Guidelines to Lower Risk of Drug-Nutrient Interactions

1. Guidelines to Lower Risk of Drug-Nutrient Interactions Presented by Janice Hermann, PhD, RD/LD OCES Adult and Older Adult Nutrition Specialist

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. Drug-Nutrient Interactions:Nutrient Absorption (cont.) • Examples: • Some anticonvulsants can compete for absorption with folate resulting in decreased folateabsorption • 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

11. Drug-Nutrient Interactions:Nutrient Production • Some medications can affect nutritional health by slowing down nutrient production

12. 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

13. 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

14. 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

15. Drug-Nutrient Interactions:Nutrient Excretion • Some medications can affect nutritional health by increasing nutrient excretion due to: • Decreased kidney reabsorption • Increased urinary excretion

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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 oxidaseinhibitor, which can result in dangerously high blood pressure • Vitamin K • Structurally similar to the anticoagulant warfarin which can decrease the effectiveness of warfarin

27. 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

28. 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 quinidineexcretion

29. 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

30. 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

31. Alcohol Interacts With Medications • A rule of thumb is to avoid alcoholic beverages when taking prescription and over-the-counter medications

32. 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

33. Follow Directions • It is very important to follow the directions on how to take a medication • Many people do not take prescription or over-the-counter medications properly • Following directions on how to take a medication can affect how or if a medication will work properly

34. Who Is At Greater Risk • Persons who are poorly nourished • Persons with serious health problems • Growing children • Pregnant women • Older adults

35. Who Is At Greater Risk (cont.) • Persons taking two or more medications at the same time • Persons using prescription and over-the-counter medications together • Persons not following medication directions • Persons taking medications for long periods of time • Persons who drink alcohol excessively

36. 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

37. 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

38. 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