DRUG NUTRIENT INTERACTION

Unit 5
 introduction
• What is “interaction”
• Interaction is a kind of action that occur as
two or more objects have an effect upon one
another
• The idea of a two-way effect is essential in the
concept of interaction, as opposed to a one-
way causal effect
 Introduction
• There are many interactions between drugs
and nutrition.
• Drugs and nutrients are absorbed from similar
sites and metabolized and excreted in similar
ways
• just as one drug can interfere with the action
of another drug, some drugs may interfere
with the action of a nutrient or vice versa
 Introduction cont’d
• Drug and nutrient interactions may result in
unintended effects which are referred to as
side effects.
E.g
– Itching
– Skin rashes
 Introduction cont’d
• Some drugs can:
- Increase
- decrease or
- alter food intake.
• inquiring about the use of medications is
therefore an important part of taking a
patient’s clinical history.
 Drug- nutrient interactions can be broadly categorized into two
aspects:

• Effect of nutrition on drugs: the influence of

nutritional factors on drug absorption, action
and effectiveness.

• Effect of drugs on nutrition: the influence of

drugs on nutritional intake, metabolism,
excretion and requirements.
EFFECTS OF DRUGS ON FOOD INTAKE
 Reduced food intake
• Have an anorexic effect, either as a direct
effect of the drugs on appetite or as a result of
side-effects such as drowsiness or lethargy
• Cause nausea and vomiting
• Affect the GIT; Non-steroidal inflammatory
drugs such as aspirin and ibuprofen often
cause indigestion, heartburn or gastritis.
 Reduced food intake cont’d
• Other drugs cause bloating, early satiety,
chronic abdominal pain or diarrhea which may
reduce the inclination to eat.
• Cause taste changes; e.g psychiatric drugs,
result in either loss of taste (making food
seem dull and bland) or changes in taste
perception (making some foods taste
unpleasant). These effects can alter both the
amount and type of food eaten.
 Reduced food intake cont’d
• Cause dry mouth; lack of saliva makes it
difficult to masticate and swallow
• Cause sore or painful mouth (common in
chemotherapy)
• Impair memory or cause confusion; people
may forget to eat
 Increased food intake
• Stimulate appetite; this is a common side
effect of corticosteroids (eg hydrocortisone),
insulin and psychotropic drugs resulting into
weight gain
• Induce cravings for particular types of foods
(particularly those high in refined
carbohydrates). Some psychotropic drugs
have this effect
 Effect of drugs on nutrient absorption
• Absorption can be impaired as a result of:
-Formation of insoluble complexes
-Competition for binding sites; e.g salicylate drugs
such as aspirin compete with vitamin C
-Damage to the absorptive surface of the
intestinal mucosa
-Lack of bile acids
-Increased intestinal motility; drugs that cause
diarrhea
 Effects of drugs on nutrient metabolism

• Carbohydrate metabolism
• Hypoglycemic drugs such as insulin and
sulphonylurea increase carbohydrate
utilization, and their action has to be balanced
with carbohydrate intake in order to maintain
glycemic control.
• Other drugs such as oral contraceptives and
corticosteroids increase glucose intolerance.
 Lipid metabolism
• Some drugs such as statins are used to correct
lipid metabolism, whereas others such as
phenobarbitone can induce hyperlipidaemia
 Vitamin and mineral metabolism
• Micronutrients are required cofactors or
coenzymes in many pathways, including those
by which drugs are metabolized.
• Increased activity of these pathways as a
result of drug metabolism may increase
micronutrient requirements.
• Drugs can also compete with, or inhibit the
metabolic conversion of some micronutrients
to their active metabolite.
 Vitamin and mineral metabolism cont’d

• Some drugs also inhibit the breakdown of

dietary amines such as tyramine, which if
allowed to accumulate can produce a
dangerous rise in blood pressure.
• Patients on such drugs therefore have to
avoid dietary sources of tyramine.
 Effects of drugs on excretion
• Diuretic drugs (e.g furosemide) which are
used to increase sodium excretion in
hypertension can also result in enhanced
losses of other elements such as potassium,
calcium, magnesium and zinc.
• Tetracycline increases the urinary excretion of
vitamin C.
 Excipients and food-drug interaction
• An excipient is added to drug formulations for
its action as a buffer, binder, filler, diluent,
disintegrant, flavoring, dye, preservative,
suspending agent, or coating. Excipients are
also called inactive ingredients.
• Several common excipients have potential for
interactions in persons with an allergy or
enzyme deficiency. E. g lactose