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Can I take St John's wort with Eliquis (apixaban)?

No, not unless your prescriber says so. This interaction is on the drug's label: the apixaban label says to avoid St John's wort, because it speeds up the liver and gut pathways that clear apixaban. Lower apixaban levels raise the risk of a stroke or clot. With rivaroxaban, a similar blood thinner, St John's wort left about a quarter less drug in the blood. Ask your prescriber or pharmacist.

How well documented: On the drug’s label. The medicine’s FDA-approved label names this supplement, or the kind of product it is.

Last reviewed

How we grade evidenceEditorial policy

What's known

  • On the label. The apixaban label tells prescribers to avoid combining it with drugs that strongly speed up two clearance pathways, the liver and gut enzyme CYP3A4 and the P-gp pump, and names St John's wort with rifampin, carbamazepine and phenytoin. Lower apixaban levels raise the risk of stroke and other clots, the label says. (Eliquis label)
  • Drug-level studies with a similar drug. Rivaroxaban (Xarelto) is cleared the same way. In two studies of 12 healthy volunteers each, 2 weeks of St John's wort cut rivaroxaban exposure by about a quarter (24% and 25%). In the study that measured it, the anti-clotting effect fell by a fifth. One team said the combination should be avoided; the other said avoiding it, or checking with lab tests, should be considered. (Scholz 2021; Huppertz 2018)
  • How big it could be. No one has measured St John's wort with apixaban itself. Rifampin, an antibiotic that speeds up the same pathways, cut apixaban exposure by 54% in 20 healthy people. How strongly St John's wort does this varies by product: it tracks the amount of hyperforin, one of the plant's compounds. (Vakkalagadda 2016; Nicolussi 2020)
  • What the reviews say. NIH's NCCIH says it has been clearly shown that St John's wort interacts in dangerous ways with many medicines, including the blood thinner warfarin. A 2025 review of food and herb interactions with blood thinners concluded that people taking them should avoid St John's wort. (NCCIH; Talasaz 2025)

What to do

  • Don't start St John's wort while you take apixaban unless your prescriber agrees. Ask your pharmacist to check any herbal blend you use for it.
  • If you already take both, call your prescriber or pharmacist soon rather than changing anything yourself.
  • Lower apixaban levels mean a higher risk of a clot or stroke. Call emergency services (911 in the US) at once for signs of a stroke: a face drooping on one side, weakness in an arm, slurred or strange speech, or sudden confusion, trouble seeing or a severe headache. Get help right away for chest pain or shortness of breath, which can mean a clot in the lung, and see a doctor urgently for pain or swelling in one leg, which can mean a clot there. (MedlinePlus: stroke, MedlinePlus: lung clot, MedlinePlus: leg clot)
  • Tell your healthcare provider about every vitamin and herbal supplement you use, as the apixaban label asks.
  • 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 Center for Complementary and Integrative Health. St. John's Wort. Last updated May 2025. NCCIH
  3. Scholz I, et al. Effects of Hypericum perforatum (St John's wort) on the pharmacokinetics and pharmacodynamics of rivaroxaban in humans. Br J Clin Pharmacol. 2021. PubMed 32959922 · doi:10.1111/bcp.14553
  4. Huppertz A, et al. Rivaroxaban and macitentan can be coadministered without dose adjustment but the combination of rivaroxaban and St John's wort should be avoided. Br J Clin Pharmacol. 2018. PubMed 30192025 · doi:10.1111/bcp.13757
  5. Vakkalagadda B, et al. Effect of Rifampin on the Pharmacokinetics of Apixaban, an Oral Direct Inhibitor of Factor Xa. Am J Cardiovasc Drugs. 2016. PubMed 26749408 · doi:10.1007/s40256-015-0157-9
  6. Nicolussi S, et al. Clinical relevance of St. John's wort drug interactions revisited. Br J Pharmacol. 2020. PubMed 31742659 · doi:10.1111/bph.14936
  7. Talasaz AH, et al. Pharmacokinetic and Pharmacodynamic Interactions between Food or Herbal Products and Oral Anticoagulants: Evidence Review, Practical Recommendations, and Knowledge Gaps. Semin Thromb Hemost. 2025. PubMed 39288907 · doi:10.1055/s-0044-1790258
  8. National Library of Medicine. Stroke. MedlinePlus. MedlinePlus
  9. National Library of Medicine. Pulmonary Embolism. MedlinePlus. MedlinePlus
  10. National Library of Medicine. Deep Vein Thrombosis. MedlinePlus. MedlinePlus