Drug – Nutrient...

Today’s Agenda

Review common terminology

Better understand drug-nutrient interactions

Affect of nutrients on drugs

Affect of drugs on nutrients

Objectives

Identify common foods that interact with medications

Identify common symptoms

Identify ways of preventing drug-nutrient interactions

Drug Nutrient Interactions Ice Breaker: Myth or Fact

1. You should always take medications with water.


1. You should always take medications with water. Myth


2. It is OK to take medications with coffee and tea.


2. It is OK to take medications with coffee and tea. Myth


3. You should never take medications on an empty stomach.


3. You should never take medications on an empty stomach. Myth


4. You cannot eat leafy greens while taking Coumadin (warfarin).


4. You cannot eat leafy greens while taking Coumadin (warfarin). Myth


5. Drug-Nutrient interactions only occur with prescription drugs.


5. Drug-Nutrient interactions only occur with prescription drugs. Myth


6. You should always tell your doctor and other health care professionals about the medications, herbs or supplements you are taking.


6. You should always tell your doctor and other health care professionals about the medications, herbs or supplements you are taking. Fact

Vocabulary

Drug: any chemical used in the prevention, diagnosis, and treatment of a disease

Polypharmacy: the use of multiple medications at one time

Drug-nutrient interaction: physical, chemical, physiologic relationship between a drug and nutrients present in food or supplements.

Drugs & Medications

A few of the major types

Antibiotics (fights bacteria)

Analgesic (Pain relievers)

Antihypertensive (Blood pressure control)

Antihyperlipidemic (reduces cholesterol)

Antidepressants (control depression)

Most Common Prescribed Drugs in the US

Hydrocodone/Ecetamonophen – analgesic or pain reliever

Zocor (simvastatin) - lowers cholesterol

Lisinopril – controls blood pressure

Norvasc – control blood pressure and angina

Prilosec (omeprazole) – treats acid-reflux

Azithromycin – antibiotic

Amoxicillin – antibiotic

Glucophage (metformin) – Treatment for Type 2 diabetes

Hydrochlorothiazide – diuretic, used to lower blood pressure

How Drugs are Changed by the Body

Absorption: process by which drugs get into the body and then enter the blood stream

Distribution: movement of drugs from one location to another

Metabolism: process by which drugs are chemically changed

Excretion: process by which drugs are removed from the body

Liver

First pass metabolism through liver via hepatic portal vein

Metabolism of drugs by liver

enzymes

Excretion of metabolites and intact drugs in urine

Kidney

Orally ingested drugs

hepatic vein

Pharmaco-dynamic

activity in body

Parenteral / IV drugs etc.

Renal artery

GI

Common Symptoms Diarrhea/Constipation

Nausea/Vomiting

Dry or sore mouth

Abnormal sense of taste

Increased appetite

Decreased appetite

Ulcers/gastric bleeding

Drugs Nutrients Interactions

AbsorptionHow much

enters blood stream

DistributionHow much is

sent to tissues in the body

MetabolismHow much is

used

ExcretionHow much

leaves

Absorption

Nutrient Absorption: Drugs may increase/decrease or block nutrient uptake in the gut

Drug Absorption – some foods may increase/decrease the absorption of a drug

Delaying digestion, or binding to the drug itself.

Example: Lisinopril may cause the amount of potassium in the blood to increase.

Example: Zantac may decrease absorption of nutrients that rely on acid for absorption (B12, thiamin, iron,)

Metabolism

Nutrient Breakdown/Metabolism: drugs may speed up the metabolism or use of nutrients, increasing the need for that nutrient or increasing risk of deficiency

Drug Breakdown/metabolism – Increase/decrease the breakdown of drugs

Example: Taking Hydrocodone with alcohol can result in liver toxicity.

Example: Dilantin increases metabolism of folic acid.

Excretion

Nutrient Excretion: Drugs may increase/decrease the excretion of nutrients in the urine

Drug Excretion – Inhibit or enhance the removal of drugs from the blood stream

Example: Taking diuretics such as Lasix may increase the reabsorption of calcium by the kidneys, while increasing the loss of electrolytes (potassium, sodium, chloride, magnesium)

Affects of Food on Drugs

Alcohol

Grapefruit Juice

Licorice

Chocolate/ Caffeine

Leafy Greens

Tyramine

Alcohol Mixing alcohol with certain drugs can result in serious, even

life-threatening interactions.

Symptoms: nausea/vomiting, loss of coordination, drowsiness

Increases risk for internal bleeding, trouble breathing, heart problems.

Prescriptions, Over the Counter, and herbal supplements

Cold/flu/allergies

Arthritis

Enlarged prostate

Sleep aids

GrapefruitCan enhance a drug’s effect by up to 1400%

Grapefruit inhibits activity of cytochrome P450 enzyme in the intestinal wall.

Serum drug levels increase and can be toxic.

Many drugs affected

Simvastatin (Zocor)

Pazopanib (Votrient)

Setraline (Zoloft)

Licorice Contains compound glycyrrhizin

May cause a drop in the level of potassium

May result in high blood pressure, abnormal heart rhythms, congestive heart failure

May interact with certain drugs:

Ace-inhibitors or diuretics

Digoxin

Insulin

Aspirin

Laxatives

corticosteroids

Chocolate

Food may act like a drug, enhancing its effects or creating a drug toxicity

The real concern is the caffeine content

High caffeine intake may increase adverse effects of Ritalin (nervousness, tremors, insomnia)

May decrease the effect of sedatives (Ambien)

MAO inhibitors (antidepressants)

Dark Leafy GreensFood may act against a drug

Vitamin K – essential vitamin that helps form blood clots and is found in greens

Coumadin/Warfarin - Prevents blood clots “thins the blood”

Too much Vitamin K works in opposition of Coumadin – can potentially result in embolism/stroke

The key is CONSISTENCY

Tyramine

Tyramine enhances the toxic effects of MAO inhibitors Can lead to a hypertensive crisis and death.

Tyramines are natural substances found in certain foods that aged or fermented. A byproduct when the amino acid tyrosine is broken down.

Aged cheeses (blue cheese, cheddar, feta, Gouda, mozzarella, gorgonzola, parmesan, Romano, Muenster, provolone, Swiss )

Dried sausages (pepperoni)

Processed meats (bologna, bacon, salami)

Sauerkraut

Other Effects

Food in the stomach can increase or decrease drug absorption.

Examples:

Fosamax (osteoporosis) absorption is decreased by 60% with coffee or juice.

Ciprofloxacin forms an insoluble complex with calcium

Herbal Supplements Herbs have pharmacological properties including side

effects and can interact with drugs

Herbal supplements are not regulated by the FDA

Many people take herbal supplements but deny this to their doctors

Dietary Supplements St John’s Wort

Green Tea

Garlic

Ginseng

Ginko Biloba

Melatonin

Saw Palmetto

Echinacea

Black Cohosh

Glucosamine & Chondroitin Sulfate

St John’s WortWhat the Science says

Although some studies of St. John’s wort have reported benefits for depression, others have not.

Side effects & cautions: interacts with many medications

Antidepressants

Birth control pills

Seizure-control drugs, such as phenytoin and phenobarbital

Warfarin and related anticoagulants.

Green TeaWhat the Science says

Laboratory studies suggest that green tea may help protect against or slow the growth of certain cancers, but studies in people have shown mixed results.

Side effects & cautions

Green tea is safe for most adults when used in moderate amounts.

Green tea contains small amounts of vitamin K, which can make anticoagulant drugs, such as warfarin, less effective.

GarlicWhat the Science says

Preliminary research suggests that taking garlic may slow the development of atherosclerosis

garlic may slightly lower blood pressure, particularly in people with high blood pressure.

Side effects & cautions

can thin the blood

May interfere with the effectiveness of saquinavir, a drug used to treat HIV infection

Ginseng What the science says

Some studied have shown that ginseng may help to lower blood sugar. Other studies show possible beneficial effects on the immune system.

Research has not yet conclusively supported all of the health claims

Side effects and cautions

Can increase effects of heparin, aspirin

May increase effects of NSAIDS: ibuprofen, ketoprofen, naproxen

When taken with MAO inhibitors can cause nervousness and hyperactivity

Avoiding Complications

Doctors, nurses, and registered dietitians should know about the drugs and herbs you are taking

Read directions carefully (prescribed & OTC & supplements)

Pay attention to when pills should be taken (empty vs. full stomach)

Don’t share or take someone else’s medications

Don’t take medications with alcohol

Ask your doctor or dietitian about deficiencies

Ask questions!

Conclusion Be open with your health care providers

Ask questions before you start taking new medications

Helpful Resources:

MedlinePlushttp://www.nlm.nih.gov/medlineplus/druginfo/meds

www.fda.gov Avoiding Drug Interactions

Familydoctor.org Herbal Products and Supplements

National Center for Complementary and Alternative Medicine, nccam.nih.gov

http://www.fda.gov

Questions?

Sarah Jacobson & Laura Gurvits

Keene State Dietetic Internship

2013-2014

Drug – Nutrient...

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