Master Degree of Pharmacology

Cairo University
Food Drug Interactions
By: Ayman M. A. Fkirin, Department of Pharmacology,
Fayoum University
Before Starting

Important Definition:

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, By: Candace Roberts,2008)

 Importance of Studying
Food Drug Interaction

To ↓ Food Drug Interactions Therapeutic importance

1) Optimum drug efficacy. 1) Alter the intended response

2) Improved compliance.
3) ↓ need for adding drugs. to the medication
4) Adverse effect are avoided. 2) Cause drug toxicity
5) Optimal nutritional status. 3) Alter normal nutritional
6) The cost of health care status
services is reduced.

(Food- drug interaction, By: Candace Roberts,2008)

MAP 1) Food Affecting Drugs:
a) kinetics:
* Absorption.
* Distribution.
* Metabolism.
* Execration.
b) Dynamic
2) Drug Affecting Food:
a) Absorption.
b) Distribution.
c) Metabolism.
d) Execration.
3) Drug Affecting
Nutritional
state
4) Prevention of
interaction
5) Recommendations.
MAP 1) Food Affecting Drugs:
a) kinetics:
* Absorption.
* Distribution.
* Metabolism.
* Execration.
b) Dynamic
2) Drug Affecting Food:
a) Absorption.
b) Distribution.
c) Metabolism.
d) Execration.
3) Drug Affecting
Nutritional
state
4) Prevention of
interaction
5) Recommendations.
 Absorption

Mechanism:
Change PH
↑ Digestive secretions
Alter rate of Absorption
Bind to drug
Compete for absorption site.
Dilution of drug particles.
Formation of physical barrier.
 Absorption
1) Grapefruit:
- Can cause more of a drug to be absorbed from intestine, even
toxic levels. (new Concern)*
- Active ingredient*:
1) Naringen.
2) Furano-coumarins Examples
3) Bergamot-tin
2) Orange juice:
- Should not consumed with antacid contains AL.
- ↓ bioavailability of some antibiotics
3) Dairy products:
- Interfere with tetracycline, Antifungal
- Exogenous Progesterone may require dairy product to work!!
**
4) Soda pop or high acid fruit or vegetable juices **:
- It is not recommended to take drugs with them.
- Can cause excess stomach acidity.
*Food-Drug Interactions By: Kamal El din EL Tahir, College of Pharmacy, KSU, 2007
**Food Drug interaction, by: Dr. William Diehl-Jones, University of Manitobia, 2005
Distribution

1) ↓albumin ↑ bioavailability of drugs

and potentiate their effect:
- phenytoin  toxicity
- warfarin  bleeding
2) Body composition:
- obese or elderly  higher ratio of
adipose tissue
- So, fat soluble drugs may accumulate
in the body ↑ risk of toxicity

(Food- drug interaction, By: Candace Roberts,2008)

(Food-Medication Interactions 13th edition by Zaneta M. Pronsky)
Metabolism

Mechanism 1) Act as structural analogue

2) Compete for metabolic enzyme.
3) Alter enzyme Activity

Examples 1) Alcohol Interact with enzymes  ↓ drugs effect.

2) Grape Fruit  Interfere with:
- specific enzyme in the intestine
- cytochrome p450.
- Effect persists for 72 hours
3)Food  ↓ first pass metabolism of propranolol.

)Food- drug interaction, By: Candace Roberts,2008(

)Food-Medication Interactions 13th edition by Zaneta M. Pronsky(
Excretion

-Affect Urinary pH
- Acidic Food  ↑ excretion of basic drugs.
- Basic Food ↑ excretion of acidic drugs.

-Lithium and sodium

-compete for tubular reabsorption in the kidney.
- High sodium intake causes more lithium to be
excreted.
- Low sodium intake will cause the kidney to retain
lithium

(Food-Medication Interactions 13th edition by Zaneta M. Pronsky)

 Pharmacodynamic
1) Some foods have additives effects to drugs:
- Caffeine containing food and theophylline.
- Tyramine containing food and MAOI.

(Food and Drug Interaction, by: R. Sudharani, N. Kanmani, P. Augusta, 2007)

(Food-Medication Interactions 13th edition by Zaneta M. Pronsky)
 Pharmacodynamic
1) Some foods have additives effects to drugs:
- Caffeine containing food and theophylline.
- Tyramine containing food and MAOI.
- Alcohol with: - sedatives.
- Beta blockers

2) Some foods have antagonistic effect of drugs:

- Vitamin K (or E*) containing food and oral anticoagulant
- Caffeine containing food and tranquilizers
- High fat diet and antihyperlipidemic drugs
- High glucose diet and hypoglycemic drugs.

3) GINKGO **
- It interferes with platelets clotting
- Many experts recommend that ginkgo not be combined with
NSAID and MAO inhibitors

*)Food and Drug Interaction, by: R. Sudharani, N. Kanmani, P. Augusta, 2007(

**)Food-Medication Interactions 13th edition by Zaneta M. Pronsky(
MAP 1) Food Affecting Drugs:
a) kinetics:
* Absorption.
* Distribution.
* Metabolism.
* Execration.
b) Dynamic
2) Drug Affecting Food:
a) Absorption.
b) Distribution.
c) Metabolism.
d) Execration.
3) Drug Affecting
Nutritional
state
4) Prevention of
interaction
5) Recommendations.
Drug Affecting food Kinetics

1) Absorption:
- Drug form complexes with food  ↓ food absorption
- Drug alters gastric acidity.
- Drug damages mucosal surface.
- Alter gastric motility.

2) Distribution:
- Drug displace Nutrient from protein binding:
e.g. Aspirin displace folate

(Food-Medication Interactions 13th edition by Zaneta M. Pronsky)

Drug Affecting food Kinetics
3) Metabolism:
- Drug increases the metabolism of nutrients  its deficiency.
- Drug causes vitamin antagonism (e.g. INH).

4) Excretion:
- Drug increases urinary excretion of nutrients.
e.g. Loop diuretics  ↑ excretion of Na, K, Cl, Mg, Ca.
- Drug decreases urinary excretion of nutrients.
e.g. Thiazide diuretics  ↓ excretion of Ca.

(Food-Medication Interactions 13th edition by Zaneta M. Pronsky)

MAP 1) Food Affecting Drugs:
a) kinetics:
* Absorption.
* Distribution.
* Metabolism.
* Execration.
b) Dynamic
2) Drug Affecting Food:
a) Absorption.
b) Distribution.
c) Metabolism.
d) Execration.
3) Drug Affecting
Nutritional
state
4) Prevention of
interaction
5) Recommendations.
Drugs Can Affect Nutritional State by:

A) At the level of the Mouth:

1) Taste & smell affection
- Drug may impair salivary flow
- Drug secreted in saliva
2) Drug may suppress natural oral bacteria
3) Drug may cause taste change. M

b) At level of stomach and intestine:

1) Drug irritate stomach
2) Drug affect intestinal peristalsis
3) Drug destroy intestinal bacteria

C) At level of CNS (Appetite changes)

1) Drug suppress appetite (e.g. SSRI)
2) Drug increase appetite: (e.g. Tricyclic antidepressants)
MAP 1) Food Affecting Drugs:
a) kinetics:
* Absorption.
* Distribution.
* Metabolism.
* Execration.
b) Dynamic
2) Drug Affecting Food:
a) Absorption.
b) Distribution.
c) Metabolism.
d) Execration.
3) Drug Affecting
Nutritional
state
4) Prevention of
interaction
5) Recommendations.
Prevention

Take pills and capsules with a large glass of water

Don’t mix a drug directly into a food or drink
Do not stir medication into food or take apart capsules.
Avoid taking drugs with hot drinks.
Take NO Medicines with Alcohol
No Dairy Foods with some drugs.
Foods containing tyramine not to be taken with MAOI.
Re-asses nutrition status frequently for high risk patients
Every drug should be Known Whether Taken on a Full or Empty
Stomach
MAP 1) Food Affecting Drugs:
a) kinetics:
* Absorption.
* Distribution.
* Metabolism.
* Execration.
b) Dynamic
2) Drug Affecting Food:
a) Absorption.
b) Distribution.
c) Metabolism.
d) Execration.
3) Drug Affecting
Nutritional
state
4) Prevention of
interaction
5) Recommendations.
 Recommendations

Doctors should know possible food interactions with the prescribed drug
i.e. from books, researches, web sites.

Doctors should inform patients

about it, And write it clearly on
the back of prescription.

Medication company should write

food interaction in drugs burshour
Before Closing

Summary
Many people eat foods that have hundred of active
substance
 That may counteract or added to action of many drugs.
 Food can affect all levels of drug kinetics and dynamic
 Drugs can affect food kinetics and Nutritional state of
patients.
 Doctors must take good nutritional history of patients of
non-compliance to drugs