Professional Documents
Culture Documents
Consequences For The Nutrition
Consequences For The Nutrition
Food Intake and Drug Metabolism: Examples Medications can lead to altered food choices. Many
drugs are reported to directly affect the sense of taste and
The metabolism of orally ingested drugs before reach- smell and some drugs themselves have an unpleasant
ing the systemic circulation (‘first-pass metabolism’ or taste that might interfere with food intake [7].
nowadays ‘presystemic clearance’) has been shown to It is well known that chemotherapeutic drugs (and to
have clinically relevant influences on the potency and ef- a lesser extent also other drugs) induce nausea and vom-
ficacy of drugs. Both the intestine and the liver account iting and therefore are associated with an increased risk
for the presystemic metabolism in humans. One of the for malnutrition. However, also drugs which decrease
major groups of drug-metabolizing enzymes is the cyto- acute and delayed emesis (e.g. aprepitant) may have ad-
chrome P450 (CYP) 3A4 enzymes. Grapefruit juice is a verse effects such as fatigue, dysphagia, taste disturbance,
classic example of a selective intestinal CYP 3A4 inhibi- constipation, diarrhea or anorexia and could therefore by
tor. It causes a type IIA interaction with certain drugs by itself adversely affect the nutritional status [8].
deactivating and destroying intestinal CYP3A4 enzymes. Limiting drug prescriptions to essential medications
The overall exposure of some drugs can be increased by for a short period as possible and periodic re-evaluations
more than fivefold when taken with grapefruit juice. It of the treatment chosen are essential to minimize adverse
has been shown that furanocoumarin derivatives in the drug-nutrient interactions [4].
juice are primarily responsible for enzymatic inhibition
[5]. The onset of the interaction is immediate and the
magnitude of the enzymatic inhibition increases with re- Conclusion
peated grapefruit juice consumption. The effect contin-
ues for several days after the discontinuation of grape- In general, most data on the pharmacodynamics and
fruit juice consumption. The increased oral absorption of pharmacokinetics of drugs in special patient populations
certain drugs can lead to increased risk for adverse reac- pertain to renal impairment and hepatic dysfunction.
tions of the specific drugs. For instance, drowsiness and Less data address drug pharmacodynamics and pharma-
prolonged sedation may result from taking the tranquil- cokinetics in the elderly, and these drug characteristics
lizers diazepam or midazolam in combination with are only infrequently assessed in regard to malnourished
grapefruit juice. Hypotension can result in people treated patients. The paucity of information on the influence of
with calcium-channel blockers (nifedipine, felodipine, the nutritional status (e.g. malnutrition, obesity, and mi-
verapamil). Patients taking the antibiotic erythromycin cronutrient deficiencies) on drugs has been criticized [8].
and consuming grapefruit juice have an increased risk On the contrary, primarily data regarding the influence
for cardiovascular symptoms, including cardiac dys- of drug-nutrient interactions on the nutritional status are
rhythmias. Other drugs with increased absorption when also missing.
References
1 Chan LN: Drug-Nutrient Interactions; in 5 Paine MF, Widmer WW, Hart HL, Pusek SN, 8 Santos CA, Boullata JI: An approach to eval-
Shils ME, Shike M, Ross AC, Caballero B, Beavers KL, Criss AB, Brown SS, Thomas BF, uating drug-nutrient interactions. Pharma-
Cousins RJ (eds): Modern Nutrition in Watkins PB: A furanocoumarin-free grape- cotherapy 2005;25:1789–1800.
Health and Disease. Baltimore, Lippincott fruit juice establishes furanocoumarins as 9 Spinewine A, Schmader KE, Barber N,
Williams & Wilkins, 2006, pp 1540–1553. the mediators of the grapefruit juice-felodi- Hughes C, Lapane KL, Swine C, Hanlon JT:
2 Chan LN: Drug-nutrient interaction in clin- pine interaction. Am J Clin Nutr 2006; 83: Appropriate prescribing in elderly people:
ical nutrition. Curr Opin Clin Nutr Metab 1097–1105. how well can it be measured and optimised?
Care 2002;5:327–332. 6 Hedenmalm K, Hägg S, Stahl M, Mortimer Lancet 2007;370:173–184.
3 Akamine D, Filho MK, Peres CM: Drug-nu- Ö, Spigset O: Glucose intolerance with atyp- 10 Mallet L, Spinewine A, Huang A: The chal-
trient interactions in elderly people. Curr ical antipsychotics. Drug Safety 2002; 25: lenge of managing drug interactions in el-
Opin Clin Nutr Metab Care 2007; 10: 204– 1107–1116. derly people. Lancet 2007; 370:185–191.
310. 7 Brownie S: Why are elderly individuals at
4 Schmidt LE, Dalhoff K: Food-drug interac- risk of nutritional deficiency? Int J Nurs
tions. Drugs 2002;62:1481–1502. Pract 2006;12:110–118.