2. Nutrient-drug interaction Lecture 23 April 16, 2015 Dr. Quadro Adapted from “Preventig Food and Drug Interactions”, University of Georgia Cooperative Extension Service

3. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Definition of drug Medicine that helps recover from illness Illegal substance that leads to bodily harm and addiction Any substance that modifies one or more body functions

4. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Multiple effects of drugs For example, Aspirin…. Limits production of prostaglandins Prostaglandins help to produce fevers, sensitize pain receptors, cause contractions of the uterus, stimulate digestive tract motility, control nerve impulse, regulate blood pressure, promote blood clotting, cause inflammation. By interfering with prostaglandin actions, aspirin may have multiple effects!

5. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104  Nutrient-drug interaction can lead to nutrient imbalance or it can interfere with drug effectiveness  Adverse interactions occur most likely if drugs are taken over long periods, if several drugs are taken or if nutrition status is poor  Elderly people with chronic diseases are most vulnerable

6. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 “Life-cycle” of a Drug  Dissolve in stomach  Absorbed in blood and moves to where needed  Exerts its action  Eliminated

7. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Action of a Food/Nutrient  Digestion in stomach  Absorbed in blood and moves to where needed  Exerts its action  Stored or eliminated (if not needed)

8. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Malnutrition Effect on Drugs Low albumin can make a drug less effective: -Warfarin and phenytoin are protein bound in blood; ↓ albumin can result in poor seizure control (phenytoin) or hemorrhage (warfarin) Body composition: obese people have a higher ratio of adipose vs. lean tissue; fat soluble drugs may accumulate in the body ↑ risk of toxicity

9. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Type of interactions Drugs can alter food intake, absorption, metabolism and excretion of nutrients Foods and nutrients can alter absorption, metabolism and excretion of drugs

10. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Nutrient-Drug Interactions Copyright 2005 Wadsworth Group, a division of Thomson Learning

11. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Drug-induced alteration of food intake can cause malnutrition but can also cause undesirable weight gain (for example, astemizole -antihistamine used to relive allergy symptoms)

12. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 KNOW YOUR DRUG

13. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Copyright 2005 Wadsworth Group, a division of Thomson Learning

14. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 An unexpected concern – Grapefruit (and tangelos) Can cause more of a drug to be absorbed from intestine – even toxic levels Interfere with the activity of a specific enzyme in the intestine – cytochrome p450

15. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104

16. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Drugs known to interact with grapefruit juice Anti-hypertensives (filodipine, nifedipine, nimodipine, nicardipine, isradipine) Immunosuppressants (cyclosporine, tacrolimus) Antihistamines (astemizole) Protease inhibitors (saquinavir) Lipid-Lowering Drugs (atorvastatin, lovastatin, simvastatin) Anti-anxiety, anti- depressants (buspirone, diazepam, midazolam, triazolam, zaleplon, carbamazepine, clomipramine, trazodone

17. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Drugs may not work when dairy products are consumed (calcium) Tetracycline Antifungal medicines –Examples Diflucan and Nizoral Drugs may require dairy products to work Progesterone supplementation

18. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 High Blood Pressure Medicine May need more or less potassium in your diet depending on the medicine (diuretics) Examples of high potassium foods – bananas, oranges, potatoes, leafy green vegetables, tomatoes

19. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Don’t mix a drug directly into a food or drink

20. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Know Whether the Drug Should Be Taken on a Full or Empty Stomach

21. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Copyright 2005 Wadsworth Group, a division of Thomson Learning

22. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Coumadin and Vitamin K structural analog Coumadin prevents clots; Vit K helps to make clots Keep intake of foods containing Vitamin K constant Vitamin K is high in spinach, kale, turnip greens, cauliflower, broccoli, brussel sprouts and other leafy greens Also don’t take Vitamin K supplements

23. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Copyright 2005 Wadsworth Group, a division of Thomson Learning Used in cancer therapy Displaces folate (antagonist) and causes folate deficiency Methotrexate Folate

24. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Tyramine – derived from amino acid tyrosine stimulates the release of other neurotransmitters that influence blood pressure. Monoamine Oxidase inactivates (metabolizes) tyramine. Monoamine oxidase inhibitors (MAOi) are prescribed to treat severe depression. blocks inactivation of tyramine in brain. if taking MAOi, increase tyramine, increase blood pressure……If blood pressure rises high enough, it can be fatal! Occurs widely in plants and animals – found is some foods

25. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 MOA Inhibitors Common brands – Nardil and Parnate Must restrict some foods containing tyramine to prevent possible fatal rise in blood pressure

26. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 MOA Inhibitors No beer, red wine or other alcohol No cheddar, American, bleu, brie, Parmesan or mozzarella cheese No beef or chicken liver, cured meats, game meat, caviar or dried fish

27. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 MOA Inhibitors No avocados, bananas, soy sauce, miso soup, saurkraut No ginseng, broad or fava beans or food or beverages containing caffeine like coffee, chocolate, cola drinks, tea

28. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Copyright 2005 Wadsworth Group, a division of Thomson Learning

29. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Coumadin – blood thinner Dilaritin – anti-seizure Norvasc – anti-hypertension Aspirin/Anti-inflammatory Oral Contraceptives Dyazide – diuretic Tetracycline – Antiboitic Lipitor/Statin – Cholesterol lowering Prednisone – corticosteroid Lasix - diuretic DRUGNUTRIENT/FOOD Vitamin K Vitamin D and Folate Deficiency Sodium Decrease Vitamin C Decrease Vitamin B and folate Decrease Potassium Calcium Antioxidants (Vitamin A, E, C) Increase Appetite Decrease Appetite

30. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Take NO Medicines with Alcohol !

31. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Alcohol & Pain Medicine Don’t take with alcohol to prevent stomach bleeding and irritation Don’t have more than 3 drinks per day to prevent liver damage if taking Tylenol Interact with enzymes – reducing effect of medicine Compete – leaving the drug longer - toxic

32. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Alcohol & Other Medicines Can lower blood pressure too much with beta blockers and nitrate containing drugs Can cause liver damage with statin drugs Beta blocker – Inderal, Lopressor Nitrates – Nitro, Transderm Nitro, Isordil Statins – Lipitor, Mevacor, Zocor, Prevachol

33. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Alcohol & Medicines for Depression and Anxiety Never mix with alcohol with any of these drugs! – make you more depressed and anxious Also caffeine may decrease the effectiveness of anti- anxiety drugs

34. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Medicines may contain additional ingredients….. Liquid preparations contain sugar or sorbitol (better taste) - problems for people with diabetes; sorbitol in large doses may cause diarrhea. Lactose add as filler to some medications may cause problems for people who are lactose intolerant. Antibiotics and antacids may contain sodium. For ex., a single dose of AlkaSeltzer may exceed the recommended daily sodium intake. Antacids neutralize stomach acid, and many nutrient depend on acid for their digestion. Regular intake of antacid will reduce nutrient absorption.

35. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 The health-professional and nutrient-drug interactions Remember that interactions occur especially after long term use of medicines Record and review drug and diet histories of patients Identify groups of people who are likely to develop drug- related nutrient deficiency Re-asses nutrition status frequently for high risk patients Become familiar with the nutrient interactions of drugs commonly used to treat the disorder of their patients Provide accurate information and clarify common misconceptions

36. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Who Is At Greater Risk Persons who are poorly nourished Persons with serious health problems Growing children Pregnant women Older adults Pregnant woman/fetus People with allergies/intolerances

37. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 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

38. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 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

39. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 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

40. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 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

41. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Pharmacogenomics Everybody is different The Right Drug To The Right Patient For The Right Disease At The Right Time

42. Department of Food Science Lecture 23: April 16, 2015 Food & Health 400:104 Goals of Pharmacogenomics “Genetic data will allow drugs to be tailored to certain groups of patients Customized pharmaceuticals may eliminate life-threatening adverse reactions Reduced costs of clinical trials Improved demonstrated efficacy of drugs Better matching patients to drugs instead of “trial and error”