Physiological and Pharmacokinetic Alterations and Drug-Nutrient Interactions During Pregnancy

Abstract

During pregnancy, a large part of the body is affected by the physiological and anatomical changes that start in early pregnancy. Many of these changes significantly affect the pharmacokinetic (absorption, distribution, metabolism, and excretion) and pharmacodynamic properties of different drugs (1-3). During treatment, the use of medicines with the content of only some active ingredients is important to ensure maternal and fetal safety during pregnancy (4-6).Drug-nutritional element interactions are defined as the physicochemical, physiological, and pathophysiological relationships between a drug and nutritional element or between a drug and multiple nutritional elements, nutrients, and constituents or the nutritional status in a broader sense (6-8). Drug-nutritional element interactions can occur in four steps: extracellular bioinactivation, decrease/increase in absorption, decrease/increase in efficacy, and decrease/ increase in excretion (elimination) (7). Therefore, the fact that health professionals consider the physiological changes and the factors affecting the distribution of the drug in the body during pregnancy is important to ensure the effectiveness of pharmacotherapy. In this review article, we aimed to investigate the effects of physiological changes during pregnancy on the pharmacokinetic properties of the drug and the interactions of drugs, nutrients, and nutritional elements. Physiological Changes and Drug Metabolism in PregnancyPregnancy is a process in which many physiological differentiations occur in the cardiovascular, respiratory, excretory, gastrointestinal, and circulatory systems, which alter the interactions of nutrition, nutritional element, and drug metabolism. In summary, the rate and volume of the heart increase, lung capacity decreases, glomerular filtration rate (GFR) increases, blood volume increases, blood circulation decreases, and gastrointestinal system (GIS) motility decreases; in addition, changes, such as nausea and vomiting, occur affecting nutrition. The physiological changes associated with pregnancy are summarized in Table 1. During pregnancy, the interactions between drug metabolism and nutrition and nutritional element may be pharmaceutical, pharmacokinetic, and pharmacodynamic. The pharmaceutical interactions occur within the delivery medium, such as enteral tube or gastrointestinal lumen. This can affect the bioavailability of the drug or nutritional element (8). The pharmacokinetic interactions include the processes of absorption, distribution, metabolism, and excretion of the drug or nutritional element. The pharmacodynamic interactions include physiological changes Physiological and Pharmacokinetic Alterations and DrugNutrient Interactions During PregnancyDuring pregnancy, many physiological and metabolic alterations occur to support the requirements of the developing fetus. Alterations associated with the respiratory, cardiovascular, hematological, urinary, and gastrointestinal systems (GIS) may result in pregnancy-related disorders and may change the pharmac...

Analysis of drug-food interactions in inpatient treatment: A university hospital case

“…The most basic types of drug-food interactions are shown in Figure 1. 16 (Adapted from the source.) To prevent drug-food interactions and reduce risk, drug administration's recommended time is 1 hour before or 2 hours after food intake 17 .…”