7

Drug-Nutrient
Interactions
Syahrul Bariah bt. Abdul
Hamid
Dept. of Nutrition & Dietetics
Fac. of Health Sc., UiTM
Overview of Drug-
Nutrient Interactions
History

 Food combinations or the addition of medicinal

remedies to food  preserve health or treat
disorders
 Least knowledge on the interactions  impact
of food on drug absorption  clinical interest
 any identified interactions are then treated
with caution
 Dr Daphne A. Roe (1982); founder or
godmother
 Need more expertise, research & knowledge on
DNI
Classifications

 In variety ways
 Drug
 Nutrient
 Patient
 Outcome/clinical manifestations
 Mechanism; chemical/physiologic
 Location; GIT, circulation, site of effect

 Location and mechanism of an interaction

 The impact of nutritional status on drug
disposition and effect
 The impact of food on drug disposition and
effect
 The impact of specific nutrients on drug
disposition
 The impact of drugs on nutritional status
 The impact of drugs on the disposition and
effect of specific nutrients
Mechanisms

Precipitating factor Object of Interaction

Altered nutritional status Drug
Food or food components Drug
Nutrient Drug
Drug Nutritional status
Drug Nutrient
 Precipitating Object of Scientific Clinical Mx
factor Interaction Basis Strategy
Altered nutritional Drug Identify Aim to minimize tx
status mechanism failure or drug
toxicity
Food or food Drug Identify ″
components mechanism &
location
Nutrient Drug ″ ″

Drug Nutritional Identify Aim to maintain or

status mechanism improve nutritional
status
Drug Nutrient Identify Aim to maintain or
mechanism & improve status of
location individual nutrient
Drug Nutrient Interactions
Can Occur When:
 Drugs are taken with food or nutritional
supplements
 Drugs are taken with alcohol
 Drugs are used to induce specific drug
nutrient interactions
 Drugs are taken in multiple drug regimens
 Drugs that cause nutrient depletion are
taken for a long time
Responsibility to Monitor
Drug-Nutrient Interactions
 Pharmacists
 Nurses
 Dietitians
Drug Action: Three Stages

 1. Pharmaceutical stage
 Dissolution or disintegration of drug

 2. Pharmacokinetic stage
 absorption, distribution, metabolism, and
elimination of the drug

 3. Pharmacodynamic stage
 body’s physiologic and/or psychologic response
to the drug
Risk For Interactions

 Occurs most commonly in long-term treatment

for chronic disease
 Depends on the function of the Mixed-
Function Oxidase System (MFOS)
 system that oxidizes a bunch of substances
 includes cytochrome P-450
 NAOPH-cytochrome P-450 reductase, and
 phosphatidylcholine
 Is effected by nutrient deficiencies (Protein, vit C,
E, and A)
How Might Drugs Affect
Nutritional Status?
 Drugs that Affect Intake
 Loss of Appetite or taste

 Drugs that Affect Nutrient Absorption

 Drugs that Affect Nutrient Metabolism
 Antivitamins
 Monoamine Oxidase Inhibitors(MAO)
 Excretion of Nutrients
 Drug-Induced Electrolyte Alterations
Drugs that Affect Intake

 Appetite suppressants:
 Ritalin used with hyperactive children
 long-term use may result in growth-
retardation
 catch-up growth may occur when
discontinued
 Cisplatin: a cytotoxin agent used in cancer
therapy
 causes nausea, vomiting, and reduced food
intake
Drugs That Affect Nutrient
Absorption

 Luminal Effects:
 Influencing Transit Time
 Laxatives
 Bile Acid Activity
 Cholestyramine sequesters bile acids
 inhibits fat digestion

 Change of pH
 Antacids change pH and reduce absorption of
Ca, Mg, Fe and Zn
Drugs that Affect Nutrient
Metabolism

 Inhibition of Synthesis of Certain Enzymes

by Competing for vitamins or Vitamin
Metabolites necessary for their structure
 Methotrexate used in treatment of leukemia and
rheumatoid arthritis
 This breakdown folate and induces a folate
deficiency
 DNA synthesis is stopped
Excretion of Nutrients

 Some drugs displace a nutrient from plasma

binding site and make it available for kidney
filtering
 D-penicillamine is used to treat heavy metal
poisoning
 It chelates the intended metal and makes it
available for kidney removal
 This also chelates other metals and removes
them from the circulation and induces a
deficiency
 eg: Zinc
Electrolyte Alterations

 Thiazide: a loop diuretic that enhances Na

loss
 also increases K loss
 K supplements may be required
Drugs of Abuse

 Legal: caffeine, nicotine, alcohol

 Illegal: marijuana, cocaine
 Can induce nutritional deficiencies by
decreasing nutrient intake
 Decrease appetite(or increase appetite)

 Caffeine: induce Calcium loss in urine

Nutritional Status May
Affect Drug Therapy
 Protein-energy deficiency
 Serum albumin level
 Changes in metabolisms: REE, TEE
 Changes in body composition: fat, LBM,
TBW
 Physiologic changes
Impact of Food or Nutrients
on Drug Disposition and
Effect
 Drug absorption with food
 Meal administration with drug vs fasted-
state drug administration with water
 Effects of specific foods and non-nutritive
dietary components on drug metabolism
 May optimize or reduced the therapeutic
effect of drugs
Some Common Drug-
Nutrient Interactions
 Anticonvulsants(ACDs)
 Phenytoin, phenobarbitol, etc
 induce deficiencies of folate, biotin, vitamin D
 reduces hydroxylation of calciferol to 25, OHD3

 Oral Contraceptives
 Increased need for B6, folate
 Increased Vitamin A in circulation: may lead to
decreased stores
 Increase serum Iron versus non users
Anti-inflammatory Drugs

 Glucocorticoids: used to decrease

inflammation, suppress the immune system
 development of osteoporosis in 50 % of long-
term users

 HIV meds: AZT used to inhibit virus

replication
 Induces megaloblastic anemia through reduced
erythropoiesis
 Treat with recombinant human
erythropoietin(EPO)
Use of Alternative
Therapy
 Herbal remedies are commonly thought to
be less toxic than drugs
 This isn’t necessarily true: Examples:
 aloe: can increase diarrhea and intestinal loss
 ginseng: can cause diarrhea and intestinal loss
 ephedra: changes in blood pressure, dizziness
Assignments! 