Herbal Interactions with Medications Quiz

Food-Drug Interactions

• Food and drug interactions involve how food or nutrients affect a medication.
• Some drugs are absorbed more efficiently on an empty stomach; others are best taken with food.
• It is crucial to read the instructions/directions for any medication.

Objectives

• Define and classify the various drug and nutrition or food and drug interactions.
• Provide clinical examples of such interactions.
• Describe significant nutrient-drug interactions involving specific foods; such as grapefruit juice, ginger, and licorice.
• Explain and discuss approaches for identifying and managing important drug-nutrient interactions.
• Discuss the role of clinical pharmacists in recognizing and managing food-drug interactions.

Drug-Nutrition Interaction

• Food-drug interaction results from the physical, chemical, or physiological relationship between a drug and a nutrient (or food).

How Drugs and Food Interact

• Food (or nutrients) can change how medications work.
• Drugs (prescription and over-the-counter) affect how the body utilizes nutrients from food. This can lead to nutritional deficiencies.

How Does This Occur?

• Pharmaceutical properties of drugs (e.g., compatibility, solubility, stability) can be altered by foods.
• Pharmacokinetic interactions (e.g., absorption, distribution, metabolism, excretion) of drugs can be affected by food properties.
• Physiologic outcome (e.g., bioavailability, volume of distribution, clearance) can influence the drug's efficacy.
• Pharmacodynamic interactions (e.g., effects on receptors, enzymes, etc.) can be affected by foods.
• Patient outcome is positively or negatively influenced based on the above factors.

Pharmacokinetic Interactions

• Foods can chemically bind to drugs. This can convert the drug into an insoluble salt which is not easily absorbed.
• Food proteins can bind to certain drugs like phenytoin. This leads to reduced phenytoin absorption; thus potentially impacting seizure control.
• Foods high in fats can increase absorption of fat-soluble drugs.
• Foods can influence gastric emptying, bile production, and gastrointestinal pH. These factors affect drug absorption.

Pharmacodynamic Interactions

• Certain foods attenuate or enhance drug effects and toxicity by interfering with their mechanisms.
• For example, foods rich in vitamin K can counteract certain blood-thinning (anticoagulant) drugs like warfarin.
• Foods high in tyramine, when taken with monoamine oxidase inhibitors (MAOIs), can be dangerously elevated blood pressure. (hypertensive crisis).
• Nutrients can change existing drug actions/mechanisms.

Food-Drug Interactions with Grapefruit Juice

• Grapefruit juice is frequently studied for its interaction with several drugs.
• Drugs like certain statins, calcium channel blockers, anticoagulants (warfarin), and some benzodiazepines can have significantly increased levels in the blood stream when consumed with grapefruit juice. This increase risk of side effects.
• A component of grapefruit juice, bergamottin, inhibits a specific enzyme (CYP3A4) primarily involved in drug metabolism.
• Grapefruit juice can decrease the plasma concentrations of some drugs.

Food-Drug Interactions with Ginger

• Ginger can slow blood clotting (anticoagulant properties), therefore it should be avoided if taken alongside blood thinners/anticoagulants.
• Certain blood thinners include aspirin, clopidogrel, diclofenac, ibuprofen, naproxen, etc.
• Ginger may interact with other herbal supplements that also slow blood clotting.
• Ginger can interact with medications for high blood pressure (calcium channel blockers).
• Ginger may lower blood sugar, so blood sugar must be closely monitored in people taking diabetes medications.

Food-Drug Interactions with Licorice

• Licorice root (glycyrrhizic acid) can cause high blood pressure and fluid retention.
• Patients with high blood pressure, heart failure, pulmonary hypertension, or kidney disease should avoid licorice consumption, or limit amounts.
• Licorice may increase the effects of certain other drugs (e.g., Cisplatin), and can cause low blood potassium.
• Specific dosage adjustments or monitoring may be necessary if patients are using licorice together with other medications.

Food-Drug Interactions with Ginseng

• Ginseng may interact with (increase) the levels of some medications.
• Monitor patients for side effects when ginseng is taken with other medications.

Food-Drug Interactions with Ginkgo Biloba

• Ginkgo can interact with some medications.
• High doses of ginkgo may reduce effectiveness of anticonvulsants.
• Ginkgo can interact with antidepressants, causing serotonin syndrome.
• Ginkgo can interfere with antihypertensive medications. Therefore, should be consumed under medical supervision for blood pressure.

Food-Drug Interactions with Other Substances

• Several other foods and substances (e.g., milk, caffeine, alcohol) may interact with certain medications.
• Be aware that different foods have effects on different medications.

Effects of Food and Nutrients on Drugs

• Certain foods can affect how drugs are metabolized (processed) in the body.
• Some drugs can irritate the stomach; thus these medications should be taken with food (e.g., aspirin, ibuprofen, etc.)
• Antibiotics can be affected by acidic foods and foods high in calcium. This can influence drug absorption and effectiveness
• Foods can decrease the absorption and effectiveness of some antibiotics.
• Many other foods and substances may interact with certain medications.

Drug Effects on Food Absorption

• Laxatives can affect the absorption of vitamins/minerals.
• Some antacids block the absorption of certain nutrients (e.g., phosphorus).
• Some cholesterol-lowering medications reduce bile acid production, affecting the absorption of fat-soluble vitamins.
• Antibiotics, in some cases, can reduce the absorption of vitamins produced in the intestines.

Drug Effects on Nutrient Metabolism

• Some medications (e.g., birth control pills) can alter the levels of some vitamins or minerals in the body.
• Anticonvulsant medications can increase the liver's removal of vitamin D.

Drug Increase Nutrient Loss

• Large doses of aspirin can cause higher loss of folate (folic acid).
• Diuretics can lead to increased potassium loss.

Effects of drugs on food/nutrients

• Many drugs affect nutrition.
• Specific vitamins and minerals need to be accounted for with many medications.

Nutrient Supplements

• Dietary supplements/nutrients can influence/interact with other nutrients or medications
• Extreme amounts of nutrients may be dangerous and can interact negatively with other medications or nutrients.

Role of Clinical Pharmacists

• Clinical pharmacists play important roles in evaluating patient data (history and physical)
• Assessing medications and their interactions
• Making recommendations and educating patients on appropriate dietary choices that will have the least interaction with the patient's medicine regimens.
• Clinical pharmacists' role is in ensuring patient safety.

Who is at Risk of Drug-Nutrient Interactions?

• People with poor diets.
• People with serious health problems.
• Developing children.
• Pregnant women.
• Older adults.

Patient Approach to Minimizing Risk

• Coordinated, interdisciplinary, team-based approach to managing potential drug-food interactions/risks is seen as crucial.
• Use decision support systems to aid screening and prescribing.
• Employ thorough patient assessments to identify/address issues.
• Close monitoring and appropriate regimen adjustment to ensure safety.

Drug-Nutrient Interaction Checker

• Websites and tools available to assess drug-nutrient interactions

Test your knowledge on the interactions between herbs and medications. This quiz covers topics such as blood clotting, diabetes medications, and the effects of various herbs like ginger and licorice. Learn the potential risks and recommendations for safe use.