Valerian and Apixaban: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Aug 8, 2026 · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Valerian
No brand names on recordApixaban
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Valerian is an herbal supplement some people use for sleep or stress, and apixaban (Eliquis) is a blood thinner. There is a theory that valerian could slow down how your body breaks down apixaban, which might let a little more of the blood thinner build up. If that happened, it could raise your chance of bruising or bleeding.
I want to be clear: this is based on lab reasoning, not strong human studies, so it may never cause a problem for you. Still, it is worth a quick chat with your pharmacist or doctor, especially if you take other things that affect bleeding. Please don't stop either one on your own. Your care team can easily keep an eye on this.
Effect: Possible increased apixaban exposure with concomitant valerian.
Mechanism: Theoretical inhibition of CYP3A4-mediated apixaban metabolism by valerian. Apixaban is an active drug (not a prodrug), so reduced clearance predicts higher AUC/Cmax and increased anticoagulant effect.
- Direction: Increased apixaban levels, higher bleeding risk.
- Evidence: Theoretical only; no robust human PK data.
- Onset: Unspecified.
- Management: Use with caution, particularly with additional bleeding risk factors or other CYP3A4/P-gp inhibitors. Monitor for signs of bleeding; individualize based on overall risk.
What happens
Increased exposure of apixaban
Interaction Deep Dive
Taking valerian together with apixaban has the potential to raise apixaban exposure. Caution is warranted with this combination, particularly when additional bleeding risk factors are present or when other medications that may elevate apixaban concentrations are also being used1.
Why it happens (mechanism)
Possible inhibition of CYP3A4-mediated metabolism by valerian
How to manage this interaction
Keep taking your apixaban exactly as prescribed and do not start or stop valerian without checking first.
- Tell your pharmacist and prescriber that you take (or are considering) valerian so they have the full picture.
- Your care team may watch you more closely for signs of bleeding, such as unusual bruising, nosebleeds, pink or red urine, black stools, or bleeding that won't stop.
- Be extra cautious if you take other things that raise bleeding risk (like NSAIDs, aspirin, or fish oil) or other supplements that affect drug levels.
- Report any new bleeding or bruising promptly.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Valerian and Apixaban together?
Valerian might modestly raise apixaban levels and bleeding risk in theory, so let your pharmacist or doctor know you use it and watch for unusual bruising or bleeding. Keep taking both as prescribed unless your care team tells you otherwise. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Valerian and Apixaban interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Valerian and Apixaban interaction managed?
Keep taking your apixaban exactly as prescribed and do not start or stop valerian without checking first. Tell your pharmacist and prescriber that you take (or are considering) valerian so they have the full picture. Your care team may watch you more closely for signs of bleeding, such as unusual bruising, nosebleeds, pink or red urine, black stools, or bleeding that won't stop. Be extra cautious… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Valerian or Apixaban need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (1)
- Steffel J, Collins R, Antz M, et al: 2021 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Europace 2021; 23(10):1612-1676.
Keep reading about Apixaban
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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