Chapter 17 Implications of Drug-Nutrient Interaction and Pharmacology

BOX 17.6 Information Given to an Older Adult on a New Prescription

Information given to an older adult on a new pre- scription should include the following basic infor-

mation: ●●

the name, purpose, and duration of prescrip- tion of the drug;

●●when and how to take the drug; ●● special diet needs;

●● expected significant side effects; ●●

●●

possible dietary suggestions to relieve side effects;

potential nutritional problems, particularly if dietary intake is inadequate;

●● dietary changes that may alter drug action; ●●

●● ●●

potential interactions between drug and vitamin/mineral supplements; and

nonnutrients (excipients) in drugs (eg, lactose, aspartame, starch, alcohol, dyes, common allergens).

tube feeding. Because blood levels of phenytoin are routinely performed to monitor the drug, much infor- mation exists about the reduction of phenytoin bio- availability when given with enteral feedings, and individual variability is significant. Recommendations to separate phenytoin suspension from tube feeding formulas are common. Stopping the tube feeding before and after the phenytoin dose is generally sug- gested, but recommendations vary from 1- to 4-hour intervals. The most common is a 1- to 2-hour feed- ing-free interval before and after the dose of phenyt- oin is administered (33).

Information may not be readily available concern- ing a drug and enteral product interaction. Checking with the manufacturers’ medical information depart- ment may yield more information.

Medical Nutrition Therapy and Food-Drug Interactions

What do RDNs and nutrition and dietetics techni- cians, registered (NDTRs) need to do with the above information? As part of the IDT, the RDN (or NDTR under the supervision of the RDN), can ensure that these individuals are educated about food-drug inter- actions before starting to use a drug (prospectively) and after they are using a drug to determine if an effect (retrospectively) might be the result of a food- drug interaction.

foods and beverages to avoid while taking the drug;

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BOX 17.7 Retrospective Medical Nuntrition Therapy: Evaluation of Symptoms as Possible Medication Interactions

●● ●● ●● ●● ●●

Medical and nutritional history, including allergies and food intolerances

Date of beginning the drug versus date of symptoms

Investigate percentage incidence of side effects with prescribed dose of the drug

Prescription and nonprescription drugs, including vitamin-mineral supplements.

Use of nutritional supplements such as enteral products or protein supplements

●●Use of herbal/natural products ●●

Nonnutrients (excipients) in drugs (eg, lactose, aspartame, starch, alcohol, dyes, common allergens)

●●

Significant dietary changes during the course of drug prescription.

This is not solely the responsibility of any specific member of the team but is often the role of the RDN or NDTR. Box 17.6 addresses information given to older adults with a new prescription; Box 17.7 is retrospec- tive MNT: evaluation of symptoms as possible medica- tion interactions.

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3. MUST for Seniors. Facts: older adults and medicine use. National Council on Patient Information and Edu- cation. www.mustforseniors.org/facts.jsp. Updated October 2010. Accessed December 29, 2015.

4. Doan J, Zakrzewski-Jakubiak H, Roy J, Turgeon J, Tan- nenbaum C. Prevalence and risk of potential cytochrome P450-mediated drug-drug interactions in older hospital- ized patients with polypharmacy. Ann Pharmacother. 2013;47(3):324-332. doi: 10.1345/aph.1R621.

5. Ferner RE, Aronson JK. Communicating information about drug safety. BMJ. 2006;333:143.

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