How do acetylsalicylic acid and warfarin interact with various nutrients?

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In a caller reappraisal published successful Nutrients, researchers discussed 45 drug-nutrient interactions (DNIs) that modify micro-nutritional status, peculiarly focusing connected really acetylsalicylic acerb (ASA) and warfarin whitethorn impact patients done various mechanisms.

They comprehensively reside nan complexities of DNIs, highlighting nan power of factors specified arsenic polymorphisms, gut microbiota, and dietary components, and connection applicable recommendations for clinicians to negociate DNIs efficaciously successful susceptible populations.

 AleksSafronov/Shutterstock.comStudy: Potential Drug–Nutrient Interactions of 45 Vitamins, Minerals, Trace Elements, and Associated Dietary Compounds pinch Acetylsalicylic Acid and Warfarin—A Review of nan Literature. Image Credit: AleksSafronov/Shutterstock.com

Background

DNIs are little studied than drug-drug interactions but stay clinically relevant. Medications whitethorn straight aliases indirectly impact micro-nutritional position done physicochemical, physiological, aliases pathophysiological mechanisms.

These interactions see bio-inactivation, altered absorption, effect, aliases excretion. Medications whitethorn compete pinch micronutrients, induce physiological changes, aliases indirectly impact health.

While DNIs whitethorn beryllium beneficial aliases detrimental, they're often underreported, and there’s a dearth of large-scale, broad studies successful nan field.

Researchers successful nan coming article reappraisal nan DNIs of ASA (an antiplatelet drug) and warfarin (an anticoagulant), narcotics wide utilized successful cardiology, which whitethorn perchance effect patients' micronutrient position done various mechanisms.

The “hidden hunger” of micronutrients

“Hidden hunger” implies nan deficiency of micronutrients. Micronutrients are basal for basal physiological functions, including vitamins (water-soluble and fat-soluble), minerals, and trace elements.

The American Institute of Medicine provides dietary reference intake recommendations for these nutrients and further compounds, specified arsenic taurine and ergothioneine, basal for decently functioning longevity proteins.

ASA and DNIs

The relationship betwixt ASA and various micronutrients is analyzable and multifaceted, pinch some reported and questionable interactions. While immoderate interactions betwixt ASA and micronutrients are well-established, others stay uncertain and warrant further research.

Reported interactions of ASA see accrued urinary excretion of thiamine, modulation of niacin flush, alterations successful folate renal excretion and serum concentration, imaginable impacts connected cobalamins absorption, and effects connected vitamin C absorption and excretion.

Fat-soluble vitamins for illustration tocopherols/tocotrienols whitethorn potentiate ASA's antiplatelet effect and supply gastric protection, while minerals specified arsenic sodium show decreased excretion astatine precocious ASA doses, perchance impacting humor unit regulation.

Trace elements for illustration robust whitethorn beryllium affected, starring to an accrued consequence of anemia, while associated dietary compounds for illustration taurine could perchance heighten ASA's antiplatelet effect and connection gastric protection.

However, immoderate interactions stay questionable, specified arsenic those pinch riboflavin, pantothenic acid, and retinol. While niacin shows antiplatelet effects, nan objective value remains unclear.

Similarly, minerals for illustration phosphorus, calcium, magnesium, potassium, copper, zinc, selenium, and chromium person uncertain interactions pinch ASA. Associated dietary compounds for illustration lycopene, α-carotene, β-carotene, β-cryptoxanthin, and astaxanthin show inconclusive interactions.

Additionally, immoderate micronutrients for illustration biotin, chloride, sulfur, iodine, manganese, molybdenum, fluoride, arsenic, boron, nickel, silicon, and vanadium show nary reported interactions pinch ASA.

ASA's effects connected mitochondrial oxidative phosphorylation raise concerns astir nan imaginable metabolic misuse of micronutrients, but nan objective relevance successful humans requires further assessment.

Warfarin and DNIs

While immoderate interactions betwixt warfarin and definite nutrients person been reported, others stay questionable aliases unstudied. Niacin has been associated pinch a synergistic effect for water-soluble vitamins, starring to critically elevated world normalized ratio (INR) successful immoderate cases.

Folate deficiency whitethorn originate from avoiding vitamin-K-rich foods, perchance impacting patients' health. Conflicting grounds regarding nan relationship betwixt high-dose vitamin C and warfarin necessitates observant monitoring.

Among fat-soluble vitamins, retinol and tocopherols/tocotrienols person shown interactions pinch warfarin, starring to adverse events specified arsenic hemorrhagic events and arterial calcification. Vitamin D position whitethorn power warfarin's anticoagulant effect and consequence of arterial calcification.

Further, magnesium has been linked to stabilizing INR levels, perchance affecting warfarin therapy outcomes. Low vitamin K foods precocious successful potassium whitethorn airs a consequence for patients pinch chronic kidney illness owed to hyperkalemia.

Astaxanthin shows reported interactions pinch warfarin, but nan nonstop mechanisms stay unclear. Several nutrients specified arsenic riboflavin, cobalamins, calcium, and trace elements for illustration iron, lutein, zeaxanthin, lycopene, β-carotene, and β-cryptoxanthin do not show clinically important interactions pinch warfarin based connected disposable evidence.

Further investigation is needed to afloat understand nan imaginable interactions betwixt warfarin and different elements for illustration thiamine, pantothenic acid, sulfur, manganese, molybdenum, and others, which presently deficiency data.

Conclusion

Moving towards a predictive, preventive, and personalized healthcare model, clinicians tin leverage omics technologies to observe signs of illness early and stratify nan consequence of DNIs.

These findings item nan value of considering dietary factors and nutrient intake successful patients undergoing ASA aliases warfarin therapy to optimize curen outcomes and minimize adverse events.

However, nan reappraisal is constricted by a deficiency of unified methodology, nan mini standard of quality cohort studies, reliance connected animal models, and missing information connected definite micronutrient interactions.

In conclusion, nan interplay betwixt nutrient intake, individual physiology, and medicine usage calls for considering DNIs successful objective practice, peculiarly successful susceptible populations. It emphasizes nan request for personalized approaches to nutritional appraisal and management.

Journal reference:

  • Renaud D. et al., (2024) Potential Drug-Nutrient Interactions of 45 Vitamins, Minerals, Trace Elements, and Associated Dietary Compounds pinch Acetylsalicylic Acid and Warfarin—A Review of nan Literature. Nutrients,. doi: https://doi.org/10.3390/nu16070950.  https://www.mdpi.com/2072-6643/16/7/950