Transcript Guidelines to Lower Risk of Drug

Guidelines to Lower Risk of DrugNutrient Interactions
Presented by
Janice Hermann, PhD, RD/LD
OCES Adult and Older Adult Nutrition Specialist
Types of Interactions
 Drug-Nutrient Interactions
 Effect of a medication on food or a nutrient in food
 Both prescription and over-the-counter medications
can affect the way your body uses nutrients in food
 Nutrient-Drug Interactions
 Effect of food or a nutrient in food on a medication
Nutrition Implications
 Little chance taking a medication for a short
time will affect your nutritional status
 However, using some medications for months
or years may affect your nutritional health
 Changing diet to include more foods rich in vitamins
and minerals is preferred to taking vitamin or
mineral supplements
Drug-Nutrient Interactions
 Medications, can affect nutrients by:
 Decreasing food intake
 Decreasing nutrient absorption
 Slowing down nutrient production
 Interfering with nutrient metabolism
 Increasing nutrient excretion
Drug-Nutrient Interactions:
Food Intake
 Some medications can affect nutritional health
by causing poor food intake due to:
 Decreased appetite
 Nausea or vomiting
 Unpleasant taste or dry mouth
 Gastrointestinal sores or inflammation
Drug-Nutrient Interactions:
Food Intake
 Many medications may cause loss of appetite
or nausea in some people, but it usually
subsides after the first few doses
 However, nutritional health can be affected if
decreased food intake persists
Drug-Nutrient Interactions:
Food Intake
 Examples:
 Appetite suppressants are medications which affect
food intake by depressing appetite
 Several cancer medications and treatments may
dramatically reduce food intake by causing:
 Loss of appetite
 Changes in taste perception
 Nausea, vomiting
 Dry mouth
 Mouth and intestinal sores or inflammation
Drug-Nutrient Interactions:
Nutrient Absorption
 Some medications can affect nutritional health
by decreasing nutrient absorption due to:
 Decreasing time in intestine
 Altering stomach acidity
 Damaging intestinal lining
 Competing for absorption
 Binding nutrients
Drug-Nutrient Interactions:
Nutrient Absorption
 Examples:
 Laxatives can cause food to move rapidly through
the intestinal track which can decrease nutrient
absorption
 Antacids can lower stomach acidity which can may
interfere with iron, folate and vitamin B12
absorption
 Many cancer medications and treatments can
damage the intestinal lining which can decrease
nutrient absorption
Drug-Nutrient Interactions:
Nutrient Absorption (cont.)
 Examples:
 Some anticonvulsants can compete for absorption
with folate resulting in decreased folate
absorption
 Some cholesterol lowering medications reduce
cholesterol by removing bile acids
 Bile acids are needed to absorb essential fatty acids and
fat-soluble vitamins
 As a result some cholesterol lowering medications can
reduce absorption of fat-soluble nutrients
Drug-Nutrient Interactions:
Nutrient Production
 Some medications can affect nutritional health
by slowing down nutrient production
Drug-Nutrient Interactions:
Nutrient Production
 Vitamin K produced by bacteria in the intestine
 Antibiotics kill harmful bacteria, but they can
also kill helpful bacteria
 Killing helpful vitamin K producing bacteria can
result in decreased vitamin K production
Drug-Nutrient Interactions:
Nutrient Metabolism
 Some medications can affect nutritional health
by interfering with body’s ability to metabolize
nutrients due to:
 Affecting enzyme systems
 Competing with enzyme systems
Drug-Nutrient Interactions:
Nutrient Metabolism
 Examples:
 Some anticonvulsants alter liver enzyme activity
causing increased metabolism of folate, vitamin D,
and vitamin K
 Methotrexate resembles folate in structure and
competes with enzymes that converts folate to its
active form, this can result in folate deficiency
Drug-Nutrient Interactions:
Nutrient Excretion
 Some medications can affect nutritional health
by increasing nutrient excretion due to:
 Decreased kidney reabsorption
 Increased urinary excretion
Drug-Nutrient Interactions:
Nutrient Excretion
 Diuretics remove excess fluid from the body
 Some diuretics may also increase loss of potassium
along with fluids
 Potassium is very important in proper functioning of
the heart and other muscles
 Large amounts of aspirin can cause increased
loss of folate
Drug-Nutrient Interactions:
Nutrient Excretion
 Examples:
 Some anticonvulsant medications can cause the
liver to increase removal of vitamin D from the body
 Isoniazid, an antituberculosis medication, is similar
in structure to vitamin B6 and induces vitamin B6
excretion
 Since treatment is for 6 months, B6 supplements are
routinely given to prevent deficiency
Food-Drug Interactions
 Some foods or nutrients in food can also alter a
medication’s effectiveness by:
 Decreasing medication absorption
 Interfering with medication metabolism
 Interfering with medication removal
Nutrient Interactions:
Medication Absorption
 Some foods or nutrients in food can increase or
decrease medication absorption by:
 Decreasing stomach emptying
 Binding to medications
 Competing for absorption
 Altering acidity
Nutrient Interactions:
Medication Absorption
 Absorbing less than the intended dose lowers
the chance a medication will work properly
 Absorbing more than the intended dose
increases the chance of an overdose effect
Nutrient Interactions:
Medication Absorption
 Medications are typically absorbed more
quickly when the stomach is empty
 Having food in the stomach typically will slow
down a medications absorption
Nutrient Interactions:
Medication Absorption
 Some medication should be taken with food
 Some medication should be taken on an empty
stomach (1 hour before or 2 hours after eating)
 Read the directions to see if a medication
should or should not be taken with food
Nutrient Interactions:
Medication Absorption
 Examples:
 Dietary calcium can bind to the antibiotic
tetracycline making it unavailable for absorption
 Amino acids compete for absorption with levodopa
Nutrient Interactions:
Medication Absorption
 Examples:
 Acidity of food or beverage consumed with a
medication can affect absorption
 Some medications are better absorbed in an acidic
environment
 Other medications can be damaged by an acid
environment, these types of medications are often
available in coated forms to resist stomach acidity
Food-Drug Interactions:
Medication Metabolism
 Some foods or nutrients in foods may interfere
with a medication’s metabolism or action in
the body by:
 Affecting enzyme systems
 Interacting with medications
 Having a similar chemical structure resulting in
competition
Food-Drug Interactions:
Medication Metabolism
 Examples:
 Components in grapefruit juice
 Inactivate enzymes that metabolize many medications
which can result in increased medication levels
 Aged and fermented foods
 Contain a chemical called tyramine that interacts with a
medication, monoamine oxidase inhibitor, which can result
in dangerously high blood pressure
 Vitamin K
 Structurally similar to the anticoagulant warfarin which can
decrease the effectiveness of warfarin
Food-Drug Interactions:
Medication Removal
 Some food or nutrients in foods may interfere
with removal of a medication from the body
by:
 Affecting enzymes involved in preparing
medications for removal
 Altering urine pH
Food-Drug Interactions:
Medication Removal
 Examples
 Liver enzymes prepare medications for removal
from the body
 These enzymes require nutrients to work properly
 If nutrients are not present the medication may stay
active in the body longer than intended
 Quinidine is excreted more readily in an acidic
urine
 Foods that cause the urine to be more basic, such as
sodium bicarbonate, may reduce quinidine excretion
Many Medications
 These are just a few examples to understand
how medications and nutrients can interact,
this is not indented to be a complete list of
possible interactions
 There are thousands of medications on the
market and numerous new medications that
come out ever year
Alcohol Interacts With Medications
 Alcohol and medications do not mix
 Alcohol can adversely affect medications
 Alcohol can slow down or speed up how the body
metabolizes a medication
 Medication action can be either intensified or reduced
 In some cases, mixing alcohol and medications can
be fatal
Alcohol Interacts With Medications
 A rule of thumb is to avoid alcoholic beverages
when taking prescription and over-the-counter
medications
Nutrient Supplements
 Nutrient supplements themselves can result in
drug-nutrient interactions
 In excessive amounts, vitamin and mineral
supplements can act like drugs instead of
nutrients
 Nutrients in excessive amounts may:
 Compete with other nutrients for absorption,
transport or metabolism
 Have a direct overdose effect
Follow Directions
 It is very important to follow the directions on
how to take a medication
 Many people do not take prescription or overthe-counter medications properly
 Following directions on how to take a
medication can affect how or if a medication
will work properly
Who Is At Greater Risk
 Persons who are poorly nourished
 Persons with serious health problems
 Growing children
 Pregnant women
 Older adults
Who Is At Greater Risk (cont.)
 Persons taking two or more medications at the
same time
 Persons using prescription and over-thecounter medications together
 Persons not following medication directions
 Persons taking medications for long periods of
time
 Persons who drink alcohol excessively
Lower The Risk of
Drug-Nutrient Interactions
 Eat a healthy diet
 Follow directions on how to take medications
 Both prescription and over-the-counter
 Read warning labels
 Do not share medications
Lower The Risk of
Drug-Nutrient Interactions (cont.)
 Tell your physician all the medications you are
taking both prescription and over-the-counter
 Tell your physician and pharmacist about any
new symptoms that develop when taking a
medication
 Keep a list of all medications
 Ask if you have any questions
Questions To Ask Your Physician
 What is the medication for?
 Medication name
 Medication purpose
 How should I take the medication?
 How often, how long
 How to store
 Recommendations on consuming food and/or
beverages with medication
 What should I expect?
 Expected outcomes
 Precautions
 Side-effects