How do acetylsalicylic acid and warfarin work together with numerous vitamins?

In a current evaluation revealed in Vitamins, researchers mentioned 45 drug-nutrient interactions (DNIs) that modify micro-nutritional standing, notably specializing in how acetylsalicylic acid (ASA) and warfarin could have an effect on sufferers by numerous mechanisms.

They comprehensively tackle the complexities of DNIs, highlighting the affect of things resembling polymorphisms, intestine microbiota, and dietary elements, and supply sensible suggestions for clinicians to handle DNIs successfully in weak populations.

Study: Potential Drug–Nutrient Interactions of 45 Vitamins, Minerals, Trace Elements, and Associated Dietary Compounds with Acetylsalicylic Acid and Warfarin—A Review of the Literature. Image Credit: AleksSafronov/Shutterstock.comResearch: 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/


DNIs are much less studied than drug-drug interactions however stay clinically related. Drugs could immediately or not directly have an effect on micro-nutritional standing by physicochemical, physiological, or pathophysiological mechanisms.

These interactions embody bio-inactivation, altered absorption, impact, or excretion. Drugs could compete with micronutrients, induce physiological adjustments, or not directly have an effect on well being.

Whereas DNIs could also be helpful or detrimental, they’re typically underreported, and there’s a dearth of large-scale, complete research within the subject.

Researchers within the current article evaluation the DNIs of ASA (an antiplatelet drug) and warfarin (an anticoagulant), medication extensively utilized in cardiology, which can doubtlessly influence sufferers’ micronutrient standing by numerous mechanisms.

The “hidden starvation” of micronutrients

“Hidden starvation” implies the deficiency of micronutrients. Micronutrients are important for primary physiological features, together with nutritional vitamins (water-soluble and fat-soluble), minerals, and hint parts.

The American Institute of Medication offers 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 embody 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 could potentiate ASA’s antiplatelet impact and supply gastric safety, whereas minerals resembling sodium present decreased excretion at excessive ASA doses, doubtlessly impacting blood strain regulation.

Hint parts like iron could also be affected, resulting in an elevated threat of anemia, whereas related dietary compounds like taurine might doubtlessly improve ASA’s antiplatelet impact and supply gastric safety.

Nevertheless, some interactions stay questionable, resembling these with riboflavin, pantothenic acid, and retinol. Whereas niacin exhibits antiplatelet results, the medical 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 elevate issues in regards to the potential metabolic misuse of micronutrients, however the medical 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 could come up from avoiding vitamin-Okay-rich meals, doubtlessly impacting sufferers’ well being. Conflicting proof relating to 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 could affect warfarin’s anticoagulant impact and threat of arterial calcification.

Additional, magnesium has been linked to stabilizing INR ranges, doubtlessly affecting warfarin remedy outcomes. Low vitamin Okay meals excessive in potassium could pose a threat for sufferers with continual kidney illness because of hyperkalemia.

Astaxanthin exhibits reported interactions with warfarin, however the precise mechanisms stay unclear. A number of vitamins resembling riboflavin, cobalamins, calcium, and hint parts 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 parts like thiamine, pantothenic acid, sulfur, manganese, molybdenum, and others, which presently lack knowledge.


Shifting in direction of a predictive, preventive, and personalised healthcare mannequin, clinicians can leverage omics applied sciences to detect indicators of illness early and stratify the chance of DNIs.

These findings spotlight the significance of contemplating dietary components and nutrient consumption in sufferers present process ASA or warfarin remedy to optimize therapy outcomes and reduce antagonistic occasions.

Nevertheless, the evaluation is proscribed by a scarcity of unified methodology, the small scale of human cohort research, reliance on animal fashions, and lacking knowledge on sure micronutrient interactions.

In conclusion, the interaction between nutrient consumption, particular person physiology, and drugs use requires contemplating DNIs in medical follow, notably in weak populations. It emphasizes the necessity for personalised approaches to dietary evaluation and administration.

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