2018.

2. Dabigatran. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T901029/Dabigatran#Drug-Interactions. Updated September 6, 2018. Accessed September 7, 2018.

3. Apixaban. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T904822/Apixaban#Drug-Interactions. Updated September 6, 2018. Accessed September 7, 2018.

4. Edoxaban. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T908365/Edoxaban#Drug-Interactions. Updated September 6, 2018. Accessed September 7, 2018.

5. Rivaroxaban—drug summary. PDR—Prescribers’ Digital Reference website. Available at: http://www.pdr.net/drug-summary/Xarelto-rivaroxaban-278#13. Accessed April 11, 2018.

Last reviewed September 2018 by EBSCO CAM Review Board
Last Updated: 2/21/2019

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