School of Pharmacy, and Graduate Program in Nutritional Sciences, University of Washington, Seattle, WA 98195-7630, USA.
JPEN J Parenter Enteral Nutr. 2013 Jul;37(4):450-9. doi: 10.1177/0148607113488799. Epub 2013 May 14.
Drug-nutrient interactions are defined as physical, chemical, physiologic, or pathophysiologic relationships between a drug and a nutrient. The causes of most clinically significant drug-nutrient interactions are usually multifactorial. Failure to identify and properly manage drug-nutrient interactions can lead to very serious consequences and have a negative impact on patient outcomes. Nevertheless, with thorough review and assessment of the patient's history and treatment regimens and a carefully executed management strategy, adverse events associated with drug-nutrient interactions can be prevented. Based on the physiologic sequence of events after a drug or a nutrient has entered the body and the mechanism of interactions, drug-nutrient interactions can be categorized into 4 main types. Each type of interaction can be managed using similar strategies. The existing data that guide the clinical management of most drug-nutrient interactions are mostly anecdotal experience, uncontrolled observations, and opinions, whereas the science in understanding the mechanism of drug-nutrient interactions remains limited. The challenge for researchers and clinicians is to increase both basic and higher level clinical research in this field to bridge the gap between the science and practice. The research should aim to establish a better understanding of the function, regulation, and substrate specificity of the nutrient-related enzymes and transport proteins present in the gastrointestinal tract, as well as assess how the incidence and management of drug-nutrient interactions can be affected by sex, ethnicity, environmental factors, and genetic polymorphisms. This knowledge can help us develop a true personalized medicine approach in the prevention and management of drug-nutrient interactions.
药物-营养素相互作用是指药物和营养素之间的物理、化学、生理或病理生理关系。大多数临床上有重要意义的药物-营养素相互作用的原因通常是多因素的。未能识别和正确管理药物-营养素相互作用可能导致非常严重的后果，并对患者的结局产生负面影响。然而，通过彻底审查和评估患者的病史和治疗方案，并执行精心制定的管理策略，可以预防与药物-营养素相互作用相关的不良事件。根据药物或营养素进入体内后的生理事件顺序和相互作用的机制，药物-营养素相互作用可分为 4 种主要类型。每种类型的相互作用都可以使用类似的策略进行管理。指导大多数药物-营养素相互作用的临床管理的现有数据主要是轶事经验、无对照观察和意见，而理解药物-营养素相互作用机制的科学仍然有限。研究人员和临床医生面临的挑战是增加这一领域的基础和高级临床研究，以缩小科学与实践之间的差距。研究应旨在更好地了解胃肠道中与营养相关的酶和转运蛋白的功能、调节和底物特异性，并评估性别、种族、环境因素和遗传多态性如何影响药物-营养素相互作用的发生率和管理。这些知识可以帮助我们在预防和管理药物-营养素相互作用方面发展真正的个体化医学方法。
