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Can I take fish oil with Eliquis (apixaban)?

Not directly studied, so ask your prescriber first. The risk is theoretical only: no study or case report has looked at fish oil with apixaban. In trials of people on warfarin or aspirin, fish oil added no extra bleeding, though one case report describes a rise in a clotting test on warfarin. Across 11 trials with 120,643 people, omega-3s did not raise bleeding overall; high-dose purified EPA raised it slightly. Report any unusual bleeding.

How well documented: Theoretical only. No study or case report in people for this pair: the concern comes from how the two work.

Last reviewed

How we grade evidenceEditorial policy

What's known

  • Theory. At high doses fish oil can make platelets less sticky, though less than aspirin does, and it might lengthen clotting time when taken with warfarin, an older blood thinner. Apixaban already raises bleeding risk, and its label says other drugs that affect clotting raise it further: aspirin and other antiplatelet drugs, other blood thinners, NSAID pain relievers, and SSRI or SNRI antidepressants. Fish oil is not on that list. (NIH ODS; Eliquis label)
  • Bleeding in trials. A 2024 review pooled 11 trials with 120,643 people. Bleeding was no more common with omega-3 supplements than without them, including bleeding in the brain or gut. People on high-dose purified EPA, a prescription form, had 50% more bleeding in relative terms, but the absolute rise was 0.6%. The extra risk tracked the EPA dose, not whether people also took antiplatelet drugs such as aspirin. The review did not report results for people on blood thinners. (Javaid 2024)
  • Studies with warfarin and aspirin. In a small 4-week trial, people on warfarin who took 3 or 6 grams of fish oil a day had no change in INR, the blood test for warfarin's effect. In 511 heart bypass patients on aspirin or warfarin, 4 grams of fish oil concentrate a day for 9 months caused no extra bleeding. One case report describes a woman whose INR rose from 2.8 to 4.3 after she doubled her fish oil to 2,000 mg a day. Warfarin works differently from apixaban, so these results don't settle it. (Bender 1998; Eritsland 1995; Buckley 2004)

What to do

  • Talk to your prescriber or pharmacist before you start fish oil, and tell them how much you plan to take, especially if you also take aspirin or an NSAID. The apixaban label asks you to tell your healthcare provider about every vitamin and herbal supplement you use.
  • Know the bleeding signs the label lists: bleeding gums, nosebleeds that happen often, heavier periods, red, pink or brown urine, red or black stools, coughing up or vomiting blood, or new headaches, dizziness or weakness. Call your healthcare provider or get medical help right away if you notice them. (Eliquis label)
  • Before surgery or dental work, tell the person treating you about both. The label says apixaban may need to be paused before a procedure, and only the prescriber should decide that.
  • Don't stop or change a prescribed medicine on your own. The label warns that stopping apixaban raises the risk of a stroke.

Sources

  1. US National Library of Medicine. Eliquis (apixaban) tablets: prescribing information and Medication Guide. DailyMed, revised April 2025. DailyMed
  2. National Institutes of Health, Office of Dietary Supplements. Omega-3 Fatty Acids: Fact Sheet for Health Professionals. Updated August 2025. NIH ODS
  3. Javaid M, et al. Bleeding Risk in Patients Receiving Omega-3 Polyunsaturated Fatty Acids: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Am Heart Assoc. 2024. PubMed 38742535 · doi:10.1161/JAHA.123.032390
  4. Bender NK, et al. Effects of Marine Fish Oils on the Anticoagulation Status of Patients Receiving Chronic Warfarin Therapy. J Thromb Thrombolysis. 1998. PubMed 10767122 · doi:10.1023/A:1008852127668
  5. Eritsland J, et al. Long-term effects of n-3 polyunsaturated fatty acids on haemostatic variables and bleeding episodes in patients with coronary artery disease. Blood Coagul Fibrinolysis. 1995. PubMed 7795149 · doi:10.1097/00001721-199502000-00003
  6. Buckley MS, et al. Fish oil interaction with warfarin. Ann Pharmacother. 2004. PubMed 14742793 · doi:10.1345/aph.1D007