Important drug–nutrient interactions

Abstract

Drugs have the potential to interact with nutrients potentially leading to reduced therapeutic efficacy of the drug, nutritional risk or increased adverse effects of the drug. Despite significant interest in such interactions going back to over more than 40 years, the occurrence and clinical significance of many drug-nutrient interactions remains unclear. However, interactions involving drugs with a narrow therapeutic margin such as theophylline and digoxin and those that require careful blood monitoring such as warfarin are likely to be those of clinical significance. Drugs can affect nutrition as a result of changes in appetite and taste as well as having an influence on absorption or metabolism of nutrients. Moreover, foods and supplements can also interact with drugs, of which grapefruit juice and St John's wort are key examples. Significant numbers of people take both supplements and medication and are potentially at risk from interactions. Professionals, such as pharmacists, dietitians, nurses and doctors, responsible for the care of patients should therefore check whether supplements are being taken, while for researchers this is an area worthy of significant further study, particularly in the context of increasingly complex drug regimens and the plethora of new drugs.

Knowledge, Attitudes and Awareness of Food and Drug Interactions among Nurses with Different Levels of Experience

“…Drugs with low therapeutic index are more likely to produce a significant harmful effect when they interact with food (Mason 2010). The five groups of participants, scored low in the interaction of digoxin with foods such as wheat bran, rolled oats and sunflower seeds.…”

“…This increase is a result of enhanced solubilization of griseofulvin by fat (Palma et al, 1986). Drugs with a large therapeutic index, produce a harmless effect when they interact with food (Mason, 2010). Griseofulvin has a wide therapeutic index.…”

“…Grapefruit juice contains a bioflavonoid that inhibits CYP3A (define), an enzyme that is involved in the metabolism of many drugs (Andrade, 2014;Hanley, et al, 2011). Such interaction can cause a 5-fold increase in the bioavailability of some drugs (Mason, 2010).Especially, orally-administered drugs such as felodipine that are metabolized by CYP3A enzymes (Hanley et al, 2011). Patients at high risk for FDI include elderly patients taking three or more medications (polypharmacy) for chronic conditions such as diabetes, hypertension, depression, high blood cholesterol, or congestive heart failure.…”

Knowledge of Food and Drug Interactions among Nurses: Assessment Strategy for Continuing Education

“…The participants from the five groups scored very low in some questions on the FDIQ such as the timing of foods and drugs such as glipizide, actose, synthroid (thyroid hormone) . To enhance therapeutic effects, drugs such as glipizide, atenolol, and synthroid that interact with foods should be taken on an empty stomach (Manrique et al, 2014;Winstanley et al, 1989). The five groups scored low on their knowledge of alcohol interaction with foods, such as milk.…”

Drug and nutrition interactions: not just food for thought

“…3 However, contemporary reviews have reframed the subject, allowing for a more systematic approach to identifying and evaluating all types of drug and nutrition interactions. 1,10,15,16 With ongoing advances in recognizing interactions, understanding their mechanisms and learning how best to manage individual interactions, patient care can be further improved.…”