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Dn. Asma Abdul Rehman

Clinical Dietitian/Nutritionist
lecturer (Nutrition Dept)
Mphil(HND), UAF
SIH, RIC
Drug Nutrient Interaction
 Content of session
• Introduction of drug
• Drug nutrient interaction
• Effect of drugs on nutrition
• Dietary effect on drug
 Introduction
According to FDA:
Drug is a substance intended for use in the
diagnosis, cure, mitigation, treatment, or
prevention of disease.

Drugs

Prescription Over the counter drugs

drugs (OTC)
 Introduction
A drug interaction is a situation in which
a substance affects the activity of a drug, i.e.
the effects are increased or decreased, or they
produce a new effect that neither produces on
its own.
 Drug-drug interaction
 Drug-nutrient interactions
 Drug-herb interactions
 Effect of Drugs on Nutrition
Nutrients Absorption
Some medications bind nutrients in the GI tract,
preventing their absorption. For example, bile acid
binders, which reduce cholesterol levels, may bind to
fat-soluble vitamins. Some antibiotics, notably
tetracycline and ciprofloxacin, bind to the calcium in
foods and supplements, reducing the absorption of
both the calcium and the antibiotic.
Other minerals, such as iron, magnesium, and
zinc, can also bind to some antibiotics. Consumers
are advised to use dairy products and all mineral
supplements at least 2 hours apart from these
medications.
 Conti..
Drugs may speed up gut transit; this reduces nutrient
absorption from food.
Altered Stomach Acidity
 Medications that reduce stomach acidity can impair
the absorption of vitamin B12, folate, and iron.
 Examples include antacids, which neutralize
stomach acid by acting as weak bases, and antiulcer
drugs (such as proton pump inhibitors and H2
blockers), which interfere with acid secretion.
 Conti..
Drugs can change nutrient excretion
 Increase urinary excretion (e.g. Lasix increases losses of
sodium, potassium, chloride, and magnesium, thiamin)
 Decrease urinary excretion (e.g. potassium sparing
diuretics like spironolactone)
Mouth
 Taste & smell affection- Drug may impair salivary flow-
Drug secreted in saliva. Drug may suppress natural oral
bacteria.
CNS
 (Appetite changes) Drug suppress appetite Drug increase
appetite
 Conti..
Effect on nutrients metabolism
 Anticonvulsants Phenobarbital and Phenytoin
increase levels of the liver enzymes that
metabolize folate, vitamin D, and vitamin K;
therefore, persons using these drugs may require
supplements of these vitamins.
 Isoniazid (INH), an anti-tuberculosis drug,
sometimes induces vitamin B6 deficiency.
 Corticosteroids, used as anti-inflammatory agents
and immuno-suppressants, have actions that
mimic those of the hormone cortisol.
 Conti..
Drugs can alter food intake and nutrition status:
• Appetite increased or decreased, unusual food
cravings
• Metabolic rate increased or decreased
• Taste/smell altered
• Oral side effects e.g. dry mouth/mouth pain
• Difficulty swallowing
• Nausea/Vomiting/Diarrhea: decreases intake,
increases losses
Polypharmacy is associated with malnutrition
 Dietary Effect on Drugs
Stomach-Emptying Rate
 Drugs reach the small intestine more quickly when the
stomach is empty.
 Aspirin works faster when taken on an empty stomach
 For example, azithromycin absorption is decreased
when it is taken with food, resulting in a 43% reduction
in bioavailability
Stomach Acidity
 Some drugs are better absorbed in an acidic
environment, so conditions that are too alkaline may
reduce their absorption. Hence, antacid medications
may reduce the absorption of these drugs.
 Conti..
Components of food may directly interact with
certain medications, forming complexes or
chelates.
For example, tetracycline forms chelates with
the calcium in milk, dairy products, and
antacids. Complexation reactions occur when
iron binds with ciprofloxacin. The
bioavailability of ciprofloxacin is reduced by
52% in the presence of iron
 Oatmeal
 Patients taking digoxin should avoid taking bran
fiber, pectin-containing foods such as apples or
pears, or fiber-containing, bulk-forming laxatives
at the same time, since these agents may bind to
the digoxin, decreasing its absorption.
 It is advisable to take some medications with
food to reduce gastrointestinal irritation and
possible nausea. Examples of these medications
include potassium supplements, ferrous sulfate,
nonsteroidal anti-inflammatory drugs, estrogen
 Conti..
• Of the cholesterol-lowering agents, lovastatin
(Mevacor) should be taken with food to
enhance gastrointestinal absorption and
bioavailability.
 Green leafy foods
 Anticoagulants Foods high in vitamin K (such as
broccoli, lettuce, spinach, cucumber)
 Vitamin K can decrease the effectiveness of
certain anticoagulant medications.
 Such foods may reduce the effectiveness of
anticoagulants (such as warfarin)
 Acidic drinks, juices, and foods may produce
excess stomach acidity which may Destroy the
medication, Cause the medication to dissolve in
the stomach instead of the intestine
 Grapefruit juice
 Grapefruit juice Inhibits enzymes involved in
drug metabolism and thereby intensifies the
effect of certain drugs
 Certain benzodiazepines (such as triazolam)
Valium and Xanax Calcium channel blockers
(such as felodipine, nifedipine, and
nisoldipine) Cyclosporine Estrogen and oral
contraceptives
 Alcohol
 Alcohol affects insulin or oral diabetic pills.
Alcohol prolongs the effects of these drugs,
which leads to low blood sugar.
 Moderate pain reliever drugs with
acetaminophen should not be taken with
alcohol because it has a higher chance of
causing severe liver damage.
Dietary effects on drug excretion
Some food components can alter drug
reabsorption by the kidneys.
For example, the amount of the medication
lithium reabsorbed by the kidneys is similar to
the amount of sodium reabsorbed.

Thus, both sodium depletion and dehydration,

which increase sodium reabsorption, can result
in lithium retention.
 Key Terms
 Drug-nutrient interactions: the results of the action
between a drug and a nutrient that would not happen with
the nutrient or drug alone.
 Half-life: amount of time it takes for the blood
concentration of a drug to decrease by one half of its
steady state level
 Bioavailability: degree to which a drug or other substance
reaches the circulation and becomes available to the target
organ or tissue
 Pharmacokinetics: movement of a drug through the body
by absorption, distribution, metabolism, and excretion
 Pharmacodynamics: physiologic and biochemical effects
of a drug or combination of drugs
Done With Today Training
Session
Thank You