A Review on Mechanisms and Clinical Effects of Food-Drug Interactions

Review Article

Abstract

The concurrent administration of medications with food is a common practice that can significantly alter therapeutic efficacy and patient safety. These interactions manifest as modifications in a drug's pharmacological profile, potentially leading to treatment failure or adverse toxic events. The mechanisms underpinning these events are broadly classified as pharmacokinetic or pharmacodynamic. Pharmacokinetic interactions, which alter drug concentrations, are more prevalent and include impacts on gastrointestinal absorption, plasma protein binding, hepatic and intestinal metabolism, and renal excretion. Of particular significance is the modulation of the cytochrome P450 (CYP) enzyme system, exemplified by the potent inhibition of intestinal CYP3A4 by components in grapefruit juice, which can dangerously elevate systemic concentrations of numerous drugs. Conversely, other foods may induce metabolic enzymes, reducing drug efficacy. Pharmacodynamic interactions involve a direct modification of the drug's effect at its target site, such as the antagonistic relationship between vitamin K-rich foods and warfarin anticoagulation, or the synergistic toxicity observed with tyramine-containing foods and monoamine oxidase inhibitors. A thorough knowledge of these mechanisms is essential for healthcare professionals to provide effective dietary counseling, manage potential risks, and optimize pharmacotherapeutic outcomes for patients