The Clinical Significance of Drug-Food Interactions of Direct Oral Anticoagulants

Int J Mol Sci. 2021 Aug 8;22(16):8531. doi: 10.3390/ijms22168531.


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.

Keywords: apixaban; betrixaban; dabigatran; dietary supplements; edoxaban; food interaction; resveratrol supplementation; rivaroxaban; treatment.

Publication types

  • Review

MeSH terms

  • Administration, Oral
  • Anticoagulants* / pharmacokinetics
  • Anticoagulants* / therapeutic use
  • Dietary Supplements*
  • Food-Drug Interactions*
  • Humans
  • Vitamin K* / antagonists & inhibitors
  • Vitamin K* / blood


  • Anticoagulants
  • Vitamin K