Intro of Drug-Nutrient Interactions
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Transcript of 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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Assignments!