XARELTO AND SUPPLEMENT INTERACTIONS

Hi all. Not happy about having to go on an anti-coagulant, but I'm starting Xarelto today since I'm 30 days out from upcoming ablation.

My question has to do with identifying potential interactions between Xarelto and any supplements, such as fish oil, that may have blood-thinning properties. I also eat garlic daily.

Haven't seen anything published, and EP was provided a complete list of all my supplements and didn't issue any cautions, but any thoughts from Forum members?

Thanks, Randy

I researched fish oil and blood thinning, and could not find any convincing evidence this is a danger.

Fish oil may not be any more of a blood thinner than, say, a glass of water.

My EP didn't know anything about Xarelto-supplement interactions. I asked him about grapefruit and he had to look it up. Yes, grapefruit (a potent inhibitor of the cytochrome P450 CYP3A4 enzyme) can affect Xarelto metabolism.

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Lone paroxysmal vagal atrial fibrillation. Age 62, female, no risk factors. Autonomic instability since severe Paxil withdrawal in 2004, including extreme sensitivity to neuro-active drugs, supplements, foods. Monthly tachycardia started 1/11, happened only at night, during sleep, or when waking, bouts of 5-15 hours. Changed to afib about a year ago, same pattern. Frequency increased over last 6 months, apparently with sensitivity to more triggers. Ablation 6/27/13 by Steven Hao.

Thank you! I only use one Coromega fish oil packet a day (but have been eating salmon lately). I didn't know about the grapefruit...good catch...I'll avoid it until I'm off the Xarelto.

Randy - the idea of fish oil helping to prevent clots is derived by the actual physical property of "lubrication" in that it makes blood platelets "slippery" and therefore discourages aggregation or clumping.

Jackie

Thanks. Anyone have an opinion whether Coumadin is inherently safer than Xarelto (or vice versa) apart from the antidote issue?

Randy,

Who is your ablation doctor? Is he letting you stay on your supplements right up to the time of surgery?

I am on a bunch of supplements, for my heart as well as others to help my methylation pathway polymorphism issues. I am hoping to get ablation surgery at CPMC with Dr. Hongo but haven't seen him yet for a consult.

Nancy M

Nancy, Dr. Natale is doing mine. His pre-ablation handout says "generally you will be asked to stop your anti-arrhythmic medication 3-5 days prior to your procedure." But it doesn't address supplements. However, if I remember correctly from the interview, he wants me off everything (flec, supplements) for the final five days before ablation.

I'm not sure what effect abrupt D/C of the various supplements I'm on (Sinatra's "awesome foursome" of CoQ, L-carn, d-ribose, magnesium, plus potassium and taurine) will be, assuming my body has gotten used to functioning with them. I may taper them off gradually starting a few days out.

There must be a good number of Forum members who've already been ablated and who were supplementing beforehand who can address this issue.

Randy,

Seems like a big order. I can see going off the meds. I'm on Sotalol right now, and I know there are alot of drug interactions with it; however, going off the supplements too would be scary. I wonder how we are supposed to avoid afib, etc. this way. I also have had ventricular tachycardia, so I certainly don't want to deal with that possibility for five days--I might be dead! I guess they've done this so many times that they look at each case and then decide what to do.

Good luck as you reduce your meds and supplements! As you say, others have done it, so I guess we can too!

Nancy M

You generally dont have to stop most supplements with the exception of Nattokinase and keeping Omega 3 to around 1 gram to 2 grams max of combined DHA-EPA.

To be on the absolute safe side and because of a general lack of experience with these supplements, many EPs will just ask that you stop them out of not being sure what effect they might be having,

It wont hurt much to take a temporary break with most of the supplements for a few days pre-ablation, but I would rather suggest just cutting down on the dosage of such things as Magnesium, potassium, taurine etc rather than having to stop entirely in the few days leading up to any ablation. A more modest dose of these nutrients is highly unlikely to interfere with your EPs efforts to trigger your AFIB sources, and also making sure you resume your optimal dosage as soon as possible right after the ablation can go a long way toward helping with lower inflammation and improved anti-oxidant status at a time when the body, and heart in particular, need a lot extra of both benefits.

Shannon



Edited 1 time(s). Last edit at 12/29/2013 09:35PM by Shannon.