IS IT POSSIBLE TO FORECAST FOOD DRUG INTERACTION?
Kamla Pathak
Professor & Head, Department of Pharmaceutics, Pharmacy College Saifai, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, 206130, Uttar Pradesh, India
Keywords: Drug interaction, medication, drugs co-administration o
Abstract

Most people have the mistaken belief that being natural, all herbs and foods are safe. It cannot be said to be true. The herbs and foods may interact with medications taken, that may result in serious side reactions. For the simple reason that like oral medication, food and herbs also traverse the same gastrointestinal path. Hence co-administration of drugs and food/herbs may affect the absorption of the drugs by altering gastric pH, secretion, gastrointestinal motility and transit time; and consequently therapeutic efficacy.

Article Information

Identifiers and Pagination:
Year:2017
Volume:9
First Page:15
Last Page:16
Publisher Id:JAppPharm (2017 ). 9. 15-16
Article History:
Received:June 24, 2017
Accepted:July 27, 2017 First
Collection year:2017
First Published:September 5, 2017

Most people have the mistaken belief that being natural, all herbs and foods are safe. It cannot be said to be true. The herbs and foods may interact with medications taken, that may result in serious side reactions. For the simple reason that like oral medication, food and herbs also traverse the same gastrointestinal path.  Hence co-administration of drugs and food/herbs may affect the absorption of the drugs by altering gastric pH, secretion, gastrointestinal motility and transit time; and consequently therapeutic efficacy (1).

In order to understand drug-food / drug-nutrition interaction, it is important to understand the ADME of the drug in question (2). The impact of drug-food interaction can be assigned to multitude of factors namely, age, weight, sex and state of health of the person; dosage of the drug and the time of administration of the interacting components. Sufficient information about the drug and the timing of medication around food intake can help avoid drug-food interaction (3).  Food may alter hepatic metabolism of some drugs. The flavonoids in grapefruit juice inhibit cytochrome P 450 metabolism of antihypertensives namely felodipine and nifedipine causing enhanced bioavailability (4). This interaction could increase both the efficacy and toxicity of the drugs. There is potential clinical significance, because citrus juices are frequently consumed in breakfast when many medications are taken. Apart from interference in absorption, the foods may alter the urinary pH, which may affect the activity of certain drugs that may influence excretion and hence the half- life.  The half-life of an acidic drug will be extended in acidic urinary pH whereas it would be reduced in alkaline urine. Foods such as milk, vegetables, etc. may alkalinize the urine whereas meats, fish, cheese and eggs can acidify the urine.

Foods may interact with medications by altering their pharmacologic actions. Diets high in vitamin K (turnip greens, green tea, cauliflower, spinach, broccoli, brussels sprouts, chickpeas, pork liver, beef liver) may cause antagonism of warfarin and decrease its therapeutic efficacy (5). As stated the timing of administration is very important to avoid drug food interaction. For example to avoid interaction, calcium rich dairy products and calcium supplements should be taken two hours before or six hours after administration of  fluoroquinolones ( ciprofloxacin, norfloxacin)/ tetracyclines/ biphosphonates( aldendronate, risedronate & ibadronate). 

When fruit juices or vegetables are co-administered with drugs, interaction at pharmacokinetic level is possible. The drug-phytochemical interaction may not be manifested as therapeutic failure but certain adverse events may take place. For e.g. grape juice blocks cytochrome P 450 and IA2 (CYP3A4 and CYO1A2) in intestinal area; hence should not be taken with certain antihypertensive drugs and cyclosporine as it may lead to higher levels of drugs (6). Thus the interactions need to be well defined.

Extensive research inputs are needed for identification of this kind of interactions. Possibly some alterations/ evolution of drug release test methodologies may be seen as methods to forecast the interactions. In future, this may become integral part of new drug approval process. However, in the current scenario, a pharmacist can help avoid drug-food interactions by practicing proactively. 

References

  1. Yaheya M, Ismail M, Drug food interactions and role of pharmacist, Asian J Pharm Clin Res, 2009,2,1-10.
  2. Zyl VM, The effects of food on nutrition, S Afr J Clin, Nutr, 2011, 24, 38-41.
  3. Hepler CD, Strand LM, Opportunities and responsibilities in pharmaceutical care, Am J Hosp Pharm, 1990, 47, 533-43.
  4. Bailey DG, Spence JD, Munoz C, Arnold JMO. Interaction of citrus juices with felodipine and nifedipine. Lancet. 1991; 337:268–269.
  5. http://www.mayoclinic.org/diseases-conditions/thrombophlebitis/expert-answers/warfarin/faq-20058443. Accessed 21 June 2017.
  6. Bailey DG, Malcom J, Arnold O, Spence JD, Grapefruit juice-drug interactions, Br J Clin Pharmacol,  1998,  46(2): 101–110.

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Editor in Chief
Prof. Dr. Cornelia M. Keck (Philipps-Universität Marburg)
Marburg, Germany

Bibliography

Welcome to the research group of Prof. Dr. Cornelia M. Keck in Marburg. Cornelia M. Keck is a pharmacist and obtained her PhD in 2006 from the Freie Universität (FU) in Berlin. In 2009 she was appointed as Adjunct Professor for Pharmaceutical and Nutritional Nanotechnology at the University Putra Malaysia (UPM) and in 2011 she obtained her Venia legendi (Habilitation) at the Freie Universität Berlin and was appointed as a Professor for Pharmacology and Pharmaceutics at the University of Applied Sciences Kaiserslautern. Since 2016 she is Professor of Pharmaceutics and Biopharmaceutics at the Philipps-Universität Marburg. Her field of research is the development and characterization of innovative nanocarriers for improved delivery of poorly soluble actives for healthcare and cosmetics. Prof. Keck is executive board member of the German Association of Nanotechnology (Deutscher Verband Nanotechnologie), Vize-chairman of the unit „Dermocosmetics“ at the German Society of Dermopharmacy, active member in many pharmaceutical societies and member of the BfR Committee for Cosmetics at the Federal Institute for Risk Assessment (BfR).

Journal Highlights
Abbreviation: J App Pharm
doi: http://dx.doi.org/10.21065/19204159
Frequency: Annual 
Current Volume: 9 (2017)
Next scheduled volume: December, 2018 (Volume 10)
Back volumes: 1-9
Starting year: 2009
Nature: Online 
Submission: Online  
Language: English

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