Food-drug interactions of novel drugs used in cardiologic and diabetic patients - a PRISMA scoping review.

BACKGROUND: Food-drug interactions are common in orally administered therapies. In order to achieve optimal therapeutic efficacy and safety, it is important for patients to understand the most appropriate way to take their medications in accordance with their diet. OBJECTIVES: To evaluate the impact of food on the oral bioavailability of novel cardiovascular and antidiabetic drugs, including sacubitril/valsartan, direct oral anticoagulants, sodium-glucose cotransporter-2 inhibitors, semaglutide, vericiguat, pitavastatin, and bempedoic acid. METHODS: PubMed, Scopus, and Cochrane Library databases were searched from inception to May 2024, following the guidelines of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) statement. The search strategy employed keywords including 'food drug interactions', 'food effect', 'bioavailability', and 'bioequivalence', combined with the names of the investigated drugs. Eligible publications comprised clinical pharmacokinetic studies and randomized clinical trials evaluating the effect of food on drug bioavailability. RESULTS: A total of 36 publications met the inclusion criteria. For most drugs, food was found to reduce the maximum concentration and delay the rate of absorption of the active substance without significantly affecting overall drug exposure. Therefore, these drugs can generally be administered regardless of meals. Semaglutide is recommended to be administered on an empty stomach, and pitavastatin demonstrated higher bioavailability in the fasted state. In contrast, vericiguat and higher doses of rivaroxaban are better absorbed when taken with food. For patients with swallowing difficulties, rivaroxaban, apixaban, and edoxaban may be crushed and administered either via a nasogastric tube or orally mixed with applesauce. CONCLUSION: For a substantial proportion of novel cardiovascular and antidiabetic therapies, dosing without strict regard to meals is supported by available evidence. This level of flexibility may facilitate patient adherence and contribute to improved therapeutic outcomes in clinical practice.