Concerns Taking Eliquis and Milk Thistle Together
In our latest question and answer, the pharmacist discusses the safety of taking Eliquis with milk thistle.
I’m taking Eliquis for a blood disorder and one Tylenol per day for foot pain. Is it safe to take milk thistle to protect my liver? Could it cause any damage to my kidneys?
Jun 13, 2025- Milk thistle at typical doses does not appear to meaningfully change how your body processes Eliquis based on current research. Milk thistle is generally not known to harm your liver or kidneys. You should still talk with your healthcare provider before adding milk thistle to make sure it's appropriate for you since you're taking a blood thinner.
Answer
Thanks so much for reaching out to us! It's certainly important to be cautious when taking prescription medications that affect blood clotting, as interactions can have serious consequences.
While drugs like Eliquis (apixaban) generally have fewer drug interactions than older drugs, like warfarin, they still have interactions to be aware of.
What Is Milk Thistle?
Milk thistle (Silybum marianum) is a flowering plant in the aster family and one of the most widely used herbal supplements for liver health.
Its active components, especially silymarin and silybin, are thought to protect liver cells by acting as antioxidants, reducing inflammation, and even stimulating liver cell regeneration. Because of these properties, it's often used by people looking to support liver function, and dietary supplements are very often 'standardized' for their silymarin content.
Is Milk Thistle Safe with Eliquis?
Eliquis is metabolized in the body by the CYP3A4 enzyme system and transported by a protein in the body called P-glycoprotein (P-gp). Some lab research suggests milk thistle may affect both pathways, but generally not to a clinically significant degree.
While lab studies show mixed results on CYP3A4 inhibition, clinical studies in humans have not shown meaningful changes in drug levels of medications that rely on this enzyme.
Additionally, milk thistle may inhibit P-gp in vitro (in lab settings), but again, this effect hasn't been shown to be clinically significant at standard supplement doses.
Overall, based on current evidence, milk thistle (at typical doses of 420-1350 mg per day) does not appear to meaningfully alter the metabolism or blood levels of Eliquis.
Having said that, due to the bleeding risks associated with Eliquis and individual variation in drug metabolism, I always recommend talking with your healthcare provider before adding any new supplement so you can be appropriately monitored.
What About the Liver and Kidneys?
In your question, you asked about the liver and kidneys.
Milk thistle is primarily known for its liver-supporting effects. Clinical studies show it may help improve liver enzyme levels and support liver cell function, especially in people with chronic liver disease. It's generally well-tolerated and not known to be harmful to the liver.
As for kidney safety, milk thistle is not known to cause kidney damage.
Final Words
- Standard doses of milk thistle appear to be safe to take alongside Eliquis, based on current research.
- Milk thistle is not known to harm the kidneys and may offer some liver-supportive benefits.
As always, keep your care team in the loop before starting any new supplement, especially if you're taking blood thinners like Eliquis.
References & sources
- Modulation of human cytochrome P450 3A4 (CYP3A4) and P-glycoprotein (P-gp) in Caco-2 cell monolayers by selected commercial-source milk thistle and goldenseal products — PubMed
- Milk thistle, a herbal supplement, decreases the activity of CYP3A4 and uridine diphosphoglucuronosyl transferase in human hepatocyte cultures — PubMed
- Eliquis Prescribing Information — BMS
Glossary — Terms in This Answer
- Eliquis
- A prescription blood thinner medication (apixaban) used to prevent blood clots.
- Silymarin
- The active compound in milk thistle that is believed to protect and support liver cell health.
- CYP3A4 enzyme system
- A group of proteins in your body responsible for breaking down and processing many medications.
- P-glycoprotein
- A protein in the body that transports certain medications and determines how they move through your system.
- Inhibit
- To slow down or reduce the activity of something, such as an enzyme or protein.
- In vitro
- Research or testing that occurs in a laboratory setting rather than in a living organism.
- Metabolized
- The process by which your body breaks down and processes a substance like a medication.
- Antioxidants
- Substances that help protect cells from damage caused by harmful molecules in the body.
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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