Important Definition:

Drug-nutrient interaction: the result of the action between a drug

and a nutrient that would not happen with the nutrient or the drug
alone

Food-drug interaction:
a broad term that includes drug-nutrient interactions and the effect
of a medication on nutritional status
1) Optimum drug efficacy.
2) Adverse effect are avoided.
3) Optimal nutritional status.
pharmacokinetika

Food Mechanism:

 Change PH

Bind to drug

 Compete for absorption site.

 Dilution of drug particles.

Absorption

1) Grapefruit:
- Can cause more of a drug to be absorbed from intestine, even
toxic levels. Ex: ciprofloxacin
2) Orange juice:
- Should not consumed with antacid contains AL.
- ↓ bioavailability of some antibiotics
3) Dairy products:
- Interfere with tetracycline
- Exogenous Progesterone may require dairy product to work!!
4) All food + bisfosfonat
- decreased of absorpsi bisfosfonat
5) wheat
- decreased absoprsi of ciclosporin, ekstrogen, digoxin and
statin
albumin(main blood protein)

Ex: anticoagulant + vit K  Decreased efectivitas of warfarin

 Metabolism 1. Inhibisi enzyme metabolism
2. Induksi enzyme metabolism

1) Grapefruit juice:
- inhibite enzyme cytochrome CYP3A
- CYP3A substrates like felodipine, midazolam, cyclosporin
2) cranberry:
- flavonoid  inhibit enzymes CYP2C9
- warfarin  blending
Excretion

-Affect Urinary pH
- Acidic Food  ↑ excretion of basic drugs
ex : amfetamin, quinidine
- Basic Food ↑ excretion of acidic drugs
ex : salisilat, fenobarbital)

-Lithium and sodium

-compete for tubular reabsorption in the
kidney.
- High sodium intake causes more lithium
to be
excreted.
- Low sodium intake will cause the kidney
to retain
lithium
1) Some foods have additive effects to drugs:
- Caffeine containing food and theophylline.
- Tyramine (dopamine/epinepherine)containing food and MAOI.

(Food and Drug Interaction, by: R. Sudharani, N. Kanmani, P. Augusta, 2007)

(Food-Medication Interactions 13th edition by Zaneta M. Pronsky)
1) Some foods have additives effects to drugs:
- Caffeine containing food and theophylline.
- Tyramine containing food and MAOI.
- Alcohol with: - sedatives.
- Beta blockers

2) Some foods have antagonistic effect of drugs:

- Vitamin K (or E*) containing food and oral anticoagulant
- Caffeine containing food and tranquilizers
- High fat diet and antihyperlipidemic drugs
- High glucose diet and hypoglycemic drugs.

3) GINKGO **
- It interferes with platelets clotting
- Many experts recommend that ginkgo not be combined with
NSAID and MAO inhibitors

*(Food and Drug Interaction, by: R. Sudharani, N. Kanmani, P. Augusta, 2007)

**(Food-Medication Interactions 13th edition by Zaneta M. Pronsky)