Can You Take Eliquis With Melatonin?
In our latest question and answer, the pharmacist discusses the potential drug interaction between Eliquis and melatonin.
Does melatonin have a negative interaction with Eliquis?
Nov 17, 2022- Melatonin may have mild blood-thinning effects that could increase bleeding risk when combined with Eliquis, though this interaction appears uncommon based on available studies.
- Tell your doctor before taking melatonin with Eliquis so you can be properly monitored and use the lowest possible melatonin dose.
- Watch for signs of bleeding such as easy bruising, bleeding gums, or black or tarry stools when taking both medications together.
Answer
While I couldn't find any studies that have specifically evaluated the combined use of Eliquis (apixaban) and melatonin, some have found evidence that melatonin could potentially have mild anticoagulant (i.e., blood thinning) effects and may increase the risk of bleeding in those taking anticoagulant or antiplatelet drugs.
As with all over-the-counter drugs and supplements, be sure to tell your doctor if you plan on starting something new so you can be appropriately monitored.
What Do The Studies Say?
There are not many studies showing melatonin increasing bleeding risk, and it's likely that the risk here is quite low.
Nevertheless, some studies have shown that melatonin may increase the time it takes your blood to coagulate (i.e., clot). One such study concluded the following:
"A single dose of oral melatonin was associated with lower plasma levels of procoagulant factors 60 min later. There might be a dose-response relationship between the plasma concentration of melatonin and coagulation activity."
There have also been isolated case reports, documented by the FDA through their 'adverse event reporting system' (CFSAN [Center for Food Safety and Applied Nutrition] Adverse Event Reporting System (CAERS)), of minor bleeding episodes in individuals taking melatonin with the anticoagulant warfarin.
Several other studies list melatonin as an agent that can increase bleeding risk, but there isn't much data behind it.
More studies need to be completed to evaluate the blood-thinning effects of melatonin. Data is just sparse here.
It is important to note that melatonin is an endogenous hormone (i.e., our body produces it naturally), so any interaction likely is dose-dependent.
Interaction Management
Due to the lack of safety data regarding the combined use of Eliquis and melatonin, they should be used cautiously together.
The available data seems to show a clinically significant interaction doesn't happen often, for most individuals, but again, it has been reported.
Until more, and higher quality studies are done evaluating the potential blood thinning effects of melatonin, it's difficult to give a recommendation one way or another.
If you do take melatonin and Eliquis together, be sure to let your doctor know. You should start on the lowest available dose of melatonin and monitor for signs/symptoms of bleeding, such as:
- Easy bruising
- Bleeding from the gums
- Black or tarry stools
Final Words
Thanks for your question! Reach back out anytime.
References & sources
- Melatonin for the prevention and treatment of jet lag — PubMed
- Oral melatonin reduces blood coagulation activity: a placebo-controlled study in healthy young men — PubMed
- CFSAN Adverse Event Reporting System (CAERS) — FDA
- Effect of oral melatonin on the procoagulant response to acute psychosocial stress in healthy men: a randomized placebo-controlled study — PubMed
- Natural anticoagulants, aging, and thromboembolism — PubMed
- Dietary supplements and bleeding — PubMed
- Melatonin effect on platelets and coagulation: Implications for a prophylactic indication in COVID-19 — PubMed
- Eliquis Prescribing Information — AccessFDA
Glossary — Terms in This Answer
- Anticoagulant
- A medication that prevents blood from clotting or slows down the clotting process to reduce the risk of dangerous blood clots.
- Antiplatelet
- A medication that prevents blood cells called platelets from clumping together to form clots.
- Coagulate
- The process by which blood thickens and forms a clot.
- Procoagulant factors
- Substances in the blood that help promote clotting and blood coagulation.
- Endogenous hormone
- A chemical messenger produced naturally by your body's own cells and tissues.
- Adverse event reporting system
- A database where healthcare providers and patients can report unexpected harmful reactions to medications or supplements.
- Dose-dependent
- A relationship where the strength or severity of an effect increases as the amount of a substance taken increases.
- Clinically significant
- An effect or result that is important enough to matter in real patient care and health outcomes.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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