In a latest assessment revealed in Vitamins, researchers mentioned 45 drug-nutrient interactions (DNIs) that modify micro-nutritional standing, notably specializing in how acetylsalicylic acid (ASA) and warfarin might have an effect on sufferers by means of numerous mechanisms.
They comprehensively handle the complexities of DNIs, highlighting the affect of things resembling polymorphisms, intestine microbiota, and dietary parts, and provide sensible suggestions for clinicians to handle DNIs successfully in susceptible populations.
Research: Potential Drug–Nutrient Interactions of 45 Nutritional vitamins, Minerals, Hint Parts, and Related Dietary Compounds with Acetylsalicylic Acid and Warfarin—A Evaluate of the Literature. Picture Credit score: AleksSafronov/Shutterstock.com
Background
DNIs are much less studied than drug-drug interactions however stay clinically related. Drugs might instantly or not directly have an effect on micro-nutritional standing by means of physicochemical, physiological, or pathophysiological mechanisms.
These interactions embrace bio-inactivation, altered absorption, impact, or excretion. Drugs might compete with micronutrients, induce physiological modifications, or not directly have an effect on well being.
Whereas DNIs could also be useful or detrimental, they’re typically underreported, and there’s a dearth of large-scale, complete research within the area.
Researchers within the current article assessment the DNIs of ASA (an antiplatelet drug) and warfarin (an anticoagulant), medication broadly utilized in cardiology, which can probably influence sufferers’ micronutrient standing by means of numerous mechanisms.
The “hidden starvation” of micronutrients
“Hidden starvation” implies the deficiency of micronutrients. Micronutrients are important for fundamental physiological features, together with nutritional vitamins (water-soluble and fat-soluble), minerals, and hint components.
The American Institute of Medication gives dietary reference consumption suggestions for these vitamins and extra compounds, resembling taurine and ergothioneine, important for correctly functioning longevity proteins.
ASA and DNIs
The interplay between ASA and numerous micronutrients is advanced and multifaceted, with each reported and questionable interactions. Whereas some interactions between ASA and micronutrients are well-established, others stay unsure and warrant additional analysis.
Reported interactions of ASA embrace elevated urinary excretion of thiamine, modulation of niacin flush, alterations in folate renal excretion and serum focus, potential impacts on cobalamins absorption, and results on vitamin C absorption and excretion.
Fats-soluble nutritional vitamins like tocopherols/tocotrienols might potentiate ASA’s antiplatelet impact and supply gastric safety, whereas minerals resembling sodium present decreased excretion at excessive ASA doses, probably impacting blood strain regulation.
Hint components like iron could also be affected, resulting in an elevated danger of anemia, whereas related dietary compounds like taurine may probably improve ASA’s antiplatelet impact and provide gastric safety.
Nevertheless, some interactions stay questionable, resembling these with riboflavin, pantothenic acid, and retinol. Whereas niacin exhibits antiplatelet results, the scientific significance stays unclear.
Equally, minerals like phosphorus, calcium, magnesium, potassium, copper, zinc, selenium, and chromium have unsure interactions with ASA. Related dietary compounds like lycopene, α-carotene, β-carotene, β-cryptoxanthin, and astaxanthin present inconclusive interactions.
Moreover, some micronutrients like biotin, chloride, sulfur, iodine, manganese, molybdenum, fluoride, arsenic, boron, nickel, silicon, and vanadium present no reported interactions with ASA.
ASA’s results on mitochondrial oxidative phosphorylation increase issues concerning the potential metabolic misuse of micronutrients, however the scientific relevance in people requires additional evaluation.
Warfarin and DNIs
Whereas some interactions between warfarin and sure vitamins have been reported, others stay questionable or unstudied. Niacin has been related to a synergistic impact for water-soluble nutritional vitamins, resulting in critically elevated worldwide normalized ratio (INR) in some instances.
Folate deficiency might come up from avoiding vitamin-Ok-rich meals, probably impacting sufferers’ well being. Conflicting proof concerning the interplay between high-dose vitamin C and warfarin necessitates cautious monitoring.
Amongst fat-soluble nutritional vitamins, retinol and tocopherols/tocotrienols have proven interactions with warfarin, resulting in antagonistic occasions resembling hemorrhagic occasions and arterial calcification. Vitamin D standing might affect warfarin’s anticoagulant impact and danger of arterial calcification.
Additional, magnesium has been linked to stabilizing INR ranges, probably affecting warfarin remedy outcomes. Low vitamin Ok meals excessive in potassium might pose a danger for sufferers with power kidney illness on account of hyperkalemia.
Astaxanthin exhibits reported interactions with warfarin, however the actual mechanisms stay unclear. A number of vitamins resembling riboflavin, cobalamins, calcium, and hint components like iron, lutein, zeaxanthin, lycopene, β-carotene, and β-cryptoxanthin don’t display clinically important interactions with warfarin primarily based on accessible proof.
Additional analysis is required to completely perceive the potential interactions between warfarin and different components like thiamine, pantothenic acid, sulfur, manganese, molybdenum, and others, which at present lack information.
Conclusion
Transferring in the direction of a predictive, preventive, and personalised healthcare mannequin, clinicians can leverage omics applied sciences to detect indicators of illness early and stratify the danger of DNIs.
These findings spotlight the significance of contemplating dietary elements and nutrient consumption in sufferers present process ASA or warfarin remedy to optimize therapy outcomes and decrease antagonistic occasions.
Nevertheless, the assessment is restricted by an absence of unified methodology, the small scale of human cohort research, reliance on animal fashions, and lacking information on sure micronutrient interactions.
In conclusion, the interaction between nutrient consumption, particular person physiology, and medicine use requires contemplating DNIs in scientific observe, notably in susceptible populations. It emphasizes the necessity for personalised approaches to dietary evaluation and administration.
