Collaborations in Clinical Practice: Drug-Supplement, Drug-Nutrient .


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Outline. Of right around 900 medications and altered medication mixes utilized as a part of the U.S.:Almost 400 may exhaust particular nutrients.Over 400 may cooperate with sustenance or nourishment components.Over 300 have been appeared to associate with dietary supplements, with unfriendly and useful connections similarly normal.. Sorts of Interactions.
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Cooperations in Clinical Practice: Drug-Supplement, Drug-Nutrient Leo Galland, M.D. Connected Nutrition, Inc. www.nutritionworkshop.com

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Overview Of very nearly 900 medications and settled medication blends utilized as a part of the U.S.: Almost 400 may exhaust particular supplements. More than 400 may connect with sustenance or nourishment parts. More than 300 have been appeared to collaborate with dietary supplements, with antagonistic and useful cooperations similarly normal.

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Types of Interactions Pharmacodynamic: two substances show pharmacologic activities that strengthen or meddle with each other\'s activities. Pharmacokinetic: the ingestion, circulation, discharge or enzymatic change of one substance is modified by another. Most unfriendly connections are of this sort.

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Pharmacokinetic Mechanisms Alteration of gastrointestinal or urinary pH. Incitement, acceptance or hindrance of compounds required in biotransformation or transport of medications or supplements . Removal of a medication from official to plasma proteins. Change of dissolvability.

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Effects of Interactions Nutrient consumption: Individual supplements may have their dietary prerequisite expanded by particular medications (or supplements). Antagonistic: A particular supplement may undesirably lessening or increment the impact of a medication or supplement being taken. Advantageous: Drugs (or supplements) may have their activities improved or symptoms decreased by particular supplements.

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Drug-Induced Nutrient Depletion About a large portion of the medications utilized as a part of clinical practice have reported supplement exhausting impacts. Co-compound Q10, folic corrosive, B2, B6, Mg, Zn are supplements well on the way to be exhausted. Components incorporate hindered retention or bioactivation; expanded discharge.

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Co-protein Q10 Depletion Statin-instigated co-Q exhaustion debilitates mitochondrial work, raising the serum lactate/pyruvate proportion . Simvastatin yet not atorvastatin drains myofibrillar co-Q. Supplemental co-Q, 100 mg/day, keeps the decrease in serum co-Q levels without impedance of the lipid-bringing down impact of statins and may turn around side effects of statin myopathy.

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Co-catalyst Q10 Depletion (cont\'d) Statin-prompted Co-Q consumption is expanded by vitamin E (700 IU/day). Co-Q is devoured in reusing tocopheryl quinones back to tocopherols. Thiazides, some beta-blockers and numerous more seasoned psychotropic medications have been appeared to meddle with co-Q subordinate proteins, making a conceivable requirement for co-Q supplementation in patients getting them.

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Are accounted for antagonistic cardiovascular impacts of vitamin E supplements identified with co-Q exhaustion in patients bringing drugs that meddle with co-Q union or co-Q subordinate chemicals?

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Vitamin E and Statins a-Tocopherol avoids statin benefits in individuals with low HDL-C and ordinary TC. Identified with tocopherol hindrance of statin-initiated height of HDL2-C. Selenium (100 mcg/day) and fish oil have the inverse impact. a-Tocopherol exhausts gamma-tocopherol by aggressive authoritative to transport protein.

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Clinically Significant Depletions-1 Adriamycin exhausts co-chemical Q10. Cardiotoxicity is diminished by co-Q and proprionyl-L-carnitine. Cisplatin exhausts Mg. Nephtrotoxicity is diminished by i.v. what\'s more, oral Mg (160 mg tid). Thiazides and 5-ASA subordinates exhaust folate, raising homocysteine focus.

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Clinically Significant Depletions-2 Loop diuretics increment discharge of K, Ca, Mg, Zn, B1, B6, C. Amending B1 deficiency enhances cardiovascular capacity of CHF patients. Cephalosporins (parenteral) can exhaust vitamin K2, bringing on discharge. Steroids drain Ca and Mg, bringing about bone misfortune. Reversible with calcium and vit D3.

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Antiretroviral Nutrient Depletion AZT exhausts muscle carnitine and expands lymphocyte apoptosis. Switched with carnitine supplementation. AZT is related with diminished serum zinc and copper; zinc 200 mg/day decreased Candida and Pneumocystis diseases in patients taking AZT.

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Phenytoin-instigated Depletions Phenytoin may exhaust biotin, folate, thiamine, vitamin D (bringing on hypocalcemia and osteomalacia and vitamin K. Memory debilitation is related with diminished RBC folate. Folic corrosive, 1 mg/day, counteracts lack without unfavorably influencing phenytoin digestion system.

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Valproic Acid Depletions Valproate drains carnitine, raising smelling salts; turned around with carnitine 2 g/day. Valproate corrosive brings down serum folate and P5P, raising homocysteine; turned around with 400 mcg folate, 120 mg B6 and 75 mg B2. Valproate hinders biotinidase. Biotin 10 mg/day switches valproate-related male pattern baldness and dermatitis in youngsters.

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Chelation and Drug Absorption Chelation by minerals disables retention of quinolone or antibiotic medication anti-infection agents, thyroid, bisphosphonates, L-DOPA, some ACE inhibitors. Indeed, even a few herbs like dandelion and fennel, can be so rich in minerals that they hinder assimilation of these same medications. .

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The Cytochrome P450 System and Drug-Supplement Interactions Expressed predominantly in liver, digestion tracts, lungs and kidneys ("Phase 1 detoxication"). 20 distinctive human CYPs, gathered by amino corrosive homology, not by capacity. CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP2E1 and CYP3A4 most critical for oxidation of medications, xenobiotics.

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CYP1A2 Liver as it were. Inactivates caffeine and bioactivates sweet-smelling and heterocyclic amines; expansive between individual contrasts (up to 100-fold).  Induced by roast cooked meat, cigarettes, poisons, dioxins and cruciferous vegetables.

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CYP2: Drug-Drug Interactions CYP2C9 represents 30% of CYP action in human liver. May be adjusted by Ginkgo biloba. CYP2C19 is primarily hepatic. Phenotype mirrors the cooperation of 8 quality alleles. CYP2D6 is additional hepatic. Bioactivates codeine/codones. 55 alleles. CYP2E1 in liver, lung, cerebrum metabolizes natural solvents like ethanol. Prompted with perpetual ethanol utilize, fasting, weight. Hindered by intense liquor admission, tea, broccoli, garlic, onion, watercress.

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CYP3A4 Liver and small digestive system. Changes around half of regular medications. Initiated by St. John\'s wort (liver, digestive system) and Echinacea (liver as it were). Repressed by peppermint oil and piperine. Intestinal however not liver CYP3A4 is repressed by grapefruit juice, Seville squeezed orange and Echinacea.

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CYP3A4 and St. John\'s Wort CYP3A4 incitement by St. John\'s wort lessens blood levels of benzodiazepines, calcium channel blockers, hostile to retrovirals, estrogens (counting OCPs), amitriptyline, cyclosporine, methadone, tacrolimus and potentially warfarin.

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Intestinal CYP3A4 Inhibition Increases blood levels of amiodarone, artemisinin, atorvastatin, buspirone, carbemazepine, cyclosporine, diazepam, diltiazem, erythromycin, estradiol, felodipine, fentanyl, fluoxetine, lovastatin, methyl-prednisolone, nifedipine, nimodipine, praziquantel, saquinavir, sertraline, sildenafil, simvastatin, verapamil

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P-glycoprotein Transporter (P-gp) Ejects xenobiotics from cells and causes reverse of a few medications from intestinal mucosa into the lumen. Produces multi-sedate imperviousness to malignancy chemotherapy. Repressed by piperine, drain thorn and intensely by St. John\'s wort. Empowered by proceeded with St. John\'s wort.

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Alteration of Intestinal CYP3A4 and additionally P-glycoprotein Often includes similar substrates. Essentially impacts tranquilizes that go gradually through intestinal mucosa. Cooperations in vivo may not be anticipated by collaborations in vitro .

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Adverse Pharmacodynamic Interactions 5-HTP and SSRI\'s Licorice and horsetail, diuretics or purgatives Phenylalanine or kava and neuroleptics Bee venom and ACE inhibitors Brewer\'s yeast and MAO inhibitors Interferon-alpha and bupleurum

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Antithrombotic Interactions 35 normal items repress platelet work in vivo taking after oral utilize. They may strengthen each other or interface with antithrombotic solution. Headache medicine vitamin E collaboration: ibuprofen represses platelet collection; vitamin E restrains platelet bond to endothelium.

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Aspirin-Vitamin E Interactions a-Tocopherol (50 IU/day) raised danger of gingival draining 25% among ASA clients. 400 IU/day a-tocopherol added to 325 mg ASA/day decreased frequency of TIAs contrasted with headache medicine alone. Vit E 50 IU/day, diminished ischemic stroke by 30% however expanded hemorrhagic stroke by 145% in hypertensive, non-diabetic male smokers. In diabetics, there was no expansion in hemorrhagic stroke and ischemic stroke diminished by 70%.

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Warfarin Interactions 49 regular items may meddle with warfarin; 21 affirmed, 28 conceivable. Home grown coumarins may seek official to plasma protein, expanding plasma free warfarin focus. Controlled reviews found no impact on vitamin E or coenzyme Q10 on INR of patients taking warfarin.

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Beneficial Drug-Supplement Interactions Reflect added substance/integral impacts of supplements and medications, or improvement of harmful medication impacts by supplements. Angle oils upgrade calming, antiarrhythmic, hostile to lipemic, stimulant, and neuroleptic drugs, beta-blockers, lithium and insulin. EPA and DHA may have differential impacts.

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Acetaminophen Toxicity Protective supplements: N-acetyl cysteine (clinical utilize) L-methionine and SAMe Milk thorn Andrographis Schisandra

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ASA/NSAID Gastropathy Protective supplements (human trials): Vit C (500-1000 mg offer) SAMe 500 mg/day Cayenne 20 grams Deglycyrrhizinated licorice 350 mg tid Colostrum 125 mg tid

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Neuroleptic Side Effects Protective supplements: Vitamin E 1200-1600 IU/day (T.D.) Branched chain amino acids (T.D.) Ginkgo biloba 350 mg/day Sarcosine (N-CH3-glycine) 2 gm/day Eicosapentaenoate (EPA) 2 gm/day Glycine 0.4-0.8 mg/kg/day

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Cisplatin Toxicity Protective supplements: Bismuth 150 mg/kg/day X 10days Ginkgo

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