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PRACTICE
AND SKILL What is Involved in Screening for Drug-Nutrient Interactions?
› Drug-nutrient interactions are alterations of a drug’s pharmacokinetics (i.e., rate of
absorption, bioavailability, distribution, and rate of excretion) and/or pharmacodynamics
(i.e., the drug’s effects on the body) by a component of the diet, including a nutritional
supplement, as well as changes in the ability to absorb or metabolize a nutrient due to the
effects of a medication. Decreased drug efficacy, increased drug toxicity, or nutritional
deficiency can occur
• What: Screening for drug-nutrient interactions is the process of identifying nutrients
and medications that interact in a way that can compromise the nutritional status of the
patient and/or the effectiveness of the drug therapy. Screening may be indicated when
the efficacy of a prescribed drug is suboptimal, when nutritional status unexpectedly
changes, or when blood testing indicates a toxic drug level
• How: The patient’s diet is screened for components that are known to interact with a
medication he or she is taking. If any are found, either a change is made in the patient’s
diet or an alternative medication is selected to avoid the interaction. The risk for
drug-nutrient interactions can be reduced by limiting the number of medications the
patient is taking to only those that are absolutely necessary and by using medications for
as short a period as possible
• Where: Screening for drug-nutrient interactions may be done in inpatient, outpatient, and
home settings
• Who: A registered dietitian (RD), nursing personnel, or pharmacy personnel may
take part in the screening process. Patient education is provided to encourage active
participation in the detection of possible drug-nutrientinteractions and in changes to the
pharmaceutical/dietary plan. It is appropriate for family members to be present during
patient education about possible drug-nutrient interactions
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Facts and Figures
› Nutrient-drug interactions are a frequent cause of adverse drug reactions and the fourth leading cause of death in hospitalized
patients (McCabe, 2004)
› Use of dietary supplements is very common in the United States; an estimated 54% of adults in the U.S. take at least 1
dietary supplement and ~ 10% take 5 or more supplements (Bailey et al., 2011)
• Use of dietary supplements increases with age; ~ 70% of adults > 71 years report regular use of dietary supplements
› Older patients are at particularly high risk for drug-nutrient interactions because they are often prescribed several
medications at a time (i.e., polypharmacy)(Salazar et al., 2007; Genser, 2008)
› Mayo Clinic researchers who surveyed 1,795 patients found that nearly 40% reported use of dietary supplements and
identified 107 potentially clinically significant interactions. Five supplements—garlic, valerian, kava, ginkgo, and St. John’s
wort—and 5 drug classes accounted for 68% and 94% of these interactions, respectively (Sood et al., 2008)
› Results of a review of 58 oral chemotherapeutics indicate that there is potential for numerous food-drug interactions. The
efficacy of many of the medications examined was dependent on ingestion either with or without food, and certain drugs
had pH- and fat-dependent absorption. Grapefruit interaction was noted in 19 of the drugs. Researchers caution that patients
receiving oral chemotherapy should be closely monitored since drug-nutrientinteractions may be difficult to manage and may
require lifestyle changes (Segal et al., 2014)
› Despite the need for further research on potential interactions, it is estimated that 6–12% of patients taking both medications
and supplements are at risk for serious drug-nutrient interactions (Mason, 2010)
Red Flags
› Newly approved pharmaceutical agents may have drug-nutrient interactions that are not yet established. Carefully monitor
the patient and report any adverse reactions to the clinician
References
1. Akamine, D., Filho, M. K., & Peres, C. M. (2007). Drug-nutrient interactions in elderly people. Current Opinion in Clinical Nutrition & Metabolic Care, 10(3), 304-310.
2. Bailey, R. L., Gahche, J. J., Lentino, C. V., Dwyer, J. T., Engel, J. S., Thomas, P. R., ... Picciano, M. F. (2011). Dietary supplement use in the United States, 2003-2006. Journal
of Nutrition, 141(2), 261-266. doi:10.3945/jn.110.133025
3. Boullata, J. (2005). Natural health product interactions with medication. Nutrition in Clinical Practice, 20(1), 33-51.
4. Chang, C.-H., Wang, Y.-W., Yeh Liu, P.-Y., & Kao Yang, Y.-H. (2014). A practical approach to minimize the interaction of dietary vitamin K with warfarin. Journal of Clinical
Pharmacy & Therapeutics, 39(1), 56-60. doi:10.1111/jcpt.12104
5. Fay, M. A., Sheth, R. D., & Gidal, B. E. (2005). Oral absorption kinetics of levetiracetam: The effect of mixing with food or enteral nutrition formulas. Clinical Therapeutics, 27(5),
594-598.
6. Genser, D. (2008). Food and drug interaction: Consequences for the nutrition/health status. Annals of Nutrition & Metabolism, 52(Suppl 1), 29-32.
7. Goho, C. (2001). Oral midazolam-grapefruit juice drug interaction. Pediatric Dentistry, 23(4), 365-366.
8. Holbrook, A. M., Pereira, J. A., Labiris, R., McDonald, H., Douketis, J. D., & Wells, P. S. (2005). Systematic overview of warfarin and its drug and food interactions. Archives of
Internal Medicine, 165(10), 1095-1106.
9. Le, J. (2014, May). Overview of pharmacokinetics. Merck manual. Retrieved July 9, 2015, from http://www.merckmanuals.com/professional/clinical_pharmacology/
pharmacokinetics/overview_of_pharmacokinetics.html
10. Lentz, K. A. (2008). Current methods for predicting human food effect. AAPS Journal, 10(2), 282-288.
11. Magnuson, B. L., Clifford, T. M., Hoskins, L. A., & Bernard, A. C. (2005). Enteral nutrition and drug administration, interactions, and complications. Nutrition in Clinical Practice,
20(6), 618-624.
12. Mason, P. (2010). Symposium 8: Drugs and nutrition: Important drug-nutrient interactions. Proceedings of the Nutrition Society, 69(4), 551-557.
13. McCabe, B. J. (2004). Prevention of food-drug interactions with special emphasis on older adults. Current Opinion in Clinical Nutrition and Metabolic Care, 7(1), 21-26.
14. Mertens-Talcott, S. U., Zadezensky, I., De Castro, W. V., Derendorf, H., & Butterweck, V. (2006). Grapefruit-drug interactions: Can interactions with drugs be avoided? Journal
of Clinical Pharmacology, 46(12), 1390-1416.
15. Moss, M. (2007). Drugs as anti-nutrients. Journal of Nutritional & Environmental Medicine, 16(2), 149-166.
16. Saito, M., Hirata-Koizumi, M., Matsumoto, M., Urano, T., & Hasegawa, R. (2005). Undesirable effects of citrus juice on the pharmacokinetics of drugs: Focus on recent studies.
Drug Safety, 28(8), 677-694.
17. Salazar, J. A., Poon, I., & Nair, M. (2007). Clinical consequences of polypharmacy in elderly: Expect the unexpected, think the unthinkable. Expert Opinion on Drug Safety, 6(6),
695-704.
18. Sood, A., Sood, R., Brinker, F. J., Mann, R., Loehrer, L. L., & Wahner-Roedler, D. L. (2008). Potential for interactions between dietary supplements and prescription
medications. American Journal of Medicine, 121(3), 207-211. doi:10.1016/j.amjmed.2007.11.014
19. Stockert, P. A. (2013). Nutrition. In P. A. Potter, A. G. Perry, P. A. Stockert, & A. M. Hall (Eds.), Fundamentals of nursing (8th ed., pp. 1004-1005). St. Louis, MO: Elsevier
Mosby.
20. Timbo, B. B., Ross, M. P., McCarthy, P. V., & Lin, C. T. (2006). Dietary supplements in a national survey: Prevalence of use and reports of adverse events. Journal of the
American Dietetic Association, 106(12), 1966-1974.
21. Viola, T. A. (2014). Drug supplement interactions significant to dentistry. General Dentistry, 62(1), 22-23.
22. Williams, N. T. (2008). Medication administration through enteral feeding tubes. American Journal of Health-System Pharmacy, 65(24), 2347-2357. doi:10.2146/ajhp080155
23. Segal, E.M., Flood, M.R., Mancini, R.S., Whiteman, R.T., Friedt, G.A., Kramer, A.R., & Hofstetter, M.A. (2014). Oral chemotherapy food and drug interactions: A comprehensive
review of the literature. Journal of Oncology Practice, 10(4), e255-268.
24. Podszun, M., & Frank, J. (2014). Vitamin E-drug interactions: Molecular basis and clinical relevance. Nutrition Research Reviews, 27(2), 215-231.
25. Won, C. (2014). Food-drug interactions in psychiatry: What clinicians need to know. Psychiatric Times, 31(6), 1-6.
26. Ferreira Silva, R., & Garbi Novaes, R.M.C. (2014). Interactions between drugs and drug-nutrient in enteral nutrition: A review based on evidences. Nutricion Hospitalaria, 30(3),
514-518.