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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