Medications, Herbal

Supplements, & Diet-Drug

Interactions
Chapter 15

Nutrition & Diet Therapy (7th Edition)

Medications in Disease
Treatment
Medications used to prevent & treat health
problems
Herbal supplements often used as
alternative therapy
Any ingested chemical can affect
metabolism & produce adverse effects
Drug-drug interactions
Diet-drug interactions

Nutrition & Diet Therapy (7th Edition)

Medications in Disease
Treatment (cont)
Prescription drugs

Use requires physician evaluation of

patients condition

Given to treat serious

conditions
May cause severe side effects

Over-the-counter drugs

Can be used safely & effectively

without medical supervision

Used for less serious

conditions
May cause adverse effects,
especially if used
inappropriately

Generic drugs

Chemically identical & act the

same as original drug
Cost significantly less than brandname counterparts

Nutrition & Diet Therapy (7th Edition)

Although OTC drugs are

considered safe enough for
self-medication, they can
cause adverse effects when
used inappropriately

Medications in Disease
Treatment (cont)
Risks from
medications
Any drug carries some
risk of adverse reaction
Drug considered safe
when benefits of use
outweigh potential risks
Risks greater when
incorrectly used
(prescribed &/or
administered)

Nutrition & Diet Therapy (7th Edition)

Potential Risks
Side effects
Drug-drug interactions
Diet-drug interactions
Medication errors-see
Table 15-1, Inappropriate
Abbrev., p.440

Medications in Disease
Treatment (cont)
Elderly people using multiple
meds are especially
susceptible to adverse effects

Patients at greatest risk

Pregnant & lactating
women
Children
Older adults
Individuals with medical
conditions that were not
studied during drug
development

Health professionals should

discuss risks & benefits of
medications; alert patients
to potential dangers &
solutions

Nutrition & Diet Therapy (7th Edition)

Medications in Disease
Treatment (cont)
Reducing risk
Patient counseling & education
Discussion of lifestyle or dietary practices as
alternatives to drug therapy
Assessment of all medications, including
prescription, OTC & dietary supplements
Monitoring side effects
Assessment of patient understanding of
medication use, interactions & drug safety

Nutrition & Diet Therapy (7th Edition)

Herbal Supplements
Widely used by consumers
to improve general health
& prevent or treat specific
illnesses
Do not require FDA
approval before marketing
FDA must show that herbal
supplement is unsafe
before it can be removed
from marketplace (ex.
ephedrine)

Nutrition & Diet Therapy (7th Edition)

Manufacturers &
distributors are responsible
for determining safety
Not required to provide
evidence
FDA notification of illness
or injury related to use of
product is not required

Effectiveness & Safety

Benefits of use of herbal products is unclear
Many herbal remedies of dubious effectiveness
Efficacy: limited number of studies to support traditional
uses & benefits
Consistency in ingredients: variations occur in composition
of herb & in preparation; may contain harmful components
Safety issues: products often considered natural,
therefore safe; may have toxic effects, howeversome
serious, even dangerous
Interactions: may potentiate or interfere with actions of
other herbs or drugs
Contamination: some products found to contain lead &
other toxic metals; other contaminants include molds,
bacteria, pesticides
Adulteration of imported products, including addition of
synthetic drugs not identified on labels
Nutrition & Diet Therapy (7th Edition)

Nutrition & Diet Therapy (7th Edition)

Use of Herbal Products in

Illness
Self-medication & herbal remedies
may delay appropriate treatment &
allow progression of illness
Herbal products may interact with
other medicationslack of research
makes assessment of interactions
difficult
Herbal products are not reliable
treatment for medical conditions

Nutrition & Diet Therapy (7th Edition)

Diet-Drug Interactions
Diet-drug interactions fall into the following
categories:
Medications can alter food intake by suppressing
appetite or causing complications that interfere with
food intake
Medications can alter absorption, metabolism &
excretion of nutrients
Nutrients & other food components can alter
absorption, metabolism & excretion of medications
Some interactions between food components &
medications can be toxic

Nutrition & Diet Therapy (7th Edition)

Diet-Drug Interactions
(cont)
Drug Effects on Food Intake
Reduce food intake through

Nausea & vomiting

Alteration of taste sensations
Suppression of appetite
Drying mouth, inflammation or lesions in mouth or GI
tract
Side effects, including abdominal discomfort,
constipation, diarrhea
Drowsiness
Other symptoms-p. 447 Table 15-5
Ex: sedatives

Nutrition & Diet Therapy (7th Edition)

Diet-Drug Interactions
(cont)
To prevent diet-drug
interactions, find out about all
Drug effects on nutrient absorption
the drugs & supplements a
Damage of intestinal mucosa:
patient takes
most widespread cause of problems

with nutrient absorption; especially

antineoplastic & antiretroviral
medications

Drug-nutrient binding:

binding of nutrients & drugs in GI

tract, preventing absorption (ex.
Ciprofloxacin)

Altered stomach acidity:

resulting in impaired absorption of

vitamin B12, folate & iron (ex.
Antacids)

Direct inhibition:

drugs that impede nutrient absorption

by interfering with intestinal
metabolism or transport

Nutrition & Diet Therapy (7th Edition)

Diet-Drug Interactions
(cont)
Dietary effects on drug absorption
Stomach emptying rate: taking medications on empty
stomach tends to increase absorption rate; taking
medications on full stomach may delay its absorption rate
(ex. Aspirin)
Stomach acidity: absorption rates affected by acid or
alkaline medium
Interactions with food components: may bind with drugs &
inhibit absorption

Drug effects on nutrient metabolism

Enhancement or inhibition of activities of enzymes needed
for nutrient metabolism (ex. Methotrexate with folate)
Alteration in absorption & metabolism

Nutrition & Diet Therapy (7th Edition)

Diet-Drug Interactions
(cont)
Dietary effects on drug metabolism

Alteration in activities of enzymes that metabolize

drugs

Increased blood concentration of drug (stronger

physiological effects)-ex. Grapefruit and statins
Decreased effectiveness of drug (ex. Warfarin and vitK)

Counteraction of drug effects in other ways

Drug effects on nutrient excretion

Alteration in mineral reabsorption

Increased excretion of vitamins & minerals (ex. INH
and vit. B6)

Nutrition & Diet Therapy (7th Edition)

Diet-Drug Interactions
(cont)
Dietary effects on drug excretion
Alterations in excretion causing toxicity or reduced
effectiveness of the drug
Increased or decreased reabsorption (ex. Li and Na)
Alterations in drug actions

Diet-drug interactions & toxicity

Interactions can result in toxicity or exacerbate drug
side effects (ex. MAOI and tyramine)
Health professions must understand mechanism of
action of drugs & diet-drug interactions for
identification &/or prevention
Nutrition & Diet Therapy (7th Edition)

Nutrition in Practice
Complementary & Alternative
Therapies

Use of complementary & alternative medicine (CAM)

most prevalent among individuals with chronic,
debilitating diseases
Reasons for popularity include growing interest in selfhelp measures & non-invasive nature of the therapies
National Center for Complementary & Alternative
Medicine established in 1998
One of institutes making up the National Institutes
of Health
Mission is to investigate CAM through scientific
studies and to provide authoritative information to
consumers & health care professionals
Health professionals need to be familiar with CAM so
they can communicate with patients & offer advice

Nutrition & Diet Therapy (7th Edition)

Nutrition & Diet Therapy (7th Edition)

Nutrition in Practice
Complementary & Alternative
Therapies
Role of health practioner
Identify & communicate with patients who are
using CAM
Educate patients regarding hazards of
postponing or discontinuing conventional
therapy
Educate patients regarding possible
interactions & adverse reactions
Identify ways to integrate CAM & conventional
treatment
Practitioner needs to regularly update knowledge
of alternative therapies in order to knowledgably
discuss options with patients
Nutrition & Diet Therapy (7th Edition)