Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997)...
Transcript of Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997)...
![Page 1: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/1.jpg)
Drugs and NutritionHow drug side effects can influence nutritional intake
Rebecca WhitePharmacist Team Manager – Nutrition & Surgery
Oxford Radcliffe Hospitals NHS Trust
![Page 2: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/2.jpg)
Factors Influencing Nutritional Intake
• Food availability• Physical capability• Appetite• Presence of gastrointestinal
symptoms• Perception of food
![Page 3: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/3.jpg)
Overview
Drugs can effect…• Appetite
– Food avoidance– Appetite
• Gastrointestinal symptoms• Perception of food
– Texture– Taste– Smell
![Page 4: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/4.jpg)
Food avoidance
To comply with dosing guidance:• Take on an empty stomach or half
an hour before food– Some penicillins, anti-TB therapy
• Not to be taken with milk– Quinolones, Tetracyclines
• Take with a full glass of water, half an hour before food– Bisphosphonates
![Page 5: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/5.jpg)
Anorexia and weight loss
• Commonly reported side effect of drug therapy
• Rarely clinically significant
![Page 6: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/6.jpg)
• Amantadine• Digoxin• Fluoxetine• Levodopa• Lithium• Metformin• Penicillamine
![Page 7: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/7.jpg)
Increased appetite and weight gain
• MAOIs• Tricyclic antidepressants• Vaproate• Beta-blockers• Oral contraceptives• Antipsychotics; Chlorpromazine,
olanzapine, clozapine, mirtazapine• Steroids• Anabolic steroids
![Page 8: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/8.jpg)
Gastrointestinal side-effects
![Page 9: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/9.jpg)
![Page 10: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/10.jpg)
Nausea and Vomiting
• Direct effect on chemoreceptors
• Direct effect on serotonin and dopamine receptors in CTZ
![Page 11: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/11.jpg)
Common Drugs• Chemoreceptors in GI tract
– Cytotoxics– Potassium– Iron Preparations– Antibiotics
• Chemoreceptor trigger zone– Cytotoxics– Anaesthetics– Opiates– Nicotine– Levodopa– SSRIs
![Page 12: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/12.jpg)
Decreased GI motilityAssociated with bloating, fullness and
constipation
• Anticholinergic– Tricyclic antidepressants– Oxybutynin– Propantheline
• Opiates– Morphine– Codeine
• Ondansetron
![Page 13: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/13.jpg)
Diarrhoea
• Increase in GI motility• Alteration of gut flora• Disturbance of mucosal surface
![Page 14: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/14.jpg)
• Erythromycin• Metoclopramide & domperidone• Broad spectrum antibiotics• Auranofin (affects 50%)• Misoprostil (affects 8%)• PPIs (affects 1-3%)• Antivirals; adefovir, tenofovir, lamivudine• Magnesium salts• Iron• Lithium (sign of toxicity)• Digoxin (sign of toxicity)• Acarbose• Sevelamer• Metformin• Colchicine (sign of toxicity)
![Page 15: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/15.jpg)
Perception of Food
• Image• Texture• Smell• Taste
![Page 16: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/16.jpg)
![Page 17: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/17.jpg)
Visual Impact
![Page 18: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/18.jpg)
Visual Impact & Texture
![Page 19: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/19.jpg)
Dry Mouth
Functions of saliva• Enhance taste• Facilitate speech• Facilitate swallowing• Irrigate, lubricate and protect
mucous membranes in upper GI tract
![Page 20: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/20.jpg)
Salivary Stimulus• Parasympathetic
– Increases volume• Sympathetic
– Decreases volume– Increases viscosity
• Saliva production decreased by:– Sympathetic stimulation
• Alpha-agonists– Parasympathetic blockade
• Anticholinegics• Antimuscarinics
![Page 21: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/21.jpg)
![Page 22: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/22.jpg)
Incidence >10%
• Anticholinergic drugs– Atropine, Oxybutynin, hyoscine,
benztropine• Antidepressant and antipsychotic
drugs– SSRIs – citalopram, fluoxetine,
paroxetine, sertraline, venlafaxine– Tricyclic – amitriptyline, imipramine– Atypicals – Phenelzine, olanzipine
![Page 23: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/23.jpg)
• Diuretics– Furosemide, chlorothiazide
• Antihypertensives– ACEI – captopril, enalapril, lisinopril– Clonidine– Methydopa
• Sedatives– Diazepam, temazepam
• Muscle relaxants– Orphenadrine
![Page 24: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/24.jpg)
• Analgesics– Codeine, methadone, tramadol– Ibuprofen, naproxen
• Antihistamines– Astemizole, chlorphenamine, loratidine
• Others– Carbamazepine, tolterodine,
carbidopa/levodopa, ipratropium
![Page 25: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/25.jpg)
Management
• Remove offending drug• Reduce dose or split dose• Try modified release preparation• Try alternative drug within same
class• Alter dose timing to minimise effect
on oral intake• Use salivary stimulants or artificial
saliva products
![Page 26: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/26.jpg)
Taste
• Sweet• Salt• Bitter• Sour• Umami
![Page 27: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/27.jpg)
![Page 28: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/28.jpg)
Drug induced taste disturbance
• Ageusia– Complete loss of one of the taste
sensations• Hypogeusia
– Increase in taste threshold• Dysgeusia
– Altered perception of taste• Parageusia
– Bad taste in the mouth
![Page 29: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/29.jpg)
Ageusia/Hypogeusia
ACEI, amphetamines, amiloride, amphoteracin, ampicillin, aspirin, azathioprine, baclofen,
benzodiazepines, candesartan, carbamazepine, cephalosporins, chlorhexidine, clarithromycin,
cimetidine, clopidogrel, colchicine, corticosteroids, didanosine, diltiazem, furosemide, glycopyrrolate,
gold salts, hydralazine, hydrochlorothiazide, hydroxychloroquine, levodopa, losartan, metformin, methimazole, methotrexate,
methyldopa, metoclopramide, metronidazole, nifedipine, penicillamine, phenytoin, propranolol,
spironolactone, sucralfate, terbinafine, triamterine, tricyclic antidepressants, venlafaxine, vincristine
![Page 30: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/30.jpg)
Dysgeusia - Bitter• Acetazolamide• Aspirin• Carbamazepine• Clarithromycin• 5-Fluorouracil• Isosorbide mononitrate• Lamotrigine• Levodopa• Metolazone• Risperidone
![Page 31: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/31.jpg)
Dysgeusia - Metallic• Allopurinol• Captopril• Ethambutol• Gold salts• Lithium• Metformin• Methyldopa• Metronidazole (12%)• Nifedipine (6%)• Pentamidine (32-72%)• Sartans• Sulphasalazine
![Page 32: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/32.jpg)
Management
• Exclude other causes• Remove offending drug• Manage oral dryness if implicated• Masking techniques• Zinc supplementation
![Page 34: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/34.jpg)
![Page 35: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/35.jpg)
Drug induced olfactory disturbance
ACEI, amiodarone, amoxicillin, amphetamines, beta-blockers, calcium
channel blockers, chlorhexidine, cimetidine, cocaine, corticosteroids,
decongestants, doxycycline, flubiprofen, gemfibrozil, gentamicin, inhaled
corticosteroids, isotretanoin, levodopa, methotrexate, pentamidine, quinolones,
statins, streptomycin, sumatriptan, terbinafine, tobacco
![Page 36: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/36.jpg)
Identifying patients at risk
• Polypharmacy• Elderly• Impaired organ function• Pre-existing nutritional status• Early recognition and corrective
action
![Page 37: Drugs and Nutrition How drug side effects can influence ...€¦ · • Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96 • Sreebny](https://reader033.fdocuments.in/reader033/viewer/2022042309/5ed58be13f40d10acd5169da/html5/thumbnails/37.jpg)
• Ackerman et al (1997) Disturbances of taste and smell induced by drugs. Pharmacother 17:482-96
• Sreebny et al (1986) A reference guide to drugs and dry mouth. Gerodontology 5:75-99
• www.drymouth.info