AF Association
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Taking ACs with food - yes but how much is required for good absorption ?

I’ve been meaning to post this question for a while.

At the end of our Patient Support meeting in Dec there was a very short discussion about eating when you take your ACs - evidently the amount of calories required for effective absorption is quite high - eg:- 250+ carlories so a quick slice of toast taken on the run with a cup of tea - is not sufficient. This was information given by our Arrythmia Nurse who says the doctors rarely tell you this and information for various DOACs are variable and very little information on the packets.

I wonder if anyone in the community has any knowledge?

Or has ever been advised about this by a medical professional?

Thanks and hope everyone had a good Sunday. My heart is still a bit erratic but I managed a walk today which was very pleasant.

Best wishes CD.

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The Apixaban leaflet says to take with or without food about which I’ve always been a little circumspect so at least I have a yogurt drink. I recall BobD posting about one of the other NOACs being very poor if taken without food.

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The one Bob was referring to was rivaroxiban. Think it needs to be with a meal, and preferably with dairy product.

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I queried this with pharmacist and she said it is ok as long as you have food in your stomach but didn't say what kind.

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I was not told specifically to take Rivaroxaban with food when it was first prescribed but the info leaflet clearly stipulates ‘with food’. I asked the pharmacist what, appart from the obvious constitutes food? Bit vague but suggested at minimum a bowl of cereal. Doctor similarly unhelpful. Then coincidentaly the question was posed on this forum and i seem to recall the responce was that a proper ressonable meal. I think subsequently it has also been suggested that dairy and or fat is the most beneficial to aid absorption.

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MY understanding is that FAT is required. So dairy probably ok but some substance as well.

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Bob - I wonder if we could get more information? It seems this may be an area where there is a need for more accurate information. I gather the pharmaceutical companies have done this research so it must be available somewhere?

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Pharmacists are usually very helpful. I had a long conversation with ours about high strength Vitamin D pills. When I collected the prescription, which wasn't for me, I was invited to her little room and she told me it had to be taken with a substantial meal containing a significant amount of fat. I used to shop especially for the occasion. It was a short booster course.

There was a post by Nanabrodie about taking Rivaroxaban about four months ago. I think it's less fussy than the vitamin D. I take it with a full fat yoghurt after a meal.

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I’ve also found my pharmacist very helpful - my point is I don’t know much about this subject and I doubt very many others do either - yet it seems important as all 3 of the most common DOACs are absorbed in different parts of the Digestion System.

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You would think our GP would tell us.........sigh!

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I don’t think they know, if you can’t find the information when you’re looking for it..........

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Really interesting discussion, thanks CDreamer.

I can only add that my EP said rivaroxaban loses up to 85% of its bioavailability unless it’s taken with a ‘substantial meal’. He was in any case switching me to apixaban and confirmed no food at all is needed with apixaban. (Which was a relief as I really can’t risk eating at night!) Apparently it is important to drink it with a good amount of water though.

I would really welcome your suggestion of us having more information on the DOACs, CDreamer. It feels like info is changing over time - even the EP said they hadn’t realised until recently how crucial the food aspect is with rivaroxaban. (And my own GP still denies that it is!) :)

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Rivaroxaban is absorbed through the stomach therefore it is important to have a substantial meal to prevent it from travelling throught to the gut - where it won’t be properly absorbed.

Apixaban is absorbed through the gut and therefore should Travel to the gut quickly. You are correct about drinking water.

Dabigatran is the most difficult - the gel that contains the active ingredient requires an acid environment to dissolve the gel - stomach - but many people are prescribed an antacid because it can cause acid reflux?? But it is not totally absorbed in the stomach but in the upper part of the gut. So do you take before food, with food, what type of food and how much water?

I found the best way to cope with that is to ensure you take with plenty of water but also never take with carbs of any sort - fruit or protein or something like yogurt worked well and I took with food.

Complicated isn’t it?

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Thank you,I was just thinking about reorganising my tablet routine, flecanaide needing to be without food,glad apixaban can be taken without food too,just read the leaflet!

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I've taken apixiban for 4 years. It clearly states on the instruction leaflet WITH or WITHOUT food! Honestly, as if i need something else to worry about. I wish some people would think before they post!

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Apixaban is not the only AC we were talking about & we said that Apixaban was with or without food.

I was thinking very clearly before I posted & most people found the discussion of interest but obviously you didn’t.

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On a bad day my af just seems to take over my life and this is something i try to avoid.

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I'm really sorry you find that, it can be quite scary. I know we have a lot to contend with but I do think this sort of information about the difference in ACs and how and when to take them is really important. Getting the balance between concern and self-care and over worrying is often a lifetimes' journey - as Oyster's post typifies.

My husband didn't listen to me about taking his Dabigatran x2 daily, 12 hours apart and was somewhat cavalier to say the least - until the support group and the Arrythmia Nurse explained that he really wasn't helping himself as when he didn't take it he wasn't protected and when he took them with 6 hours he increased his bleed risk. He is now very much more aware and punctilious about taking them and I worry a lot less now.

But then as someone commented on the day - You're just the wife - why on earth would he listen to me!

Best wishes.

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I am on Rivaroxaban and have always taken it after my evening meal, my GP suggested this. I think there was a discussion on here recently saying that it is in fact best taken halfway through the meal (might have been Bob who said this). When I have been in hospital have always been given this late evening, the last round of the drug trolly - so no food!!! Queried this a few times and asked if I could have it after my evening meal, but never happened. Last time I was in hospital, 12 months ago, they had changed the rules, they used to take your usual drugs that you took in with you and lock them up and dole them out when they decided to. Now you are allowed to keep your usual drugs with you and take when you want (you have to sign a form that you are responsible for this) but a much better idea so you can stick to your own routine.

Cassie

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Very pleased to hear that as I blew up at a poor nurse when she tried to take my drugs from me - she jumped back in alarm poor thing! I noted they just list everything now.

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PS. I tend to take all of my drugs with food, two heart tablets at breakfast, cancer tablet and fluid tablet at lunch, noac after evening meal and another heart tablet an hour after evening meal. It is probably just me but I have always had this thing that it is better to have something in you stomach when taking strong drugs. I know that there are certain drugs that must not be taken with food so would abide by this. I do have to take painkillers but they do not have to be taken with food.

Cassie

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Yes but some drugs need an empty stomach eg- Flecainide so I don’t take everything together and make sure I try to know which should be taken with or without food, during, before or after.

Evidently it can make quite a difference.

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Very interesting subject CDreamer and Bob. I wasn't told about taking food with ACs, but I've noted all that's been said and will do from now on. I look forward to a positive conclusion.

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Very useful thanks CDreamer. I don't take anti-coags but CoQ10 needs to be taken with fat.

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How about Edoxaban? I take mine in the morning and sometimes don't; eat til an hour or many hours later. I specifically asked haemotology if that was ok. Also does Lanzoprazole, to protect your stomach, impact, as I've been given that as well?In hospital I was not given food to coincide with the times I take my tablets.

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I can’t answer those questions - which is why I think we should be asking for much more detailed information around absorption of meds, when to take them and what with.

Personally I avoid all PPI’s for the long term side effects.

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At the October patients day a cardiologist was asked this question after the event and he said a biscuit was sufficient.

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And I wonder about that reply - for Which AC?

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I can't honestly remember. But at the time I was satisfied that his response applied to Rivaroxaban at least.

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Interesting sequence of opinions here. I remember an earlier post where someone had been told by a doctor that just a biscuit was likely sufficient with the AC drug, but I can't remember whether a specific DOAC was mentioned. Was that a post by you BobD ? Also, does anyone know if Bisoprolol should be with or without food, or does it not matter? I'm taking all my pills together immediately after my porridge every morning. Not much fat in there, as we use only skimmed milk and the porridge has added oat bran. I'm using Apixaban, so that is probably not an issue for me.

Edit: RickyM was writing at the same time!

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And I thought Warfarin INR was an issue. Very interesting comments regarding this. BTW I take my warfarin at 19:30 every day.

Be Well

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Thank you didn't know this

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You may take apixaban with or without food.

rxlist.com/eliquis-drug/pat...

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My understanding as well - but take with plenty of water for effective absorption.

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Thank you for this topic. I will find out a definite answer, and get back to you all as soon as I can. I do recall a discussion at patients day where one of the speakers mentioned that rivaroxaban must be taken with food - but it was unclear how much.

Regards, Rachel - AF Association Patient Services

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Thanks Rachel that would be most helpful.

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Thank you so much, Rachel. If it isn’t too much trouble, might you also be able to find out if the timing of taking lansoprazole or other PPIs has any impact on the anticoagulant? (ie if a gap is needed, or better taken together etc.) Someone mentioned it above and I know I’ve had confused answers from pharmacists, Drs and cardiologist when I’ve asked! (If it’s not appropriate for me to ask, please just ignore!)

Thank you for everyting you do to provide such fantastic support for us all x

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I would also be interested in the answer to Janefinn s question. At present I take lanzaprole 30 mins before swallowing anything else! I know lanzaprole cant be taken at the same time as milk so it is possible that it may stop the absorption of tablets. I would be interested to know the answer. Many thanks in anticipation. X

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Hello all, as promised, I emailed Dr Faye who spoke at 2017 AF Association Patients Day about anticoagulants. His reply is as follows:

Rivaroxaban should be taken with some food, a biscuit is good enough, does not need to be a three course meal as Pfizer would have you believe. It should be taken about the same time each day

Apixaban is twice daily and does not need to be taken with food, but should be taken 12hours apart

Edoxaban is once a day and does not need to be taken with food. However if you have very good renal function (uncommon in the AF population) then you may not be able to have it. It should be taken about the same time each day

Despite what the various companies say, this is a family of Xa inhibitors and they have these minor differences but are essentially as good as each other.

Sadly he did not give information about Dabigatran. However, I have found the following from Drugs.com - "Take this medicine with a full glass of water. You may take dabigatran with or without food. Do not crush, chew, break, or open a dabigatran capsule. Swallow the pill whole."

I hope that this helps you all understand how each medication should be taken.

Regards, Rachel - AF Association

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Rachel, please forgive me for butting in to your post, but you are the first admin that I've come across. I am trying to get back subscribed to Healthunlocked because I'm unable to get any daily updates. Please help me.

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Hello Dave :-) do you mean daily email updates, if so maybe I can help you with this.

Have you checked your settings, go to the drop down menu next to the 'Search AF association' box on the right at the top of the page (It is a tiny version of your Avatar) ,select 'Settings' now set the level of alerts you wish to receive .

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Thank you for this. I didn't know,AF people have poor renal function?as far as I know I am fine.Are normal blood tests sufficient to highlight problems?

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