Drug and Fruit Juice Interactions

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Khushbu on Jul 14, 2012 Says :

nice and informative ppt on fruit juices.

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Slide 1 :

DRUG INTERACTIONS WITH FRUIT JUICES AKSHAY PharmD

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INTRODUCTION Fruit juices can significantly alter the pharmacokinetics of drugs. Oral availability may increase or decrease depending on the type of juice consumed whether the drug is a substrate for specific enzymes and transporters in the intestinal wall

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This article describes the mechanism for these interactions and summarises the fruit juices and drugs involved

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Drug interactions with grapefruit juice are some of the most clinically important and well documented The common drug interactions occurs with Grape fruit juice Orange fruit juice ( sweet and bitter orange) Lime fruit juice Apple fruit juice Appear to have drug interactions potential

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Mechanisms in the intestinal wall

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1. Inhibition of CYP3A4 The cytochrome P-450 enzyme CYP3A4 is found in the epithelial cells of the small intestine as well as the liver Drugs that are substrates for CYP3A4 are partially metabolised as they cross the gut wall Grapefruit, Sweet orange and lime juices inhibit intestinal CYP3A42 and increase the oral availability of several drugs

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2. Inhibition of P-glycoprotein P-glycoprotein (P-gp) is a transporter that protects the body from toxins and drugs by actively pumping these out of the enterocyte into the intestinal lumen Both grapefruit juice and sweet orange juice inhibit intestinal P-gp P-gp is suggesting that it may play only a minor role in drug interactions

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3. Inhibition of OATP Organic Anion Transport Polypeptides (OATP) are a group of transporters found in enterocytes, hepatocytes and some other cells Two subtypes in the intestinal wall, OATP2B1 and OATP1A2, assist in the uptake of some drugs Grapefruit, sweet orange and apple juices inhibitor intestinal OATP and decrease the oral availability of the OATP substrate fexofenadine (ALLEGRA)

Slide 9 :

Interactions causing ? oral availability Clinically important fruit juice/ drug interactions that ? oral availability

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Interactions causing ? oral availability Fruit juices, including grapefruit, sweet orange and apple, can also decrease the oral availability of some drugs Clinically important fruit juice/ drug interactions that ? oral availability

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CONCLUSION CLINICAL MANAGEMENT SUGGESTIONS i.e. TAKING MADICATIONS WITH FRUIT JUICES CAN CAUSE POTENTIAL DRUG INTERACTIONS DRUGS ARE CHEMICAL SUBSTANCES THAT MAY CAUSE ANY SIDE EFFECTS WITH DRUG INTERACTION . THE AUTHOR SUGGEST TO TAKE MEDICATIONS WITH WATER AND MAINTAINING INTERVAL OF 1 TO 2 HRS FOR EACH DRUG THEY TAKE

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REFERENCES Saito M et al. Drug Safety 2008; 28(8): 667-694. Bailey, DG et al. Clin Pharm Ther 2009; 73: 529-37. Di Marco MP et al. Life Sciences 2006; 71: 1149-1160. Takanaga, H et al. J Pharm Exper Ther 2008; 293: 230-236. Lin JH and Yamazaki M. Clin Pharmacokinet 2010; 42: 59-98. Dresser GK et al. Clin Pharmacol Ther 2010; 71: 11-20

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THANK YOU

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