19 May 2009

Grapefruit Juice: Interactions with Prescription Drugs



Grapefruit “Juicy” Details on Health Benefits and Drug Interactions
Presentation by:Elaine Turner & Gail Rampersaud, FSHN
University of Florida

Grapefruit Juice: Interactions with Prescription Drugs
Grapefruit Juice: What’s the Story?

Some pills become too potent when you drink grapefruit juice Grapefruit juice and drugs don’t mix
Forbidden Fruit? Grapefruit Juice-Medicine Interaction Studied Grapefruit Takes the Defense Sex, drugs, and grapefruit

Food/Drug Interactions
Food can affect:
* absorption
* utilization
* excretion
Influence can be:
* positive
* negative

Effects of Grapefruit Juice Enhances Absorption
* inhibits an intestinal enzyme
* less metabolism in GI tract
* like giving larger dose

Normal Drug Metabolism
ORAL DOSE
ENZYME
LIVER
GI TRACT
BLOOD
Effect of Grapefruit Juice
Enzyme Inhibition
Effects of Grapefruit Juice
Are All Drugs Affected? – no!

* oral medications only
* low bioavailability
* amount of effect varies

Which Types of Drugs are Affected?
* Antihypertensives
* Immunosuppressants
* “Statins”
* Anti-anxiety, Antidepressants
* Antihistamines
* HIV/AIDS protease inhibitors

Which Types of Drugs are Affected?
* Usually an alternative drug is available
o e.g., Pravachol instead of Lipitor

Consumer Actions
Ask Pharmacist:
Consumer Actions
Ask Physician:
Take Home Message
Media Statements:

* Usually too general
* Talk with pharmacist and physician
* May not need to avoid grapefruit juice

Grapefruit juice and drugs don’t mix.ppt

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Nutrient-drug interaction



Nutrient-drug interaction
Presentation by:Dr. Wassef
Department of Food Science

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

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!
* 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

Action of a Drug

o Dissolve in stomach
o Absorbed in blood and moves to where needed
o Has a reaction
o Eliminated

Action of a Food/Nutrients
o Digestion in stomach
o Absorbed in blood and moves to where needed
o Has a reaction/stored
o Not needed is Eliminated

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

Mix Food, Drink and Drugs Carefully
* Ask doctor questions
* Talk to pharmacist
* Read medicine labels
* Read printed material from pharmacy
* Read inserts provided by manufacturers

Nutrient-Drug Interactions
KNOW YOUR DRUG
Don’t mix a drug directly into a food or drink
Know Whether the Drug Should Be Taken on a Full or Empty Stomach
A New Concern - Grapefruit
* 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

Drugs may not work when dairy products are consumed
* Tetracycline (also no iron supplements)
* Antifungal medicines
o Examples Diflucan and Nizoral
Drugs may require dairy products to work
* Progesterone supplementation

High Blood Pressure Medicine
* May need more or less potassium in your diet depending on the medicine
* Examples of high potassium foods – bananas, oranges, potatoes, leafy green vegetables, tomatoes

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 or E supplements

Used in cancer therapy
Displaces folate (antagonist) and causes folate deficiency
Methotrexate
Folate
Tyramine found in some food.
Monoamine oxidase inhibitors (MAOi)
MOA Inhibitors
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
DRUG
NUTRIENT/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
Take NO Medicines with Alcohol
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
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

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

Medicines may contain additional ingredients…..
The health-professional and nutrient-drug interactions
In Summary

* Tell your doctor and pharmacist about all your medicines
* Take your medicines to every doctor visit
* Learn all you can about your drugs
* Use alcohol and caffeine very cautiously if at all
* Drink plenty of water

Pharmacogenomics
Everybody is different
The Right Drug
To The Right Patient
For The Right Disease
At The Right Time
Goals of Pharmacogenomics

Nutrient-drug interaction.ppt

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Food-Drug Interactions



Food-Drug Interactions

Definition of Terms
* Drug-nutrient interaction: the result of the action between a drug and a nutrient that would not happen with the nutrient or the drug alone
* Food-drug interaction: a broad term that includes drug-nutrient interactions and the effect of a medication on nutritional status

Food-Drug Interaction
* For example, a drug that causes chronic nausea or mouth pain may result in poor intake and weight loss
Key Terms
* Bioavailability: degree to which a drug or other substance reaches the circulation and becomes available to the target organ or tissue
* Half-life: amount of time it takes for the blood concentration of a drug to decrease by one half of its steady state level
* Side effect: adverse effect/reaction or any undesirable effect of a drug

Other Terms
* Bioavailability: % free to function
* Absorption rate: % absorbed and time for absorption
* Transported: amount in blood (free or bound)
* Metabolized: altered by enzymes in tissues
* Mixed-function oxidase system (MFOS): enzyme system that metabolizes drugs, carcinogens, compounds in foods, etc.

Pharmacokinetics
Movement of drugs through the body by
* Absorption
* Distribution
* Metabolism
* Excretion
Pharmacodynamics
Benefits of Minimizing Food Drug Interactions
* Medications achieve their intended effects
* Improved compliance with medications
* Less need for additional medication or higher dosages
* Fewer caloric or nutrient supplements are required
* Adverse side effects are avoided
* Optimal nutritional status is preserved
* Accidents and injuries are avoided
* Disease complications are minimized
* The cost of health care services is reduced
* There is less professional liability
* Licensing agency requirements are met

Therapeutic Importance
Patients at Risk for Food-Nutrient Interactions
* Patient with chronic disease
* Elderly
* Fetus
* Infant
* Pregnant woman
* Malnourished patient
* Allergies or intolerances

Food and Drug-Related Risk Factors
* Special diets
* Nutritional supplements
* Tube feeding
* Herbal or phytonutrient products
* Alcohol intake
* Polypharmacy
* Drugs of abuse
* Non-nutrients in foods
* Excipients in drugs or food

Malnutrition Effect on Drugs
Food/Nutrient Effects on Drugs
Absorption
Food/Nutrient Effects on Drugs
Metabolism
Changes in diet may alter drug action
Grapefruit Inhibits Metabolism of Many Drugs
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

Food/Nutrient Effects on Drug Action: MAOIs
Food/Nutrient Effects on Drug Action: Caffeine
Food/Nutrient Effects on Drug Action: Warfarin
Food/Nutrient Effects on Drug Action: Alcohol
Drug Effects on Nutrition: Metabolism
Drug Effects on Nutrition: Excretion
Drug Effects on Nutrition: Absorption
Drug Side Effects that Affect Nutritional Status
Examples of Drug Categories That May Decrease Appetite
Drugs That May Increase Appetite
Drugs Affecting Oral Cavity, Taste and Smell
Drugs that Affect the GI Tract
Examples of Drug Classes That Cause Diarrhea
Drugs That May Lower
Glucose Levels
Drugs That Raise Blood Glucose
Nutrition Implications of Excipients in Drugs
Nutrition Implications of Excipients in Drugs
Food/Nutrient Effects on Drugs – Enteral Feedings
Enteral Nutrition and Drugs
MNT for Food-Drug Interactions
TJC 2006 Standards Re Education on Medications
Avoiding Food-Drug Interactions: Prospective
Avoiding Food-Drug Interactions: Retrospective
Avoiding Food-Drug Interactions: Example
Summary

Food-Drug Interactions.ppt

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