The short answer
Avoid combining St. John’s wort with apixaban unless your prescriber has arranged a different treatment plan. Product labeling identifies a risk of reduced anticoagulant exposure. Moving the supplement to another hour is not the recommended solution, and you should not stop the prescribed anticoagulant on your own.
What this answer covers
Oral Hypericum perforatum (St. John’s wort) products with adult oral apixaban; exact extract composition varies.
- Supplement or preparation
- St. John’s wort
- Medication ingredient
- apixaban
Why is this interaction important?
St. John’s wort can increase the activity of CYP3A4 and P-glycoprotein, pathways that affect apixaban exposure. The Eliquis label explicitly names it among combinations to avoid because reduced drug exposure can increase stroke and other clot risks.
What does the label establish?
Apixaban acts directly on clotting factor Xa. The recommendation concerns reduced drug exposure and protection against clotting. It does not provide a universal percentage change for all St. John’s wort products or a randomized clinical event estimate for this exact supplement pair. The actionable recommendation is based on the named interaction and established transporter or enzyme pathway.
Can I take them several hours apart?
The prescribing information advises avoiding concomitant use rather than supplying a spacing interval. Altered transporter or enzyme activity is not limited to the moment two products reach the stomach. Tell the prescriber about recent starts, stops and product changes so the entire treatment plan can be assessed. Do not compensate with an extra anticoagulant dose.
What should happen if I already take both?
Contact your prescriber or pharmacist promptly and provide the St. John’s wort label, dose and duration. Discuss alternatives for the reason you take the herb while continuing the prescribed anticoagulation plan. A lack of bleeding does not show that apixaban is working adequately, because the concern here is reduced protection against clots.
Evidence and practical considerations
Absorption & effectiveness
Avoid combining St. John’s wort with apixaban unless your prescriber has arranged a different treatment plan. Product labeling identifies a risk of reduced anticoagulant exposure. Moving the supplement to another hour is not the recommended solution, and you should not stop the prescribed anticoagulant on your own.
- Exact scope
- Oral Hypericum perforatum (St. John’s wort) products with adult oral apixaban; exact extract composition varies. with adult oral apixaban tablets
- Medication form and route
- adult oral apixaban tablets
- Timing or duration
- Concurrent oral use. Source-specific durations are recorded in the evidence entries; no unstudied duration threshold or separation schedule is inferred.
What remains uncertain
- Explicit label-supported avoidance; no exact product-specific exposure reduction or event rate established. No simple dose-spacing remedy. Botanical extract composition can vary.
Factors that may matter: Exact supplement preparation, dose and additional ingredients; Kidney function, age, bleeding history and other antiplatelet or anticoagulant medicines; Current medication formulation and recent supplement start or stop.
Read the supporting source summaries
Source 1: current U.S. regulatory prescribing information
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: People receiving oral apixaban for approved indications.
The label warns of serious bleeding and increased clot risk after premature discontinuation. It explicitly advises avoiding St. John’s wort because combined CYP3A4/P-gp induction reduces apixaban exposure.
How this applies: The current label explicitly names St. John’s wort and avoidance with oral apixaban. Exact scope: Oral Hypericum perforatum (St. John’s wort) products with adult oral apixaban; exact extract composition varies.
General antiplatelet-drug precautions do not establish the effect size or causality of each botanical. No herb-specific hourly separation schedule is supplied.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Article prepared | |
| Current labels and targeted original sources assessed; all current available claims adjudicated and consumer article prepared. Uncertainty and indirect evidence retained. Clinical sign-off not recorded. | |
| Research summary published |
Article revision: ddf0176eaaa57011
This guide brings together the evidence records used by our interaction checker. Each finding retains its own preparation limits, research date, and source summaries.
Full citations require verification. Reading this answer and the source summaries does not.
Taking other supplements or medications?
Use the checker to explore your other combinations. Ask a pharmacist to review the exact products, amounts and medical conditions in your complete list.
Open the interaction checkerInformation, not medical advice. Do not change prescribed treatment based on this guide.