PENGARUH DIET (ZAT GIZI)

TERHADAP METABOLISME
OBAT

Almira Sitasari
(Slide dibuat oleh Isti Suryani dengan
perbaikan)
Pengaruh Status Gizi pada
Metabolisme Obat
 Low albumin levels can make drugs more
potent by increasing availability to tissues
 Lower doses
 Warfarin and phenytoin are highly protein
 Body composition:
(related to risk of toxicity)
OBAT DAN WAKTU
MENGKONSUMSINYA
Makanan dan Efek Meningkatkan

 Obat yg efeknya dpt ditingkatkan oleh

mkn & biasanya hrs dimakan bersamaan
dng mkn agar didapatkan efek yg tetap.
 Contoh : obat jantung pemblok beta
(Blocadren Unt mencegah angina unt
menormalkan kembali denyut jantung yg
tdk beraturan dan menanggulangi
tekanan darah tinggi)
Makanan dan Efek Menurunkan

 Gunakan satu jam sebelum makan

atau 2 jam sesudah makan
 Contoh : Kaptopril digunakan unt
menanggulangi tekanan darah
tinggi dan laju jantung
PENGARUH DIET
PROTEIN

Dibutuhkan untuk sintesis enzim yg

memetaboliser obat , kekurangan
protein dapat berakibat penurunan
metabolisme obat shg obat lebih
lama tinggal di dalam tubuh
(ekskresi mjd lambat). Kelebihan
juga akan mengakibatkan efek obat
berkurang
Makanan berprotein tinggi ( daging,
Produk susu) – Levedopa

 Efek Levedopa dpt berkurang. Obat

ini dipergunakan unt mengendalikan
tremor pada penderita penyakit
Parkinson.
Akibatnya kondisi penderita tidak
bisa terkendali dengan baik.
Susu & Produk susu – Antibiotika
tetrasiklin

 Efek tetrasiklin mjd berkurang.

Antibiotika unt melawan infeksi.
Untuk mencegah interaksi gunakan
tetrasiklin satu jam sebelum atau 2
jam sesudah minum susu atau
produk susu ~ chelat
 Kecuali : doksisiklin dan monosiklin
(minocin)
LEMAK

 Lemak dibutuhkan oleh enzim

pemetabolisme obat sebagai
komponen membran dan interaksi
spesifik. Asam linoleat dan asam
arakhidonat penting untuk
mengendalikan metabolisme obat
Makanan berlemak - Griseofulvin

 Efek Griseofulvin dpt meningkat.

Obat ini diberikan secara oral untuk
mengobati infeksi jamur pada
rambut, kulit, kuku tangan dan
kuku kaki.
 Sebaiknya ditelan bersamaan
dengan mkn berlemak : susu,
alpukat, kue-kue dll
KARBOHIDRAT

 Efek Karbohidrat thd metabolisme

obat sedikit. Tetapi KH dpt
menghambat metabolisme
Barbiturat shg waktu tidur mjd lebih
panjang.
 Kadar glukosa yg tinggi
mengakibatkan kandungan sitokrom
pemetabolisme obat mjd turun
Makanan ber KH - Asetaminofen

 Efek Asetaminofen dpt berkurang .

Asetaminofen adl obat penghilang
nyeri dan demam.
TERIMA KASIH
VITAMIN & MINERAL

 Vitamin Larut Air : B, C

 Vitamin larut lemak : A, D, E & K
 Mineral
Vitamin B

 Riboflavin (B2)– Asam Borat

 Kombinasi ini dpt menghilangkan
Riboflavin dari tubuh. Akibatnya
terjadi kekurangan vitamin B2
 Sumber Asam Borat : Obat kumur,
salep kulit, supositoria wasir
 Vit B6 (Piridoksin) – Pil KB
 Vit B6 (Piridoksin) – Estrogen
 Vit B6 (Piridoksin) – Hidralazin
(hidralazine : menanggulangi tekanan
darah tinggi)
 Vit B6 (Piridoksin) – Isoniazida (TBC)
 Vit B6 (Piridoksin) – Levedopa
(penggunaan Sinemet akan mengurangi
interaksi)
 Sumber B6 : pisang, kuning telur,
daging, kacang, sereal
Anemia sideroblastik
 Vit B12 – Kalium Klorida penderita
tekanan darah tinggi yg
menggunakan diuretika sering
diberikan tambahan Kalium klorida
krn tubuh sering kehilangan kalium
 Pengganti NaCl : Adolph’s Salt
Substitute, morton salt Substitute,
NoSalt, NuSalt
 Vit B9 (Asam Folat) – Barbiturat (Pil
Tidur)
 Vit B9 (Asam Folat) – Fenitoin (Obat
kejang pada penderita ayan), tambahan
asam folat yg terlalu banyak akan
mengurangi efek Fenetoin
 Vit B9 (Asam Folat) – sulfasalazin
(Obat unt Kolitis Ulseratif)
Vitamin C
 Vit C – Aspirin. Vitamin C takaran tinggi
(lebih dari 2000 mg) setiap harinya dpt
meningkatkan kadar darah aspirin hingga
mjd toksik
 Vit C – Barbiturat
Terjadi perpanjangan efek Barbiturat
 Vit C – Pil KB
Resiko hamil dpt meningkat jika
digunakan vit C takaran tinggi
(1000 mg atau lebih setiap
harinya). Penggunaan takaran 250 -
500 mg dpt mengurangi interaksi
 Vit C – Quinidine
menurunkan efek quinidine
 Vit C – Primidon
vit c menurunkan efek primidon
(Obat ayan)
 Vit C – Uji Glukosa air kemih
Terjadi kesalahan kadar glukosa
Vit A D E K

 Vit A, D, E, K – Minyak mineral

(Pencahar) >> gangguan absorpsi
 Vit A, D – Kolestiramin

(Obat penurun kolesterol)

Monitoring for
Food-Drug Interactions
 Prospective: MNT offered when the patient
first starts a drug
 Retrospective: evaluation of symptoms to
determine if medical problems might be the
result of food-drug interactions
 Avoiding Food-Drug Interactions:
Prospective

 When medications are initiated, patients should

be provided with complete written and verbal
drug education at an appropriate reading level
including food-drug interaction information
 Patients should be encouraged to ask specific
questions about their medications and whether
they might interact with each other or with
foods
 Patients should read the drug label and
accompanying materials provided by the
pharmacist
Avoiding Food-Drug Interactions:
Prospective
 In acute-care settings, patients receiving
high risk medications should be identified
and evaluated
 Nurses should have information regarding
drug-food interactions and drug
administration guidelines available at the
bedside
 Med pass times should be evaluated in light
of potential food-drug interactions
Avoiding Food-Drug Interactions:
Prospective
 Systems should be established so that
pharmacists can communicate with food
and nutrition staff regarding high risk
patients
Avoiding Food-Drug Interactions:
Retrospective
 Clinicians including dietitians should obtain a
full drug and diet history including the use of
OTC and dietary supplements and review
potential drug-food interactions
 A plan should be developed for dealing with
potential drug-food interactions for short and
long term drug therapy
 When therapeutic goals are not met, clinicians
should ask questions about how and when
drugs are being taken in relation to foods and
nutritional supplements
Avoiding Food-Drug Interactions:
Retrospective
 Clinicians should evaluate whether medical
problems could be the result of drug-food
interactions
 Often it may be the dietitian who is most
aware of these issues
Avoiding Food-Drug Interactions:
Example
 A 20-year-old disabled patient who was a
long term resident of a nursing home was
admitted to an acute care hospital for a
workup to determine the cause of chronic
diarrhea
 The enteral feeding had been changed
numerous times in an effort to normalize
the patient’s bowel function
 The patient was currently receiving a
defined formula feeding at a slow rate
Avoiding Food-Drug Interactions:
Example
 The workup revealed no apparent medical
reason for the impaired bowel function
 After reviewing the pts medications, the
dietitian suggested that the patient’s
medications (given in liquid elixir forms
containing sugar alcohols) might be causing
the diarrhea
 The patient’s medications were changed, and
the diarrhea resolved
 The patient returned to the nursing home on
a standard enteral feeding formula
Summary

 Most drugs have nutritional status

side effects.
 Always look for therapeutically
significant interactions between food
and drugs
 Identify and monitor high risk
patients, those on multiple
medications and marginal diets
Daftar Pustaka
Brandt R, Guyer KE, Banks WL Jr. 1977. Urinary Glucose and Vitamin C. Am J
Clin Pathol. Nov;68(5):592-4.

Frey HH dan Janz D (Ed). 1985. Antiepileptic Drugs. Berlin : Springer-Verlag

Fernstrorm JD. 2013. Large neutral amino acids: dietary effects on brain
neurochemistry and function. Amino Acids. Sep;45(3):419-30. doi:
10.1007/s00726-012-1330-y

Mahan, Kathleen dan Sylvia Escott-Stump. 2004. Krause’s : Food, Nutrition,

and Diet Therapy 11th ed. Philadelphia : Saunders

McCabe BJ, Frankel EH, Wolfe JJ. 2003. Handbook of Food-Drugs Interactions.
Florida : CRC Press

Stargove, Treasure, dan McKee. 2008. Herb, Nutrient, and Drug Interactions :
Clinical Implications and Therapeutic Strategies. Missouri : Elsevier
“Let food be thy medicine”- Hippocrates

TERIMA KASIH