Introduction

Understanding the interactions between dietary constituents and pharmacological compounds is essential to monitor drug therapy correctly and to assess the potential nutritional impact of medications. Most therapeutic agents exhibit some form of interaction that ultimately affects the nutritional status of the host, by altering absorption or utilization of nutrients. Frequently, these changes are not readily identified or may be obscured by the underlying disease.

The interactions between therapeutic agents and nutrients are part of the large number of interactions occurring between nutritional and non-nutritional constituents of the human diet. These constituents include all substances added to the food chain -incidentally or deliberately - during harvesting, processing, packaging, distribution, and preparation of foods. Some examples are pesticides, food additives, antibiotics, hormones, and environmental toxins.

Drug-nutrient interactions operate in two directions: drugs can have a significant impact on nutrient absorption and utilization, and the nutritional status of the host affects the drug's ability to be absorbed and transported and to exert an effect on the target tissues.

Drug-nutrient interactions can be broadly classified into two categories: direct physicochemical interaction and physiological or functional interaction. Drug-nutrient interactions can also be classified according to their site of occurrence: within the food matrix, in the gastrointestinal (GI) tract, or during transport, metabolism, and excretion. The mechanisms and sites of drug-nutrient interactions are listed in Table 1.

Table 1 Mechanisms and sites of drug-nutrient interactions

Site

Mechanism

Effect

Food matrix

Binding and chelation

Decreases bioavailability

Gastrointestinal

Changes in gastrointestinal motility, binding and

Increase in transit time reduces absorption,

tract

chelation, bile-acid concentration, and gastric pH

decreases bioavailability, and reduces absorption of fat-soluble nutrients

Circulation

Albumin concentration

Affects absorption of iron, vitamin B12, and other substances

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