Key result
DOACs have clinically significant food and supplement interactions, requiring dietary caution and avoiding St. John's wort.
Why the study?
Although DOACs were initially considered free of significant food interactions, clinical observations have reported interactions with food, dietary supplements, or herbs that can potentially alter drug plasma concentrations.
Do direct oral anticoagulants have clinically significant pharmacokinetic interactions with food and dietary supplements?
Do direct oral anticoagulants have clinically significant pharmacokinetic interactions with food and dietary supplements?
Recognizing specific drug-food interactions with DOACs is essential for ensuring their safe and effective use in clinical practice.
Answers are grounded in this paper and cite their sources.
Warrants vigilance for food-supplement interactions in DOAC therapy; leaves open the need for prospective trials.
Cardiovascular diseases are the most common cause of death in the world. For almost 60 years, vitamin K antagonists (VKAs) were the mainstay of anticoagulation therapy, but in recent years direct oral anticoagulants (DOACs) have become the anticoagulant treatment of choice. DOACs were initially considered drugs with no significant food interactions; however, clinical observations from daily practice have proved otherwise as interactions with food ingredients have been reported. Food, dietary supplements or herbs may contain substances that, when administered concomitantly with DOACs, can potentially affect the plasma concentration of the drugs. The aim of this paper was to evaluate the clinical significance of drug–food interactions of DOACs, such as dabigatran, rivaroxaban, apixaban, edoxaban and betrixaban. Patients treated with anticoagulants should avoid products containing St. John’s wort and take special care with other food ingredients. As the interest in dietary supplements is on the rise, healthcare providers can contribute to the development of well-designed clinical trials on interactions between DOACs and food, and distribute sufficient knowledge about the proper use of these supplements among patients.
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Grześk et al. (2021) conducted a review in Patients requiring anticoagulation (e.g., non-valvular atrial fibrillation, deep vein thrombosis, pulmonary embolism). Direct oral anticoagulants (dabigatran, rivaroxaban, apixaban, edoxaban, betrixaban) and food/supplement interactions was evaluated. Direct oral anticoagulants have clinically significant interactions with food and supplements, requiring patients to avoid St. John's wort and manage specific dietary habits.
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