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The influence of food on the absorption and metabolism of drugs: an update

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Summary

Food-drug interactions can lead to a loss of therapeutic efficacy or toxic effects of drug therapy. Generally, the effect of food on drugs results in a reduction in the drug’s bioavailability; however, food can also alter drug clearance. The benefits of considering metabolism and pharmacokinetic information in the drug discovery process have been high-lighted by Humphrey and Smith (79) and the process of rational drug design should include considerations of the chemistry, pharmacology and pharmacokinetics of the drug (80) and the impact of diet on these parameters.

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References

  1. Welling P. (1985): Nutrient effects on drug metabolism and action in the elderly. Drug Nutr. Interact., 4, 173–207.

    PubMed  CAS  Google Scholar 

  2. Steinijans V., Hauschke D., Jonkman J.H.G. (1992): Controversies in bioequivalence studies. Clin. Pharmacokinet., 22, 247–253.

    Article  PubMed  CAS  Google Scholar 

  3. Toothaker R.D., Welling P.G. (1980): The effect of food on drug bioavailability. Annu. Rev. Pharmacol. Toxicol., 20, 173–199.

    Article  PubMed  CAS  Google Scholar 

  4. Sriwatanakul K., Weintraub M. (1983): Understanding food-drug interactions. Comp. Ther., 9, 6–11.

    CAS  Google Scholar 

  5. Roberts J., Tumer N. (1988): Age and diet effects on drug action. Pharmacol. Ther., 37, 111–149.

    Article  PubMed  CAS  Google Scholar 

  6. Abernethy D.R., Greenblatt D.J. (1986): Drug disposition in obese humans: an update. Clin. Pharmacokinet., 11, 199–213.

    Article  PubMed  CAS  Google Scholar 

  7. Osis M. (1986): Scheduling drug administration: drug and food interactions. Gerontion, 1, 810.

    Google Scholar 

  8. Roe D.A. (1983): Drugs and nutrition in the elderly. In: Roe D.A. (Ed.) Geriatric Nutrition. New Jersey, Prentice-Hall, pp. 155–173.

    Google Scholar 

  9. Roe D.A. (1985): Therapeutic effects of drug-nutrient interactioos in the elderly. J. Am. Diet. Assoc., 85, 174–181.

    PubMed  CAS  Google Scholar 

  10. Welling P.G. (1977): Influence of food and diet on gastrointestinal drug absorption: a review. J. Pharmacokinet. Biopharm., 5, 291–334.

    Article  PubMed  CAS  Google Scholar 

  11. Welling P.G. (1984): Interactions affecting drug absorption. Clin. Pharmacokinet., 9, 404–434.

    Article  PubMed  CAS  Google Scholar 

  12. Lamy P.P. (1983): Nutrition, drugs, and the elderly. Clin. Nutr., 2, 9–14.

    Google Scholar 

  13. Committee on Aging: Group for the advancement of psychiatry. (1994): Impact of tacrine in the care of patients with Alzheimer’s disease. Am. J. Geriatric. Psychiatry., 2, 285–289.

    Article  Google Scholar 

  14. Welty D.F., Siedlik P.H., Posvar E.L. et al. (1994): The temporal effect of food on tacrine bioavailability. J. Clin. Pharmacol., 34, 985–988.

    PubMed  CAS  Google Scholar 

  15. Roe D.A. (1984): Therapeutic significance of drug-nutrient interactions in the elderly. Pharmacol. Rev., 36, S109-S122.

    Google Scholar 

  16. McLean A.J., McNamara P.J., duSovich P. et al. (1978): Food, splanchnic blood flow, and bioavailability of drugs subject to first-pass metabolism. Clin. Pharmacol. Ther., 24, 5–10.

    PubMed  CAS  Google Scholar 

  17. Randle N.W. (1987): Food or nutrient effects on drug absorption: a review. Hosp. Pharm., 22, 694–718.

    Google Scholar 

  18. Jonkman J.H.G. (1989): Food interactions with sustained release theophylline preparations: a review. Clin. Pharmacokinet., 16, 162–179.

    Article  PubMed  CAS  Google Scholar 

  19. Jacknowitz A. (1987): Food and drug interactions. US Pharm., 12, 66–72.

    Google Scholar 

  20. Roe D.A. (1986): Drug-food and drug-nutrient interactions. J. Environ. Pathol. Toxicol. Oncol., 5, 115–135.

    Google Scholar 

  21. Hathcock J.N. (1985): Metabolic mechanisms of drug-nutrient interactions. Fed. Proc., 44, 124–129.

    PubMed  CAS  Google Scholar 

  22. Cook M.C., Taren D.L. (1990): Nutritional implications of medication use and misuse in elderly. J. Fla. Med. Assoc., 77, 606–613.

    PubMed  CAS  Google Scholar 

  23. Cutie A.J., Altman E., Lenkel L. (1983): Compatibility of enteral products with commonly employed drug additives. J. Parenter. Enter. Nutr., 7, 186–191.

    Article  CAS  Google Scholar 

  24. Roe D.A. (1986): Drug-nutrient interactions in the elderly. Geriatrics, 41, 57–74.

    PubMed  CAS  Google Scholar 

  25. Bauer L.A. (1982): Interference of oral phenytoin absorption by continuous nasogastric feedings. Neurology, 32, 570–572.

    PubMed  CAS  Google Scholar 

  26. Kempster P.A., Wahlquist M.L. (1994): Dietary factors in the management of Parkinson’s disease. Nutr. Rev., 52, 51–58.

    PubMed  CAS  Google Scholar 

  27. Growden J.H. (1994): Metabolic determinants of fluctuations in levodopa response. Drugs Nutr Neurol 3,

  28. Pincus J.H., Barry K.M. (1987): Plasma levels of amino acids correlate with motor fluctuations in Parkinsonism. Arch. Neurol., 44, 1006–1009.

    PubMed  CAS  Google Scholar 

  29. Montamat S., Cusack B., Vestal R.E. (1989): Management of drug therapy in the elderly. N. Engl. J. Med., 321, 303–309.

    Article  PubMed  CAS  Google Scholar 

  30. Melander A., Danielson K., Hanson A. et al. (1977): Enhancement of hydralazine bioavailability by food. Clin. Pharmacol. Ther., 22, 104–107.

    PubMed  CAS  Google Scholar 

  31. Melander A., Danielson K., Schersten B. et al. (1977): Enhancement of the bioavailability of propanolol and metroprolol by food. Clin. Pharmacol. Ther., 30, 108–112.

    Google Scholar 

  32. Coon M.J. (1978): Oxygen activation in the metabolism of lipids, drugs, and carcinogens. Nutr. Rev., 36, 319–328.

    Article  PubMed  CAS  Google Scholar 

  33. Liedholm H., Melander A. (1986): Concomitant food intake can increase the bioavailability of propranolol by transient inhibition of its presystemic primary conjugation. Clin. Pharmacol. Ther., 40, 29–36.

    Article  PubMed  CAS  Google Scholar 

  34. Daneshmend T.K., Roberts C.J. (1982): The influence of food on the oral and intravenous pharmacokinetics of a high clearance drug: a study with Labetalol. Br. J. Clin. Pharmacol., 14, 73–78.

    PubMed  CAS  Google Scholar 

  35. Hathcock J.N. (1985): Nutrient and non-nutrient effects of drug metabolism. Drug Nutr. Interact., 4, 217–234.

    PubMed  CAS  Google Scholar 

  36. Watkins P.B., Wrighton S.A., Schuetz E.G., Molowa D.T., Guzelian P.S. (1987): Identification of glucocorticoid-inducible cytochrome P-450 in the intestinal mucosa of rats and man. J. Clin. Invest., 80, 1029–1036.

    Article  PubMed  CAS  Google Scholar 

  37. Kaminsky L.S., Fasco M.J. (1992): Small intestinal cytochrome P450. Crit. Rev. Toxicol., 21, 407–422.

    Article  CAS  Google Scholar 

  38. Gonzalez F. (1992): Human cytochromes P450: problems and prospects. Trends Pharm. Sci., 13, 346–352.

    Article  PubMed  CAS  Google Scholar 

  39. Krishna D.R., Klotz U. (1994): Extrahepatic metabolism of drugs in humans. Clin. Pharmacokinet., 26, 144–160.

    Article  PubMed  CAS  Google Scholar 

  40. Ducharme M.P., Provenzano R., Dehoome-Smith M., Edwards D.J. (1993): Trough concentrations of cyclosporine in blood following administration with grapefruit juice. Br. J. Clin. Pharmacol., 36, 457–459.

    PubMed  CAS  Google Scholar 

  41. Benton R., Honig P., Zamani K. et al. (1994): Grapefruit juice alters terfenadine pharmacokinetics resulting in prolongation of QTc. Clin. Pharmacol. Ther., 55, 146.

    Google Scholar 

  42. Kivisto K.T., Neuvonen P.J., Klotz U. (1994): Inhibition of terfenadine metabolism: pharmacokinetic and pharmacodynamic consequences. Clin. Pharmacokinet., 27, 1–5.

    Article  PubMed  CAS  Google Scholar 

  43. Bailey D.G., Arnold J.M., Spence J.D. (1994): Grapefruit juice and drugs: how significant is the interaction? Clin. Pharmacokinet., 26, 91–98.

    Article  PubMed  CAS  Google Scholar 

  44. Anderson K.E. (1988): Influences of diet and nutrition on clinical pharmacokinetics. Clin. Pharmacokinet., 14, 325–346.

    Article  PubMed  CAS  Google Scholar 

  45. Pantuck E.J., Pantuck E.B., Kappas A. et al. (1991): Effects of protein and carbohydrate content of diet on drug conjugation. Clin. Pharmacol. Ther., 50, 254–258.

    Article  PubMed  CAS  Google Scholar 

  46. Anderson K.E., Conney A.H., Kappas A. (1979): Nutrition and oxidative drug metabolism in man: relative influence of dietary lipids, carbohydrates, and protein. Clin. Pharmacol. Ther., 26, 493–501.

    PubMed  CAS  Google Scholar 

  47. Kappas A., Anderson K.E., Conney A.H. et al. (1976): Influence of dietary protein and carbohydrate on antipyrine and theophylline metabolism in man. Clin. Pharmacol. Ther., 20, 643–653.

    PubMed  CAS  Google Scholar 

  48. Anderson K.E., Conney A.H., Kappas A. (1982): Nutritional influences on chemical biotransformation in humans. Nutr. Rev., 40, 161–171.

    Article  PubMed  CAS  Google Scholar 

  49. Anderson K.E., Pantuck E.J., Conney A.H. et al. (1985): Nutrient regulation of chemical metabolism in humans. Fed. Proc., 44, 130–133.

    PubMed  CAS  Google Scholar 

  50. Fagan T.C., Walle T., Oexmann M.J. et al. (1987): Increased clearance of propranolol and theophylline by high-protein compared with high-carbohydrate diet. Clin. Pharmacol. Ther., 41, 402–406.

    Article  PubMed  CAS  Google Scholar 

  51. Berlinger W.G., Park G.D., Spector R. (1985): The effect of dietary protein on the clearance of allopurinol and oxypurinol. N. Engl. J. Med., 313, 771–776.

    Article  PubMed  CAS  Google Scholar 

  52. Herman R.J., Chaudhary A., Szakacs C. (1994): Disposition of lorazepam in Gilbert’s syndrome: effects of fasting, feeding, and enterohepatic circulation. J. Clin. Pharmacol., 34, 978–984.

    PubMed  CAS  Google Scholar 

  53. Guengerich F.P. (1984): Effects of nutritive factors on metabolic processes involving bioactivation and detoxification of chemicals. Annu. Rev. Nutr., 4, 207–231.

    Article  PubMed  CAS  Google Scholar 

  54. Thurman R.G., Kauffman F.C. (1980): Factors regulating drug metabolism in intact hepatocytes. Pharmacol. Rev., 31, 229–251.

    Google Scholar 

  55. Ginter E., Vejmolova J. (1981): Vitamin C-status and pharmacokinetic profile of antipyrine in man. Br. J. Clin. Pharmacol., 12, 256–258.

    PubMed  CAS  Google Scholar 

  56. Smithard D.J., Langman M.J.S. (1978): The effect of vitamin supplementation upon antipyrine metabolism in the elderly. Br. J. Clin. Pharmacol., 5, 181–185.

    PubMed  CAS  Google Scholar 

  57. Holloway D.E., Hutton S.W., Peterson F.J. et al. (1982): Lack of effect of subclinical ascorbic acid deficiency upon antipyrine metabolism in man. Am. J. Clin. Nutr., 35, 917–924.

    PubMed  CAS  Google Scholar 

  58. Trang J.M., Blanchard J., Conrad K.A. et al. (1982): The effect of vitamin C on the pharmacokinetics of caffeine in elderly men. Am. J. Clin. Nutr., 35, 487–494.

    PubMed  CAS  Google Scholar 

  59. Houston J.B. (1977): Effect of vitamin C supplementation on antipyrine disposition in man. Br. J. Clin. Pharmacol., 4, 236–239.

    PubMed  CAS  Google Scholar 

  60. Wilson J.T., Van Boxtel C.J., Alvan G. et al. (1976): Failure of vitamin C to affect the pharmacokinetic profile of antipyrine in man. J. Clin. Pharmacol., 16, 265–270.

    PubMed  CAS  Google Scholar 

  61. Houston J.B., Levy G. (1976): Drug biotransformation interactions in man. VI: Acetaminophen and ascorbic acid. J. Pharm. Sci., 65, 1218–1221.

    Article  PubMed  CAS  Google Scholar 

  62. Cotzias G.C. (1969): Metabolic modification of some neurologic disorders. JAMA, 210, 1255–1262.

    Article  PubMed  CAS  Google Scholar 

  63. Hathcock J.N. (1987): Nutrient-drug interactions. Clin. Geriatr. Med., 3, 297–307.

    PubMed  CAS  Google Scholar 

  64. Pantuck E.J., Pantuck C.B., Garland W.A. et al. (1979): Stimulatory effect of Brussels sprouts and cabbage on human drug metabolism. Clin. Pharmacol. Ther., 25, 88–95.

    PubMed  CAS  Google Scholar 

  65. Pantuck E.J., Pantuck C.B., Anderson K.E. et al. (1984): Effects of Brussels sprouts and cabbage on drug conjugations in humans. Clin. Pharmacol. Ther., 35, 161–169.

    Article  PubMed  CAS  Google Scholar 

  66. Kappas A., Alvares A.P., Anderson K.E. et al. (1978): Effect of charcoal-broiled beef on antipyrine and theophylline metabolism. Clin. Pharmacol. Ther., 23, 445–450.

    PubMed  CAS  Google Scholar 

  67. Conney A.H., Pantuck E.J., Hsiao K-C. et al. (1976): Enhanced phenacetin metabolism in human subjects fed charcoal-broiled beef. Clin. Pharmacol. Ther., 20, 633–642.

    PubMed  CAS  Google Scholar 

  68. Anderson K.E., Schneider J., Pantuck E.J. (1983): Acetaminophen metabolism in subjects fed charcoal-broiled beef. Clin. Pharmacol. Ther., 34, 369–374.

    Article  PubMed  CAS  Google Scholar 

  69. Monks T.J., Caldwell J., Smith R.L. (1979): Influence of methylxanthine-containing foods on the theophylline metabolism and kinetics. Clin. Pharmacol. Ther., 26, 513–524.

    PubMed  CAS  Google Scholar 

  70. Drouillard D.D., Vestal E.S., Dvorchik B.H. (1978): Studies on theobromine disposition in normal subjects. Clin. Pharmacol. Ther., 23, 296–302.

    PubMed  CAS  Google Scholar 

  71. Brodie M.J., Boobis A.R., Toverud E-L. et al. (1980): Drug metabolism in white vegetarians. Br. J. Clin. Pharmacol., 9, 523–525.

    PubMed  CAS  Google Scholar 

  72. Reidenberg M.M., Kostenbauder H., Adams W.P. (1969): Rate of metabolism in obese volunteers before and during starvation and in azotemic patients. Metabolism, 18, 209–213.

    Article  PubMed  CAS  Google Scholar 

  73. Reidenberg M.M. (1976): Obesity and fasting: effects on drug metabolism and drug action in man. Clin. Pharmacol. Ther., 22, 729–734.

    Google Scholar 

  74. Roe D.A. (1984): Nutrient and drug interactions. Nutr. Rev., 42, 141–154.

    Article  PubMed  CAS  Google Scholar 

  75. Buchanan N., Robinson R., Koornhof H.J. et al. (1979): Penicillin pharmacokinetics in kwashiorkor. Am. J. Clin. Nutr., 32, 2233–2236.

    PubMed  CAS  Google Scholar 

  76. Lewis G.P., Jusko W.J., Burke C.W. et al. (1971): Prednisone side effects and serum-protein levels. Lancet, 2, 778–781.

    Article  PubMed  CAS  Google Scholar 

  77. Fleming C.R., Higgins J.A. (1977): Alcohol: nutrient and poison (editorial). Ann. Intern. Med., 87, 492–493.

    PubMed  CAS  Google Scholar 

  78. Rall T.W. (1990): Hypnotics and sedatives; ethanol. In: Gilman A.G., Rall T.W., Nigs A.S. et al (Eds). Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 8th edn. New York, Pergamon Press, pp. 345–382.

    Google Scholar 

  79. Humphrey M.J., Smith D.A. (1992): Role of metabolism and pharmacokinetic studies in the discovery of new drugs — present and future perspectives. Xenobiotica, 22, 743–755.

    Article  PubMed  CAS  Google Scholar 

  80. Gumbleton M., Sneader W. (1994): Pharmacokinetic considerations in rational drug design. Clin. Pharmacokinet., 26, 161–168.

    Article  PubMed  CAS  Google Scholar 

  81. Krstenansky P.M., Cluxton Jr R. (1987): Astemizole: a long-acting, nonsedating antihistamine. Drug Intell. Clin. Pharm., 21, 947–953.

    PubMed  CAS  Google Scholar 

  82. Weintraub M., Evans P. (1987): Astemizole: a long-acting and less sedating H1-blocking antihistamine. Hosp. Formulary, 22, 918–927.

    Google Scholar 

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Authors and Affiliations

  1. Medicine and Pharmacy Services, Department of Veterans Affairs Medical Center, Bay Pines, Florida, USA

    L. Williams MD & D. P. Hill

  2. Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Gainesville, Florida, USA

    J. A. Davis & D. T. Lowenthal

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  1. L. Williams MD
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Williams, L., Hill, D.P., Davis, J.A. et al. The influence of food on the absorption and metabolism of drugs: an update. European Journal of Drug Metabolism and Pharmacokinetics 21, 201–211 (1996). https://doi.org/10.1007/BF03189714

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