Understanding Drug Nutrient Interactions
Vitamins and lipids have central functions in metabolism. The way in which they interact with drugs may result in clinically relevant physiological impairments, but also possibly in positive effects. Improved knowledge of potential interactions between drugs and nutrients could have a significant impact on public health. To understand the extent of drug nutrient interactions (DNIs), more research is needed, particularly on the elderly, to help future drug development processes.
Top level summary
- DNIs are defined as alterations of pharmacokinetics or pharmacodynamics of a drug or nutritional element, or a compromise in nutritional status as a result of the addition of a drug
- Examples of where DNIs can occur include statins, contraceptives, proton pump inhibitors, and cases where vitamins and lipids have a synergistic effect with drugs
- Although DNIs have not been extensively studied to date, it is particularly relevant for the elderly, as they are often prescribed several medications at once
- Adverse drug reactions can have serious consequences, with drug side effects responsible for an estimated 197,000 deaths each year in the European Union
- Increasing understanding of DNIs could have a significant impact on public health
Understanding the potential of DNIs
While drug-drug interactions are widely recognized as clinically relevant, DNIs have previously been underexplored, despite the number of studies on their presence and relevance. This is becoming increasingly important as the population ages, and more individuals suffer from multimorbidity, making polypharmacy prevalent.
In the European Union, drug side effects are estimated to be responsible for 197,000 deaths a year, with the risk of adverse drug reactions increasing with advancing years. Despite the potential consequences, DNIs are not considered during the drug development phase, as there is limited nutritional knowledge among researchers and professionals in the health care field.
Making the distinction
In order to start to classify DNIs, a proposed framework has been developed as part of a recent workshop to help structure the consequences. For example, by distinguishing the effects of meals, individual foods, specific nutrients or nutrition status on drug action, and vice versa, it is easier to determine the impact of drugs on nutrition status:
- Class 1 – effect of obesity and malnutrition on drug action
- Class 2 – effect of nutrition on drug action
- Class 3 – effect of specific nutrients or dietary supplements on drug action
- Class 4 – effect of drugs on nutrition status
- Class 5 – effect of drugs on nutrient status
Taking the pharmacological mechanism and localization of the interaction into account could lead to further sub-classes.
What do we know already?
Several potential associations have already been made between certain drugs and nutrients, which are shaping future research in this area.
For example, lipid-lowering therapy with statins can significantly
reduce the incidence of cardiovascular disease and decrease the
likelihood of coronary events. However, aggressive lowering of lipids
by statins comes with the risk of decreasing eicosapentaenoic acid
(EPA) and docosahexaenoic acid (DHA) levels simultaneously. EPA and
DHA can be considered as an alternative way to help reduce plasma
triglyceride levels and to beneficially inﬂuence the levels of other
blood lipids as well. Clinical trials have shown that EPA and DHA as
supplementation may also be effective in combination with
lipid-lowering drugs like statins.
In addition, nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen and naproxen, can cause peptic ulcers, diminish renal function and impair vitamin B6 metabolism. However, they may have additive or synergistic effects with certain vitamins or lipids, for example to reduce pain. If an adequate dose of EPA and DHA (which have anti-inflammatory properties) is provided, NSAIDs might be taken at a lower dose to have a clinical benefit and reduce potential side effects of the drug.
Building a bank of evidence
The growing number of studies on DNIs suggests that exploring the impact of drugs on nutrient status could prove beneficial in the future. Particularly given the nutritional status of many elderly people, it would be worthwhile conducting a systematic assessment of nutrient-drug interactions, starting with classes of drugs used in common complex disorders. While current medicine is pharma-dominated, further research could pave the way for nutrition playing a bigger role in public health.
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 S. Peter et al., ‘Public health relevance of drug-nutrient
interactions,’ Eur J Nutr., 2017, published online ahead of
Accessed 8 September 2017.
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 A. Pirillo and A.L. Catapano, ‘Omega-3 polyunsaturated fatty acids in the treatment of atherogenic dyslipidemia’, Atherosclerosis Supplements, Aug;14(2), 2013, p. 237-42. https://www.ncbi.nlm.nih.gov/pubmed/23958479. Accessed 8 September 2017.
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