Interaction of
Food & Drugs
M.sc. Analytical Chemistry
Semester-IV
What is a drug- food interaction?
• When nutrients in food affect a drug’s activity
1. Can increase or decrease activity.
2. Changes in how much of the drug is able to be effective
3. Alterations in how a drug is absorbed, distributed, processed for use
(metabolism), and expelled from the body.
• Applies both prescription and over-the counter (OTC) Drugs
1. Vitamins
2. Herbs
3. Supplements
4. Beverages
Drug-Food-Nutrient Interactions
When providing nutritional care, health
professionals need to be very familiar with
interactions of food, drugs. and nutrients Such
knowledge improves the health professional's
ability to collect relevant data and use them
constructively in planning and Implementing care.
Even a client who is not taking any prescription
medications may be using over the counter
medications.
Importance of Understanding Drug-Food-
Nutrient Interactions
Drugs and nutrients interact in a variety of
ways. The term drug nutrient interaction
generally refers to the effects drugs and
nutrients have on each other in the body, while
drug food interaction usually relates to the
effect foods and drugs have on each other in
the gut.
Why are drug-food interactions
important?
• Impact how effective a drug is, or its efficacy
1. Increased metabolism - can cause less of the drug to be available
to be effective
2. Decreased metabolism – can cause high levels of drug in the body
which can be toxic and cause unwanted side effects
• Drug Safety
• Effects of drug-food interactions vary in severity
1. Increased risk of adverse outcomes
2. Adverse drug reactions
3. Increased healthcare costs
• Limited research in this area
Terminology
Prescription drugs are those that are available only by a
physician's prescription. These drugs are considered to be
potent, potentially dangerous, or addicting and therefore not
safe for sale over-the-counter.
Over-the-counter drugs are those the FDA considers
safe for self-medication.
Drugs are administered via many routes including
topical to skin or mucous membranes (i.e., creams,
ointments. suppositories, drops, lozenges, inhalations): oral,
and parenteral (i.e., subcutaneous, intramuscular or
intravenous).
Drug Action in the Body
Depending on their route of administration drugs may exert a
local or systemic effect. A drug is said to act locally when it
exerts its action in the area immediately around the
administration site. Systemic action occurs when a drug is
transported via the blood to target tissues and organs that
are some distance from the site of administration or
absorption. Local effects are most likely to result when drugs
are applied topically to the skin and mucous membrane or in
some instances when they are injected. Systemic effects may
result regardless of the route of administration.
Absorption and
Distribution
Many drugs must be absorbed into the blood stream before they
exert their desired effects. Drugs administered orally and sublingually
are generally absorbed across the mucosa via simple diffusion. Drugs
administered parenterally are most frequently absorbed via filtration
and diffusion. The rate of absorption significantly influences how quickly
drugs begin to act and may affect the peak blood level of a drug.
Cardiovascular function influences how rapidly drugs are
absorbed and distributed via the bloodstream. The degree to which a
drug binds with erythrocytes and plasma proteins (especially albumin)
also influences drug distribution and the amount of "free" drug available
to carry out its intended action. Normally, once drugs reach the blood
stream, they are rapidly distributed throughout the body.
Biotransformation
Once in the body the chemical form of many
drugs is altered; this is called biotransformation.
Drugs that are not changed are said to be
biochemically inert. Enzyme systems in the liver are
particularly active in biotransformation of drugs.
Some drugs depend on biotransformation for their
activity, while others are gradually inactivated by this
process.
Excretion
Drugs are excreted from the body via
numerous routes (e.g. sweat glands,
saliva, bile, mother's milk, and urine).
The kidneys play a major role in the
excretion of many drugs.
Physiochemical Actions
Drugs generally exert their effects at the cellular level via chemical
and physiologic actions. They act by providing a needed material (i.e.,
supplementation), by interfering with normal cell function (i.e.,
pharmacodynamics action), or by interfering with activities of harmful
cells (chemotherapeutic action).
Many factors influence the action of drugs on target tissues
including the dose, the blood level of the drug, the client's age (very
young and very old persons tend to have increased sensitivity to drugs),
body weight (often excluding adipose tissue) in relation to dose, the
client's sex, rate of excretion of the drug, drug combinations, and food-
drug nutrient interactions.
Clinical Significance of Drug-
Food-Nutrient Interactions
Knowledge of drug-food-nutrient interactions is important for four main
reasons. Health professionals use this information to
1. Identify and treat persons at risk of malnutrition as a side effect of drug
therapy
2. Minimize undesirable effects of food and nutrients on absorption and action
of drugs
3. Use beneficial effects of foods in enhancing absorption and minimizing
irritant effects of drugs
4. Identify ways in which diet and drugs act together as a part of an overall
treatment plan
Sometimes drug-food-nutrient-interactions are both harmful and
beneficial, as with the interaction of iron supplements and food. Iron
supplements are absorbed best if taken with citrus fruit juice on an otherwise
empty stomach. However, they often cause gastrointestinal symptoms when
taken this way. In this example the health professional needs to weigh the value
of possible increased compliance in taking the medication if it is taken with food
and side effects are reduced against the decrease in iron absorption that food
causes.
Drug-food-nutrient interactions are usually dose dependent. A small
amount of ethanol may stimulate the appetite, while heavy use tends to dull
appetite. Too large or too small a dose of insulin will prevent a desirable rate of
glucose utilization, while the wrong amount of food can similarly cause problems
when insulin is being administered.
Other factors that influence decisions regarding management of drug-
food-nutrient interactions are the size of the drug dose and whether use of the
drug is for a short or long time. In some instances a lower dose of a drug may
minimize undesirable effects on nutrition. If a drug is given for only a short time,
temporary effects on nutritional status may be tolerated by a client. However,
with long-term drug use, the same effects may be too serious to ignore
Inactive Ingredients
Many drugs contain not only a pharmacologically active
ingredient but also a variety of other substances such as
fillers, coatings, colorings, flavorings, and solvents. These so-
called inactive ingredients are used primarily to facilitate
administration of drugs.
Occasionally, these additional substances (e.g., sugars,
alcohols, sodium, potassium, water, and yellow dye) may be
the source of a problem for a client. For example the sodium
salt of many drugs is the commonly used form. meaning that
these drugs are likely to be quite high in sodium-containing
drug might be contraindicated for a person who has
congestive heart failure
Malnutrition as a Drug Side Effect
Decreased intake
Many drugs interfere with ingestion, digestion, and absorption of nutrients. Some drugs
(e.g., griseofulvin, penicillamine) alter taste perceptions. Others (e.g., potassium iodide, bromine-
containing compounds) are secreted in the saliva causing an unpleasant taste in the mouth. Still
others (e.g., potassium chloride) leave a bad aftertaste in the mouth if they are chewed or held
there. The result may be decreased food intake.
Anorexia, nausea, vomiting, diarrhea, constipation, and gastrointestinal irritation are
common side effects of many drugs. Drugs do not have to be taken orally to cause these side
effects. Many drugs administered parenterally exert effects on the gastrointestinal tract via
systemic pathways. A few potent drugs and drug-drug combinations (e.g. Chemotherapeutics for
cancer therapy and aspirin alcohol respectively) may directly damage gastric mucosa epithelial
cells.
Drugs that have anticholinergic activity such as antihistamines, chlorpromazine (a major
tranquilizer), and tricyclic antidepressants may significantly decrease saliva production, resulting in
xerostomia. In long-term use of these drugs xerostomia may lead to tooth loss. In a dry
environment the bacterial flora of the mouth changes; this may contribute to development of
superinfections.
Decreased Absorption
Some drugs interfere with absorption of nutrients. A drug
may decrease nutrient absorption by binding with a nutrient.
Examples include the binding of phosphorus by aluminum
hydroxide and the tying up of fat-soluble vitamins by mineral oil.
Drugs that increase gastrointestinal motility such as cathartics may
also interfere with absorption. The following types of drugs may
be associated with malabsorption: ethanol, antimicrobial agents,
antimitotic agents, cathartics, hypocholesterolemics, diuretics,
phenytoin (Dilantin-an anticonvulsant), and oral contraceptives.
Large doses of some broad-spectrum antibiotics alter the
microflora in the gut decreasing synthesis of vitamin K, biotin, and
perhaps some other vitamins.
Increased Excretion
Drugs may decrease levels of some
nutrients in the body by increasing
their excretion. For example, many
diuretics result in increased urinary
excretion of potassium.
Altered Metabolism
Some drugs alter nutrient metabolism. Ethanol, adrenal
corticosteroids, hypoglycaemic, antivitamins, anticonvulsants,
and oral contraceptives are examples of drugs that change
nutrient utilization. In some cases the drug's action depends
on its interference with metabolism of a nutrient. For
example, isoniazid (a tuberculostatic agent) interferes with
pyridoxine metabolism, and methotrexate (a cancer
chemotherapeutic agent) and phenytoin interfere with folic
acid metabolism.
Measures to Decrease Side Effects
The effect of drugs on nutritional status depends on the client's
nutrient requirements and reserves, his usual intake of the nutrients involved,
drug dose, the magnitude of the effect of the drug, and duration of therapy.
Health professionals can encourage clients to increase their intake of specific
nutrients to offset adverse effects of drug therapy if this will not interfere with
drug action. It may be necessary to occasionally monitor the body's level of a
specific nutrient to make sure that it is not low enough to cause serious
nutritional problems and not high enough to prevent the drug from working.
Proper supplementation with pyridoxine decreases the toxic effects of
isoniazid, and vitamin B, decreases optic neuritis induced by chloramphenicol
(an antibiotic). When increased nutrient intake is impossible or does not
adequately compensate for serious nutritional problems caused by drug use,
then the benefit of drug therapy may need to be re-evaluated and alternative
therapies or approaches (such as reducing the drug dose) considered.
Effects of Food on Drugs
Taking food with a drug may either
interfere with or improve subsequent
absorption, action, or excretion of the drug,
depending on what substances are involved.
Some foods contain pharmacologically active
substances that alter the effects of drugs.
Effects on Drug Absorption
Taking food with drugs ay influence the
rate and/or the total amount of drug
absorption. Food in the gastrointestinal tract
affects pH, motility, and secretions These in
turn, affect ionization, stability solubility, transit
time, and absorption of certain drugs. the food
itself may have properties that influence
absorption.
Rate Of Absorption
Achieving a rapid rate of drug absorption is of special concern
when it is desirable to have the drug act quickly or to achieve the
highest possible blood level of the drug for a given dose. In most
cases if a drug is taken with food, the rate of absorption is slowed.
There are a few exceptions For example, absorption of griseofulvin
(an antifungal agent) is improved by taking it with a fat-containing
meal. A rapid rate of absorption is of less importance when drugs are
given chronically to maintain a constant blood level.
Occasionally, slow absorption of a drug is desirable, as with
some time release drugs, which have a protective coating, Increased
exposure to gastric acids as with decreased gastric emptying can lead
to dissolution of the protective coat and release of the drug more
rapidly or in a larger amount than is desired.
Total Amount of Absorption
Sometimes the presence of food in the gastrointestinal tract
significantly reduces absorption of a drug that is taken at about the
same time. Food may bind with some drugs. causing loss of the drug in
the stool. For example, calcium in dairy products forms an unabsorbable
compound with tetracycline. Some drugs may be destroyed by gastric
acid and pepsin in the stomach. Destruction is greater when gastric-
emptying is slowed by food. It is for this reason that many antibiotics
should be given on an empty stomach (e.g. one hour before or three
hours after a meal). A few drugs are completely inactivated in the
intestinal tract and ate of no use if given orally. Insulin is a notable
example. If we Take it after meal then will chances of hypoglycemia
How can we avoid drug-food interactions?
• As a medicinal professionals, always be aware of common introductions
specially those associated with common drugs and foods and educate your
patients.
• Counsel patients to:
1. Always read Drug labels carefully
2. Learns about the warnings for the drugs they take
3. Keep medications in the original containers to keep them identifiable
4. Check with a doctor or pharmacist before taking an OTC during if they are
taking any prescription medications
5. Use one pharmacy for all of their drug needs (keep information Central)
6. Inform all healthcare professionals about all medications and supplements
they are taking
7. Keep a record of all prescription drugs, OTC drugs and dietary
supplements including herbs that they take tell them to try to keep this list
with them it all time specially when they are going to medical appointment
To be avoided
Key points
• A patients diet can have a significant impact on the
medications safety and efficacy
• Information on food drug interaction is limited but an
important area of patient care
• Pharmacist can play a significant role in educating patients
on the best way take their medications in regards to food
• Some drug-food introductions may require dose adjustment
or maybe avoided by separating dose and food
• Some drug-food interactions should absolutely be avoided
to prevent serious adverse outcomes
Thank You for your
Concern..
PRESENTED BY
TASKINFATMA M.SAIYED
22-PCH-075
