Взаємодія ліків та їжі

Abstract

Взаємодія ліків обов’язково включає аналіз взаємовідносин препаратів з продуктами харчування, напоями чи дієтичними добавками. Харчові компоненти можуть змінювати параметри фармакокінетики препаратів та/чи їх фармакодинамічні характеристики. Найбільш вивчені питання взаємодії пероральних лікарських засобів з їжею на етапах всмоктування та біотрансформації. Тривалий прийом препаратів також впливає на засвоєння харчових складників і може спровокувати дефіцит певних нутрієнтів. Розуміння усіх особливостей взаємовідносин їжі з лікарськими засобами допомагає клініцистам прогнозувати негативні варіанти взаємодії та профілактувати їх виникнення.

Drug interactions is a section of clinical pharmacology that studies drug-druginteraction and a valuation of the relationship between drugs and food, drinks (drug-drug interaction/drug-nutrient) and herbal drug (drugherb interaction). The nutritional benefits of patients (hunger, fasting, popular diets, etc.) can have a different effect on the pharmacokinetics or pharmacodynamics of drugs. Most of the reported adverse reactions are related to changes in the bioavailability of drugs and, as a consequence, of the clinical efficacy of drugs. The working model for the classification of drug and food interactions is traditionally divided into pharmaceutical, pharmacokinetic and pharmacodynamic variants. Several mechanisms are proposed for the development of “fooddruginteraction”: physiological (changes in stomach motility, blood circulation stimulation and bile excretion, changes of pHor flora), physical and chemical (binding of drugs with food components) and biochemical (changes in the activity of enzymes, conveyors, modification of pharmacodynamic effects, etc.). The emergence of meaningful “food-drug interactions” can be expected (risk groups) in the elderly and children, patients with concomitant chronic poliorgan pathology, who take several drugs with a narrow therapeutic window and have an imbalance of nutrition. Most significant drug-food interactions have been documented during oral administrating of drugs. Food can change the degree and the rate of absorption, and thus can reduce the effectiveness of the prescribed therapy. The most significant variant of the pharmacokinetic interaction occurs at the level of biotransformation enzymes and/or protein carriers. For example, grapefruit bioflavonoids are potent inhibitors of CYP3A4 and CYP1A2. The consumption of grapefruit juice during the treatment with drugs of different groups can lead to the development of serious, potentially dangerous adverse reactions. Such changes can cause pomeranians, tangerines, grapes, mangoes, apples, spinach, tomatoes, cranberries, etc. in the clinic as well as in the experiment. Some products contain substances that can affect the same receptors or sites the same way as medicines, and therefore change the effect of drugs in one direction or another (agonists or antagonists). Long-term medication of prescriptive or non-prescriptive drugs can provoke subclinical or clinically significant deficiencies of certain nutrients. Medicines change the appetite, provoke nausea and vomiting, affect the taste buds, reduce the production of hydrochloric acid, alter the gastrointestinal motility or destroy its mucous membrane. The cases of adverse reactions to drugs associated with eating and/or dietary supplements have been documented and forced to draw attention to this problem at the state level. Different countries have published special recommendations on the rules for treatment with certain groups of drugs and the features of their interaction with beverages or food. Therefore, for the safe use of drugs it is important to know all the options for interaction of drugs, including the food components. This will ensure a personalized approach to each patient, and thus contribute to adherence of treatment. Collaboration of patients with doctors and pharmacists will help to reduce the risk of future dangerous variants of food and drug interactions.