Drug and nutrition interactions: not just food for thought

Abstract

Summary What is known and objective The management of drug‐drug interactions – from recognition of the interaction potential, to addressing the negative consequences – are well‐recognized and avoided, or rapidly addressed when identified clinically. Drug‐nutrition interactions are no less important than drug‐drug interactions in patient care. Unfortunately, beyond those caused by food, these interactions are less commonly recognized or identified and managed. This article will re‐introduce the topic of drug‐nutrition interactions to clinicians. Comment Although many clinicians are acutely aware of and vigilant for potential drug‐drug interactions, most are less aware of the possibility of drug‐nutrition interactions beyond classic food‐drug interactions. Interaction can occur between a drug and a nutrient, multiple nutrients, food in general, specific foods or components, or nutrition status. An interaction is considered clinically significant if it alters therapeutic drug response and/or compromises nutrition status. Mechanistically the interactions may be physicochemical reactions, actions at membrane transporters or metabolizing enzymes, or an influence on physiologic function. Appreciating the many types of drug‐nutrition interactions will aid the clinician and have the potential to influence patient outcome. What is new and conclusion Ongoing advances in knowledge about drug and nutrition interactions have potential to improve patient care. Drug‐nutrition interactions need to be better recognized, understood on a mechanistic basis, predicted, and managed as necessary.

Impact of direct drug delivery via gastric access devices

“…Drug--nutrient interactions result from physical, chemical, physiological or pathophysiological relationships not only between a drug and a nutrient but also between a drug and multiple nutrients, food in general, specific foods or components or nutrition status [55,56]. From a clinical perspective, the interaction could be considered significant if it alters the therapeutic response or compromises nutritional status.…”

“…There has been an increased understanding of drug--nutrient interactions and the mechanisms which can influence drug absorption [55,59,60]. As patients with gastric access devices are more prone to these interactions, heightened awareness of recognition and prevention is required among prescribers, pharmacists and drug administrators [56].…”

Is a flavonoid-rich diet with steamer cooking safe during calcineurin inhibitors therapy?

“…However, food–drug interactions may also occur due to changes in the drug's pharmacokinetic and pharmacodynamic and lead to clinically relevant side effects . Recently, Boullata has commented on the potential importance of drug and diet interactions during the management of disease. This article focuses on the assessment of the benefit/risk of a flavonoid‐rich diet during calcineurin inhibitors therapy.…”

Intestinal disposition of quercetin and its phase-II metabolites after oral administration in healthy volunteers

“…The low dietary concentration of flavonoids combined with their poor bioavailability is generally not sufficient to cause FDIs . However, the growing use of herbal extracts and purified flavonoids as dietary supplements may induce sufficiently high concentrations of (unconjugated) flavonoids in the small intestine to cause FDIs . Furthermore, not only the flavonoid aglycones themselves but also their phase‐II metabolites could induce FDIs at various stages of their disposition …”

“…[13] However, the growing use of herbal extracts and purified flavonoids as dietary supplements may induce sufficiently high concentrations of (unconjugated) flavonoids in the small intestine to cause FDIs. [14] Furthermore, not only the flavonoid aglycones themselves but also their phase-II metabolites could induce FDIs at various stages of their disposition. [15,16] Quercetin is a major dietary flavonoid notably present in onions, apples, teas or berries [17] (Figure 1b).…”