PRISMA Scoping Review Examines Food-Drug Interactions in Cardiovascular and Diabetic Medications

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Frontiers in Medicine Published April 27, 2026 Medically reviewed April 27, 2026 DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Consider food effects on absorption for cardiovascular and diabetic medications to optimize adherence.

This PRISMA scoping review analyzed 36 publications to evaluate the impact of food on the oral bioavailability of medications used in patients with cardiovascular disease and diabetes. The scope included clinical pharmacokinetic studies and randomized clinical trials assessing the fasted state versus fed state. Primary outcomes focused on maximum concentration, rate of absorption, and overall drug exposure.

Results demonstrated that food generally reduced maximum concentration and delayed the rate of absorption for several agents. However, there was no significant effect on overall drug exposure for the majority of medications reviewed. Specific recommendations varied; semaglutide is recommended for administration on an empty stomach, while pitavastatin showed higher bioavailability in the fasted state. Conversely, vericiguat and higher doses of rivaroxaban were better absorbed when taken with food.

For patients with swallowing difficulties, the review noted that rivaroxaban, apixaban, and edoxaban may be crushed and administered via nasogastric tube or orally mixed with applesauce. Safety data regarding adverse events were not reported in the included literature. The authors suggest that dosing without strict regard to meals may facilitate patient adherence and contribute to improved therapeutic outcomes.

Limitations were not explicitly detailed in the source material. Clinicians should interpret these findings as a synthesis of existing pharmacokinetic data rather than new clinical trial evidence. Practice relevance centers on balancing bioavailability concerns with practical adherence strategies for complex medication regimens.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedApr 2026

View Original Abstract ↓

BackgroundFood–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.ObjectivesTo 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.MethodsPubMed, 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.ResultsA 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.ConclusionFor 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.