DRUG-FOOD INTERACTIONS: THE INFLUENCE ON THE PATIENT’S THERAPEUTIC PLAN

Abstract

Diet influences tolerance to drugs and their effectiveness by attenuating, slowing down, or, on the contrary, reinforcing their effects. The interaction often involves drug absorption through the digestive tract, but some nutrients alter drug metabolism and elimination (e.g. grapefruit juice) interferes with the hepatic clearance of many drugs. This review will not be limited only to the interactions relating to absorption and will develop by highlighting the pharmaco-dynamic interactions, which cause the potentiation or antagonism of the pharmacological effect at the origin, of an increased risk of toxicity, in particular, in elderly patients, poly-medicated, transplant recipients, cancer patients, HIV-seropositive patients, malnourished patients, and those patients which are on enteral nutrition and theoretically are the most exposed. The present work offers the most exhaustive possible synthesis of the various drug-food interactions observed or demonstrated in clinical practice, their potential risk and the key messages for the internist ment on the major role of grapefruit, its derivatives, St. John's wort (Hypericum perforatum), and other medicinal plants in common drug-food interactions.