Key result
NOAC interactions with food and supplements lack clinical evidence despite potential P-gp and CYP3A4 modulation.
Why the study?
Although NOACs have fewer drug and food interactions than VKAs, no studies have compared the effects of P-glycoprotein and cytochrome P450 interaction drugs on the quality of NOAC anticoagulation.
Although NOACs have fewer interactions than vitamin K antagonists, clinicians must remain vigilant regarding concomitant use of strong P-gp and CYP3A4 modulators, including certain herbal products and foods.
Answers are grounded in this paper and cite their sources.
Clinicians should remain vigilant for NOAC interactions with P-gp/CYP3A4 modulators; leaves open the need for dedicated clinical studies.
Non-vitamin K antagonist oral anticoagulants (NOACs) are a therapeutic option to prevent stroke in patients with atrial fibrillation (AF). In fact, NOACs have become the recommended choice by international clinical practice guidelines over vitamin K antagonists (VKA), because of their efficacy and safety profile, especially in newly initiated patients. The more predictable pharmacokinetic and pharmacodynamic profile of this family of drugs allows preventing anticoagulation drug monitoring. Furthermore, NOACs have significantly fewer drug and food interactions in comparison with VKAs. Despite this, there are no studies that compare the effects on the quality of anticoagulation of NOACs with the intake of potential interactions drugs of P-glycoprotein and cytochrome P450 (CYP). This review brings an overview of NOACs pharmacokinetics profile and their potential drug-food interactions. We also briefly discuss the potential role of prebiotics and probiotics in patients under therapy with NOACs.
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Sánchez‐Fuentes et al. (2022) conducted a review in Atrial fibrillation and venous thromboembolism (patients taking NOACs). Non-vitamin K antagonist oral anticoagulants (NOACs) was evaluated. There is currently scarce clinical evidence regarding the interaction of NOACs with food, herbal products, probiotics, and prebiotics, though some modulate P-gp and CYP3A4 activity.
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