. Author manuscript; available in PMC: 2020 Sep 1.

Published in final edited form as: Circ Genom Precis Med. 2019 Aug 28;12(9):421–429. doi: 10.1161/CIRCGEN.119.002314

Table.

Known and proposed mechanisms by which the gut microbiota may influence cardiovascular drug outcomes

Drug	Bacteria	Mechanism(s)	Outcome
Known microbiome-drug interactions
Digoxin⁵²	Eggerthella lenta	Inactivation by reduction	Bacterial reductase activity decreases amount of active drug reaching target tissues
Proposed microbiome-drug interactions
Simvastatin⁶⁶	Not known	Microbial derived bile acids competing for host uptake transporters Alteration in bacterial communities with bile salt hydrolase (bsh) activity	Decreased amount of drug reaching target tissues Variability in FXR receptor signaling
Rosuvastatin^{67, 68}	Not known	Alteration in host gene expression of bile acid metabolism pathways Alteration in bacterial communities with bile salt hydrolase (bsh) activity	Variability in FXR receptor signaling
Atorvastatin^69–71	Not known	Decreased amount of secondary bile acids	Variability in FXR receptor signaling
Amlodipine⁷²	Not known	Pre-systemic metabolism by dehydrogenation	Decreased amount of active drug reaching target tissues
Captopril⁷³	Not known	Not known	Decreased intestinal permeability and improved villi length

FXR- farnesoid X receptor