Name: Amira Khalid Mouraya

ID: 201906021

1. Effects of Drug-nutrient interaction on bioavailability of drugs.

Food intake exerts a complex influence on the bioavailability of drugs. It may

interfere not only with tablet disintegration, drug dissolution and drug transit through
the gastrointestinal tract, but may also affect the metabolic transformation of drugs in
the gastrointestinal wall and in the liver. Different food components can have
different effects, and food may interact in opposite ways, even with drugs that are
chemically related.

As judged mainly from single meal, single dose studies, food intake enhances the
bioavailability of several different drugs, such as propranolol, metoprolol,
hydrallazine, hydrochlorothiazide, canrenone (from spironolactone), nitrofurantoin,
erythromycin (stearate), dicoumarol, phenytoin and carbamazepine, but reduces that
of drugs such as isoniazid, rifampicin, tetracycline, penicillin and ampicillin, while
having no consistent effect on the bioavailability of metronidazole, oxazepam,
melperone, propylthiouracil, sulphasomidine and sulphonylureas. For some drugs
such as digoxin and paracetamol, the rate but not the extent of absorption is reduced.

2. Clinical Significance of Drug-nutrients Interaction.

Drugs have the potential to interact with nutrients potentially leading to reduced
therapeutic efficacy of the drug, nutritional risk or increased adverse effects of the
drug. Despite significant interest in such interactions going back to over more than 40
years, the occurrence and clinical significance of many drug-nutrient interactions
remains unclear. However, interactions involving drugs with a narrow therapeutic
margin such as theophylline and digoxin and those that require careful blood
monitoring such as warfarin are likely to be those of clinical significance. Drugs can
affect nutrition as a result of changes in appetite and taste as well as having an
influence on absorption or metabolism of nutrients. Moreover, foods and supplements
can also interact with drugs, of which grapefruit juice and St John's wort are key
examples. Significant numbers of people take both supplements and medication and
are potentially at risk from interactions.

Multiple drug regimens carry the risk of adverse interactions. Precipitant drugs
modify the object drug's absorption, distribution, metabolism, excretion or actual
clinical effect. Non-steroidal anti-inflammatory drugs, antibiotics and, in particular,
rifampin are common precipitant drugs prescribed in primary care practice. Drugs
with a narrow therapeutic range or low therapeutic index are more likely to be the
objects for serious drug interactions. Object drugs in common use include warfarin,
fluoroquinolones, antiepileptic drugs, oral contraceptives, cisapride and 3-hydroxy-3-
methylglutaryl coenzyme A reductase inhibitors. Many other drugs, act as precipitants
or objects, and a number of drugs act as both.
3. Explore the various effects of vitamin on drug action

Certain dietary supplements can change absorption, metabolism, or excretion of a

medication and therefore affect its potency. You may be getting either too much or
too little of a medication you need.

Consequently, combining dietary supplements and medications could have dangerous

and even life-threatening effects. For example, drugs for HIV/AIDS, heart disease,
depression, treatments for organ transplants, and birth control pills are less effective
when taken with St. John’s Wort, an herbal supplement. Depending on the medication
involved, the results can be serious.

In addition, warfarin (a prescription blood thinner), ginkgo biloba (an herbal

supplement), aspirin and vitamin E (a supplement) can each thin the blood. Taking
any of these products together may increase the potential for internal bleeding or
stroke.

Children, in particular, could be harmed by taking both supplements and medicines.

Parents should know that children’s metabolisms are so unique, that at different ages
they metabolize substances at different rates. For kids, ingesting dietary supplements
together with other medications make adverse events a real possibility.

If you’re planning a surgery, be aware that some dietary supplements can interact in a
harmful way with medications you need to take before, after, or during that surgery.
Your health care professional may ask you to stop taking dietary supplements two or
three weeks before the procedure to avoid potentially dangerous changes in heart rate,
blood pressure, or bleeding risk.

And if you’re pregnant or breastfeeding, you’ll want to discuss any dietary

supplements with your health care professional.

4. Effects of Anti-acids on Minerals Metabolism

Side effects of antacid therapy are dose dependent and compound related. High dose
antacid intake may lead to fluid retention in the body depending on the sodium
content of the different antacid preparations. Sodium bicarbonate ingestion provokes
metabolic alkalosis and alkaliuria, the "non-systemic calcium and magnesium
containing antacids" cause these changes too, but to a lower degree. Urinary pH
elevation favors the precipitation of calcium and magnesium salts, predisposing to
renal stone formation. In patients with renal insufficiency the calcium and magnesium
absorption may lead rapidly to toxic serum concentrations. Calcium and magnesium
containing acids may provoke an acid rebound, which is clinically not relevant
following magnesium-hydroxide-ingestion. Phosphorus depletion is an important side
effect of aluminum hydroxide intake. The phosphorus depletion syndrome combined
with skeletal demineralization and osteomalacia may occur. As well as calcium and
magnesium cations the tribasic aluminum will be absorbed from the gut in small
amounts. In patients with renal insufficiency aluminum deposition in the brain grey
matter following Al(OH)3 ingestion will occur and seems to be a co-factor for the
development of a dialysis encephalopathy syndrome.
References

1. https://link.springer.com/article/10.2165/00003088-197803050-00001
2. https://www.fda.gov/consumers/consumer-updates/mixing-medications-and-
dietary-supplements-can-endanger-your-health
3. https://europepmc.org/article/med/6858403
4. https://pubmed.ncbi.nlm.nih.gov/20509982/
5. https://www.aafp.org/afp/2000/0315/p1745.html