intro of drug-nutrient interactions

8/9/2019 Intro of Drug-Nutrient Interactions

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Drug-Nutrient

InteractionsSyahrulSyahrul BariahBariah bt .bt. Abdul AbdulHamidHamidDept. of Nutrition &Dept. of Nutrition &

DieteticsDieteticsFac. of Health Sc.,Fac. of Health Sc., UiTMUiTM


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Ov er v iew of Drug-Nutrient Interactions


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History

Food combinations or the addition of Food combinations or the addition of medicinal remedies to foodmedicinal remedies to food preser v epreser v ehealth or treat disordershealth or treat disorders

Least knowledge on the interactionsLeast knowledge on the interactionsimpact of food on drug absorptionimpact of food on drug absorptionclinical interestclinical interest any identifiedany identifiedinteractions are then treated withinteractions are then treated withcautioncaution

Dr Daphne A. Roe (1982); founder orDr Daphne A. Roe (1982); founder orgodmothergodmotherNeed more expertise, research &Need more expertise, research &knowledge on DNIknowledge on DNI


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C lassifications

In v ariety waysIn v ariety waysDrugDrug

NutrientNutrient

PatientPatient

O utcome/clinical manifestationsO utcome/clinical manifestations

Mechanism; chemical/physiologicMechanism; chemical/physiologic

Location; GIT, circulation, site of effectLocation; GIT, circulation, site of effect

Location and mechanism of an interactionLocation and mechanism of an interaction


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The impact of nutritional status on drugThe impact of nutritional status on drugdisposition and effectdisposition and effect

The impact of food on drug dispositionThe impact of food on drug dispositionand effectand effect

The impact of specific nutrients on drugThe impact of specific nutrients on drugdispositiondisposition

The impact of drugs on nutritional statusThe impact of drugs on nutritional statusThe impact of drugs on the dispositionThe impact of drugs on the dispositionand effect of specific nutrientsand effect of specific nutrients


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Mechanisms

Precipitating factor O bject of Interaction Altered nutritional status Drug

Food or food components DrugNutrient DrugDrug Nutritional statusDrug Nutrient


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Precipitatingfactor

O bject of Interaction

ScientificBasis

C linical MxStrategy

Alterednutritional

status

Drug Identifymechanism

Aim to minimizetx failure or drug

toxicityFood or foodcomponents

Drug Identifymechanism &location

Nutrient Drug

Drug Nutritionalstatus Identifymechanism Aim to maintain orimpro v enutritional status

Drug Nutrient Identifymechanism &location

Aim to maintain orimpro v e status of indi v idualnutrient


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Drug NutrientInteractions C an O ccurWhen:

Drugs are taken with food orDrugs are taken with food ornutritional supplementsnutritional supplements

Drugs are taken with alcoholDrugs are taken with alcohol

Drugs are used to induce specific drugDrugs are used to induce specific drugnutrient interactionsnutrient interactions

Drugs are taken in multiple drugDrugs are taken in multiple drugregimensregimens

Drugs that cause nutrient depletionDrugs that cause nutrient depletionare taken for a long timeare taken for a long time


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Responsibility toMonitor Drug-NutrientInteractions

PharmacistsPharmacists

NursesNurses

DietitiansDietitians


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Drug Action: Three

Stages1. Pharmaceutical stage1. Pharmaceutical stage

Dissolution or disintegration of drugDissolution or disintegration of drug

2. Pharmacokinetic stage2. Pharmacokinetic stage

absorption, distribution, metabolism, andabsorption, distribution, metabolism, andelimination of the drugelimination of the drug

3.3. PharmacodynamicPharmacodynamic stagestage

bodys physiologic and/orbodys physiologic and/or psychologicpsychologicresponse to the drugresponse to the drug


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Risk For Interactions

O ccurs most commonly in longO ccurs most commonly in long- -termtermtreatment for chronic diseasetreatment for chronic disease

Depends on the function of the MixedDepends on the function of the Mixed- -Function O xidase System (MF O S)Function O xidase System (MF O S)

system that oxidizes a bunch of substancessystem that oxidizes a bunch of substances

includes cytochrome Pincludes cytochrome P- -450450

NA O PHNA O PH--cytochrome Pcytochrome P--450 reductase, and450 reductase, and

phosphatidylcholinephosphatidylcholine

Is effected by nutrient deficiencies (Protein,Is effected by nutrient deficiencies (Protein,v it C , E, and A)v it C , E, and A)


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How Might Drugs Affect NutritionalStatus?

Drugs that Affect IntakeDrugs that Affect IntakeLoss of Appetite or tasteLoss of Appetite or taste

Drugs that Affect Nutrient AbsorptionDrugs that Affect Nutrient Absorption

Drugs that Affect NutrientDrugs that Affect NutrientMetabolismMetabolism

Anti v itamins Anti v itamins

Monoamine O xidase Inhibitors(MA O )Monoamine O xidase Inhibitors(MA O )

Excretion of NutrientsExcretion of Nutrients

DrugDrug--Induced Electrolyte AlterationsInduced Electrolyte Alterations


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Drugs that Affect Intake

Appetite suppressants: Appetite suppressants:

Ritalin used with hyperacti v e childrenRitalin used with hyperacti v e children

longlong--term use may result in growthterm use may result in growth- -retardationretardation

catchcatch--up growth may occur whenup growth may occur whendiscontinueddiscontinued

C isplatin: a cytotoxin agent used in cancerC isplatin: a cytotoxin agent used in cancertherapytherapy

causes nausea, v omiting, and reducedcauses nausea, v omiting, and reducedfood intakefood intake


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Drugs That Affect Nutrient

AbsorptionLuminal Effects:Luminal Effects:

Influencing Transit TimeInfluencing Transit Time

Laxati v esLaxati v es

Bile Acid Acti v ityBile Acid Acti v ity

C holestyramineC holestyramine sequesters bile acidssequesters bile acids

inhibits fat digestioninhibits fat digestion

C hange of pHC hange of pH

Antacids change pH and reduce Antacids change pH and reduceabsorption of C a, Mg, Fe and Znabsorption of C a, Mg, Fe and Zn


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Drugs that Affect Nutrient

MetabolismInhibition of Synthesis of C ertainInhibition of Synthesis of C ertainEnzymes by C ompeting for v itaminsEnzymes by C ompeting for v itamins

or Vitamin Metabolites necessary foror Vitamin Metabolites necessary fortheir structuretheir structure

MethotrexateMethotrexate used in treatment of used in treatment of leukemia and rheumatoid arthritisleukemia and rheumatoid arthritis

ThisThis breakdownbreakdown folatefolate and induces aand induces afolatefolate deficiencydeficiency

DNA synthesis is stoppedDNA synthesis is stopped


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Excretion of Nutrients

Some drugs displace a nutrient fromSome drugs displace a nutrient fromplasma binding site and make itplasma binding site and make ita v ailable for kidney filteringa v ailable for kidney filtering

DD--penicillamine is used to treat hea v ypenicillamine is used to treat hea v ymetal poisoningmetal poisoning

It chelates the intended metal andIt chelates the intended metal andmakes it a v ailable for kidney remo v almakes it a v ailable for kidney remo v al

This also chelates other metals andThis also chelates other metals andremo v es them from the circulation andremo v es them from the circulation andinduces a deficiencyinduces a deficiency

eg: Zinceg: Zinc


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Electrolyte Alterations

Thiazide: a loop diuretic thatThiazide: a loop diuretic thatenhances Na lossenhances Na loss

also increases K lossalso increases K loss

K supplements may be requiredK supplements may be required


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Drugs of Abuse

Legal: caffeine, nicotine, alcoholLegal: caffeine, nicotine, alcohol

Illegal: marijuana, cocaineIllegal: marijuana, cocaine

C an induce nutritional deficiencies byC an induce nutritional deficiencies bydecreasing nutrient intakedecreasing nutrient intake

Decrease appetite(or increase appetite)Decrease appetite(or increase appetite)

C affeine: induce C alcium loss in urineC affeine: induce C alcium loss in urine


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Nutritional Status May

Affect Drug TherapyProteinProtein--energy deficiencyenergy deficiency

Serum albumin le v elSerum albumin le v el

C hanges in metabolisms: REE, TEEC hanges in metabolisms: REE, TEE

C hanges in body composition: fat,C hanges in body composition: fat,LBM, TBWLBM, TBW

Physiologic changesPhysiologic changes


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Impact of Food orNutrients on DrugDisposition and Effect

Drug absorption with foodDrug absorption with food

Meal administration with drugMeal administration with drug v sv sfastedfasted--state drug administration withstate drug administration withwaterwater

Effects of specific foods and nonEffects of specific foods and non- -nutriti v e dietary components on drugnutriti v e dietary components on drug

metabolismmetabolismMay optimize or reduced theMay optimize or reduced thetherapeutic effect of drugstherapeutic effect of drugs


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Some C ommon Drug-

Nutrient Interactions Anticon v ulsants(A C Ds) Anticon v ulsants(A C Ds)

Phenytoin, phenobarbitol, etcPhenytoin, phenobarbitol, etc

induce deficiencies of folate, biotin,induce deficiencies of folate, biotin,v itamin Dv itamin D

reduces hydroxylation of calciferol to 25,reduces hydroxylation of calciferol to 25,O HD3O HD3

O ral C ontracepti v esO ral C ontracepti v esIncreased need for B6, folateIncreased need for B6, folate

Increased Vitamin A in circulation: may leadIncreased Vitamin A in circulation: may leadto decreased storesto decreased stores

Increase serum Iron v ersus non usersIncrease serum Iron v ersus non users


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Anti-inflammatory Drugs

Glucocorticoids: used to decreaseGlucocorticoids: used to decreaseinflammation, suppress the immuneinflammation, suppress the immunesystemsystem

de v elopment of osteoporosis in 50 % of de v elopment of osteoporosis in 50 % of longlong--term usersterm users

HIV meds: AZT used to inhibit v irusHIV meds: AZT used to inhibit v irusreplicationreplication

Induces megaloblastic anemia throughInduces megaloblastic anemia throughreduced erythropoiesisreduced erythropoiesis

Treat with recombinant humanTreat with recombinant humanerythropoietin(EP O )erythropoietin(EP O )


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Use of Alternati v e

TherapyHerbal remedies are commonlyHerbal remedies are commonlythought to be less toxic than drugsthought to be less toxic than drugs

This isnt necessarily true: Examples:This isnt necessarily true: Examples:aloe: can increase diarrhea and intestinalaloe: can increase diarrhea and intestinallossloss

ginseng: can cause diarrhea and intestinalginseng: can cause diarrhea and intestinal

losslossephedra: changes in blood pressure,ephedra: changes in blood pressure,dizzinessdizziness


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intro of drug-nutrient interactions

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