Direct oral anticoagulants can interact with food and dietary supplements such as St. John's wort, potentially altering plasma drug concentrations and requiring clinical caution.
Do food, dietary supplements, and herbs affect the plasma concentration and clinical safety of direct oral anticoagulants?
Patients treated with DOACs should exercise caution with dietary supplements and avoid St. John's wort due to clinically significant drug-food interactions.
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.
Grześk et al. (Sun,) conducted a review in Cardiovascular diseases requiring anticoagulation. Direct oral anticoagulants (DOACs) and dietary supplements was evaluated. Direct oral anticoagulants can interact with food and dietary supplements such as St. John's wort, potentially altering plasma drug concentrations and requiring clinical caution.
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