Pablo de Olavide University. These interactions can affect the antihypertensive drugs, altering their therapeutic efficacy and causing toxic effects. The aim of this study was to conduct a review of available data about interactions between antihypertensive agents and food. Methods: The purpose of this review was to report an update of main findings with respect to the interactions between food and antihypertensive drugs by way of a search conducted in PubMed, which yielded a total of articles initially. Results: After excluding different articles, which were not focusing on the specific objective, the main results refer to interactions between antihypertensive drugs and food in general as well as between antihypertensive agents and grapefruit juice.
|Published (Last):||22 March 2009|
|PDF File Size:||10.6 Mb|
|ePub File Size:||11.89 Mb|
|Price:||Free* [*Free Regsitration Required]|
Interactions between drugs and drug-nutrient in enteral nutrition: A review based on evidences. Introduction: Enteral nutrition EN provides calories, macronutrients and micronutrients in adequate quantity and quality to meet the patient's needs.
Some drugs when crushed and diluted may have their properties altered, including the reduction of bioavailability causing the reduction of the serum concentration of the drug; tube obstruction; drug-drug interaction or drug-nutrient interaction.
Results: For this survey, 42 articles were identified during database searching. Discussion: Some interactions were found such as the aluminium hydroxide and lactulose with the enteral nutrition, which may result in a precipitation and reduction of drug bioavailability.
Mineral oil will alter the absorption of fat-soluble vitamins and reduces the tube light. Others results were found as phenytoin, warfarin, captopril and furosemide with enteral nutrition may reduce the maximum serum concentration.
Conclusion: Drug interactions are more common in day-to-day activities than health professionals may suppose. Knowledge on the matter may also assist in reducing cases of obstruction of tubes, through which enteral nutrition and medications are administered. Thus, the multidisciplinary team, acting together, may have more beneficial effects to the patient.
Key words: Enteral nutrition. Drug interactions. Food interactions. Food-drug interactions. Interacciones de los alimentos. Nutritional therapy constitutes a set of procedures aimed at maintaining or restoring the nutritional status of the patient by administering food artificially.
The critically ill patient requires the use of nutritional therapy enteral or parenteral , mainly to minimize the reduction of physiological stress and adverse effects of protein catabolism 1,2. Enteral nutrition EN is performed by means of a nasogastric tube or ostomies, through which calories and nutrients are provided in adequate quantity and quality, according to the patient's needs.
This nutritional therapy is indicated when oral food intake is undesirable or insufficient to maintain the nutritional status, so as to prevent the patient from malnutrition process The medication administration by tubes is a common practice in the hospital routine, which should be taken into accident in order to choose the best pharmaceutical form of drug administration or to select or the drugs which may be crushed, given the high incidence of patients who use multiple medications.
Some drugs when crushed and diluted alter some of their effects, including the reduction of bioavailability causing the reduction of the serum concentration of the drug; tube obstruction; the drug-drug interaction when there are simultaneous administration of two or more drugs; or the drug-nutrient interaction 5,6.
Insofar as changes occur, there may be an interference in the therapy proposed to the patient, since many drugs have pharmaceutical forms which permit a slow release in the body, or whose formulation is intended to be release in another portion of the gastrointestinal tract other than the stomach.
Some drugs may alter the absorption of nutrients; even to the point of inhibiting the metabolic process of the latter, as well as the concomitant intake of food may affect the bioavailability of the drug through interactions 6,7. Aiming for the promotion of rational and safe use of medications concomitant to enteral and parenteral nutritional therapy, the formation of a multidisciplinary team of Nutritional Therapy MTNT became mandatory in Brazilian hospitals, composed mainly by nurse, pharmaceutical, physician, nutritionist, and other professionals 1.
The objective of this study was to analyze clinically relevant possible interactions, between drugs and nutrients in enteral nutrition in order to increase safety and in the concomitant administration medications with nutritional therapy. Published articles from January to April with the following study designs were selected: literature review, prospective, retrospective, analytical and descriptive.
Articles characterized as letters to the editor, reports or case series and sketches were excluded from the survey. For this survey 42 articles were identified during database searching. These were about those topics: drug-drug interactions, drug nutrient interactions, changes that occur when a new item is added and the stability of enteral nutrition.
Table 1 presents the selected studies emphasizing the reference, the method, the casuistry, if drugs were added the observed chemical interactions and the observed clinical results.
Studies about drug-nutrient and drug-drug interactions, have been growing in number and collaborating to increase effectiveness therapy. As REIS et al. The most commonly prescribed drugs were: mineral oil in liquid form; dimethicone, dipyrone and paracetamol; in solid form: folic acid, pyrimethamine and sulfadiazine acid.
Omeprazole comes in capsule form and its release is gastric, and differentiated administration is required. The ferrous sulfate due to its viscosity may cause tube obstruction 7. The inclusion of interactions in the matter of drug adminsitration and nutrition, motivate the management of recommendations for there effectiveness of the treatment proposed to the patient.
Given this situation, the authors suggest some recommendations, such as to take into account the nutritional status of the patient, to avoid over or underestimation in nutrient retention and pay attention to the prescriptions, to prevent unexpected therapeutic response. With regard to medicines and nutrition, they advise stopping the administration of the diet one hour before and two hours after drug therapy to avoid the afore said changes, paying attention to the rhythm of dripping after restarting no as to administered the full volume and proposal energy 7.
In vitro studies are conducted in order to promote greater confidentiality to what is already known on the clinical and laboratory evaluation. SILVA and LISBOA , in their integrative literature review identified an in vitro study and clinical studies with warfarin, which showed the reduction in bioavailability of the drug when administered in conjunction with enteral nutrition.
As recommendations, they suggest that attention to the possible risks in prescribing and administering medicines. The nurse, in the condition of responsible for the nursing staff, should be aware of these risks and always promote continuing education. Another study demonstrated the role of the pharmaceutical with the team evaluating the medical prescriptions, which resulted in the change of presentation of medicines, leading to decreased interactions and incompatibilities between drugs and enteral nutrition 9.
SILVA et al. The authors divided the drugs into three categories: antiepileptic drugs, antibiotics and anticoagulants. Among the antiepileptic drugs, there was the phenytoin whose serum levels are reduced when administered with enteral nutrition.
It was suggested, therefore, enhancing the knowledge of the subject by the nursing staff and the proposition of management protocols ensuring an effective treatment The most commonly prescribed medications, but with contraindications to be crushed for their administration are: captopril, clonidine, digoxin, spironolactone, phenytoin, furosemide, haloperidol, midazolam, prednisone, propranolol, and ranitidine.
The location of drug release also alters the desired effect, for example, the drugs which are prepared for action in the stomach are not suitable for the tubes whose distal end is located in the small intestine, since there is an increase of bioavailability of the drugs with extensive first-pass metabolism by the liver. The study proposes specific cares while administering because some medications when crushed may release airborne particles and intoxicate those who are manipulating them.
It is also important not to mix medications in the same dilution and to wash the tube before and after the completion of the medication LOPES et al. The intake of some drugs with food in some cases is recommended for example, carvedilol, nifedipine, propranolol and diclofenac but not in others, due to interferences both in the absorption of the drug as in the absorption of vitamins and minerals for example, acetylsalicylic acid, omeprazole, ranitidine, mineral oil, aluminum hydroxide, spironolactone, laxatives and captopril.
From the analysis performed in the study, a large number of interactions between foods and nutrients may be verified, which leads to an increase of interferences in the treatment or even an improvement in the therapeutic process, which requires the evaluation of each case individually.
SEHN et al. Given those findings, the conclusion was in favor of the use of computer programs to identify the interactions and assess the profile of prescriptions, as well as in favor of the continuing education of professionals, which demonstrate being important to reduce the interactions Among the patients, those who received nine or more drugs in the first and sixth day of hospitalization showed a higher number of drug interactions.
Midazolam was the most frequent drug among the potential interactions identified. Among the pair of drugs that interacted more, fentanyl and midazolam were the ones more frequently identified. Actions that can be taken in order to minimize those interactions are as follows: observe signs and symptoms, monitor therapy response, adjust the timing of medications and avoid the combination.
It is also important that health professionals learn how to identify, classify, be acquainted with the clinical management, so that the interactions may be avoided As a result, some of the drugs with restrictions to be administered by tube were highlighted: amiodarone - to be avoided due to lack of study, atenolol - reduces the drug absorption when administered with nutrition, phenobarbital - to be avoided due to lack of specific data on administration by tubes.
Hydrochlorothiazide - with nutrition, there is a reduction in the drug absorption, hydroxyurea - cytostatic, care with the handler, nifedipine retard - it should not be crushed so that not to lose the slow release or block the tube, nimodipine - reduces absorption of the drug with the nutrient. The recommendations the study proposes are: interruption of nutrition one hour before and two hours after for administration of the drugs that have interaction with nutrition; readjustment of the infusion pump when it is paralyzed for total caloric intake, rinsing the tube before and after administering medications, and avoiding grinding the drugs that have toxic effects on handler Most studies relate the interactions present between drugs and enteral nutrition.
It is important to understand those interactions, because the enteral feedings are administered continuously in the most of the cases, and during this process medications are administered via tube without paralyzing the process of dieting, which is one of the main reasons to conduct studies related to this topic. Studies that evaluate the preparation and administration of medication are insufficient. It was also observed that all selected studies were performed by Brazilian authors in hospitals in Brazil.
From the evidence demonstrated in the chosen studies, it may be concluded that drug interactions are closer and more present in the day-to-day than health professionals could expect.
The knowledge about this issue, especially when it comes to drugs that are given often to patients in such a hospital sector ICU , is vital for the appropriate therapy to the patient and all staff involved in the process of nutritional therapy should be aware of the risks of interaction, from the time of prescription to the time of drug administration.
Such knowledge may also assist in reducing cases of tube obstruction, through which enteral nutrition and medications are administered. Thus, the multidisciplinary team doctor, nurse, pharmaceutical and nutritionist , acting together, may bring about more beneficial effects to the patient. Rev Paul Pediatr 26 3 , Rev Bras de Cien Farmac vol. Monitoramento do uso de medicamentos prescritos me uma unidade de terapia intensiva.
Nutr Vol. Hosp , Bras 56 1 : , Einstein 8 3 Pt 1 : , Infarma v. Potencial drug interactions in intensive care patients at a teaching hospital. Latino-am Enfermagem 17 2 , mar-abril, Enf Internet. Correspondence: Renata Ferreira Silva. Servicios Personalizados Revista. Introduction Nutritional therapy constitutes a set of procedures aimed at maintaining or restoring the nutritional status of the patient by administering food artificially.
Results For this survey 42 articles were identified during database searching. Discussion Studies about drug-nutrient and drug-drug interactions, have been growing in number and collaborating to increase effectiveness therapy.
Conclusion From the evidence demonstrated in the chosen studies, it may be concluded that drug interactions are closer and more present in the day-to-day than health professionals could expect. References 1. Aceptado: VI
Interactions Between Drugs and Drug-Nutrient in Enteral Nutrition: A Review Based on Evidences
Interactions between drugs and drug-nutrient in enteral nutrition: A review based on evidences. Introduction: Enteral nutrition EN provides calories, macronutrients and micronutrients in adequate quantity and quality to meet the patient's needs. Some drugs when crushed and diluted may have their properties altered, including the reduction of bioavailability causing the reduction of the serum concentration of the drug; tube obstruction; drug-drug interaction or drug-nutrient interaction. Results: For this survey, 42 articles were identified during database searching. Discussion: Some interactions were found such as the aluminium hydroxide and lactulose with the enteral nutrition, which may result in a precipitation and reduction of drug bioavailability. Mineral oil will alter the absorption of fat-soluble vitamins and reduces the tube light.
2010, Número 1
Montoro, J. Salgado Editorial Novartis-Rubes pp. Hay, K. Smiciklas-Wright and J. Treu Nutrition and aging: Drug-Nutrient Interactions.
U.S. Food and Drug Administration