Physiological changes associated with aging affect the absorption, distribution, metabolism, and excretion of drugs and thus therapeutic outcomes. These changes may be further amplified by interactions with nutrients. The purpose of this review was to summarize drug-nutrient interactions found in elderly patients. Mechanisms of the interactions can be categorized as ex vivo bio-inactivations, interactions in absorption and elimination phases, and physiological interactions. The goal of enteral nutrition (EN) is to maximize the therapeutic response of medication without adversely affecting EN tolerance. Therefore, to ensure safety, consistent monitoring is necessary for enteral feeding of patients receiving medication via an enteral tube. Elderly patients receiving parenteral nutrition (PN) are often treated concomitantly with medication via the parenteral route. The stability and compatibility of PN formulations infused with other additives, including medication, may be influenced. Limitation of the number of prescriptions to essential medications only during the minimum period along with periodic re-evaluations of the treatment are thus necessary to minimize undesirable drug-nutrient interactions in elderly patients.
Absorption ; Aged* ; Aging ; Enteral Nutrition ; Food-Drug Interactions ; Humans ; Metabolism ; Nutritional Support ; Parenteral Nutrition ; Prescriptions

Only anticoagulation has been shown to reduce atrial fibrillation-related deaths. Vitamin K antagonists are difficult to use due to their narrow therapeutic range, unpredictable response, requirement for frequent coagulation monitoring, frequent dose adjustment, slow onset-offset, and numerous drug-drug and drug-food interactions. New oral anticoagulants (NOACs), such as dabigatran, rivaroxaban, and apixaban have been developed and are available in Korea, and edoxaban was shown to be effective and safe, also. NOACs showed better pharmacodynamics with predictable serum concentrations and effects, and no requirement for coagulation monitoring. These drugs have been shown to be more effective and safer than warfarin for prevention of stroke and systemic thromboembolism in patients with nonvalvular atrial fibrillation. Broad, appropriate, and aggressive use of NOACs would improve the results of treatment in patients with nonvalvular atrial fibrillation in Korea.
Anticoagulants* ; Atrial Fibrillation* ; Food-Drug Interactions ; Humans ; Korea ; Stroke* ; Thromboembolism ; Vitamin K ; Warfarin ; Dabigatran ; Rivaroxaban

Epilepsy ; diet therapy ; metabolism ; Food-Drug Interactions ; Humans ; Ketone Bodies ; biosynthesis

Animals ; Anticarcinogenic Agents ; pharmacology ; Cytochrome P-450 Enzyme System ; drug effects ; genetics ; metabolism ; Food-Drug Interactions ; Gene Expression Regulation, Enzymologic ; Herb-Drug Interactions ; Humans ; Plant Preparations ; pharmacology

BACKGROUND: Following the implantation of heart valve prostheses, it is important to maintain therapeutic INR to reduce the risk of thromboembolism. The objective of this study was to suggest a practical dosing guideline for Korean outpatients with prosthetic heart valves managed by a pharmacist-run anticoagulation service (ACS). MATERIAL AND METHOD: A retrospective chart review was completed for all patients enrolled in the ACS at Seoul National University Hospital from March, 1997 to September, 2000. Patients who were at least 6 months post-valve replacement and had nontherapeutic INR value (less than 2.0 or greater than 3.0) were included. The data on 688 patients (1,782 visits) requiring dosing adjustment without any known drug or food interaction with warfarin were analyzed. The amount of adjusted dose and INR changes based on the INR at the time of the event were calculated. Aortic valve replacements (AVR) patients and mitral or double valve replacement (MVR/DVR) patients were evaluated separately. RESULT: Two methods for the warfarin dosage adjustment were suggested: Guideline I (mg-based total weekly dose (TWD) adjustment), Guideline II (percentage-based TWD adjustment). The effectiveness of Guideline I was superior to Guideline II overall in patients with both AVR and MVR/DVR. CONCLUSION: The guideline suggested in this study could be useful when the dosage adjustment of warfarin is necessary in outpatients with mechanical heart valves.
Anticoagulants ; Aortic Valve ; Dose-Response Relationship, Drug ; Food-Drug Interactions ; Heart Valve Prosthesis ; Heart Valves* ; Heart* ; Humans ; International Normalized Ratio ; Outpatients* ; Retrospective Studies ; Seoul ; Thromboembolism ; Warfarin*

OBJECTIVETo explore the influence of ursodeoxycholic acid on the therapeutic effects of low-calorie diet in steatohepatitis with obesity and hyperlipidemia.

METHODSThirty-five Sprague-Dawley rats fed with high-fat diet for 10 weeks were randomly allocated into 3 groups, and continued to experiment for 2 weeks. The animals in model group (n = 10) were still fed with high-fat diet; low-calorie diet group (n = 10) with common diet but only one third of the amount of normal demand; ursodeoxycholic acid group (n = 15) with low-calorie diet and ursodeoxycholic acid (15 mg/kg.d(-1)); and another 9 rats with common diet for 12 weeks as normal group.

RESULTSCompared with normal group, such indexes as body weight, liver weight, and the level of serum lipids and aminotransferase were all increased significantly in model group. Furthermore, all rats in model group developed steatohepatitis. On the other hand, such indexes as body weight and the degree of steatosis in rats of low-calorie diet group were decreased sharply compared with those in model group, but neither disorders of serum lipid nor the degree of hepatic inflammation and necrosis in low-calorie diet group were improved obviously. Disorders of serum lipid, aspartate aminotransferase, hepatic inflammation and necrosis in ursodeoxycholic acid group were ameliorated to some extent.

CONCLUSIONSUrsodeoxycholic acid might help to improve the therapeutic effects of low-calorie diet on steatohepatitis with obesity and hyperlipidemia.

Animals ; Diet ; Disease Models, Animal ; Food-Drug Interactions ; Hepatitis ; complications ; diet therapy ; Hyperlipidemias ; complications ; diet therapy ; Obesity ; complications ; diet therapy ; Rats ; Rats, Sprague-Dawley ; Ursodeoxycholic Acid ; pharmacology

China pharmacopoeia is a civil code which is to ensure pharmaceutical quality and protect people's drug safety and effectiveness. Drug standards are consist of two parts, the pharmaceutical standards and medical standards. Medical standards include four contents, such as prescription, function and indications, usage and dosage and attentions. This paper summarized the revised contents of medical standards and suggested some propositions.
Contraindications ; Documentation ; Drug Administration Schedule ; Drug Compounding ; standards ; Drug Dosage Calculations ; Drug Prescriptions ; standards ; Drugs, Chinese Herbal ; adverse effects ; pharmacology ; standards ; Female ; Food-Drug Interactions ; Humans ; Pregnancy ; Terminology as Topic

There is a close relationship between sexual activity and meals or alcohol consumption. It is of great clinical significance for clinicians to understand the effects of food and alcohol on the pharmacokinetics of phosphodiesterase-5 inhibitor vardenafil so as to give correct instructions to patients. Although a high-fat ( > 55% fat calories) meal modestly reduces C(max) by 18% and prolongs t(max) of vardenafil by approximately 1 hour, no significant effects of a typical moderate-fat meal (30% fat calories) on vardenafil pharmacokinetics were observed in a study carried out in 25 healthy adult males. So the adjustment of vardenafil dosage is not warranted based on a wide therapeutic index and the efficacy observed with vardenafil in Phase III studies, which need not be restricted with respect to food. In another study, the pharmacokinetics and safety profile of vardenafil were not affected if it was taken together with 0.5 g/kg ethanol. The above characteristics of vardenafil make the administration more convenient for patients.
Adult ; Alcohol Drinking ; Erectile Dysfunction ; drug therapy ; Food-Drug Interactions ; Humans ; Imidazoles ; adverse effects ; pharmacokinetics ; Male ; Phosphodiesterase Inhibitors ; adverse effects ; pharmacokinetics ; Piperazines ; adverse effects ; pharmacokinetics ; Sulfones ; adverse effects ; pharmacokinetics ; Triazines ; adverse effects ; pharmacokinetics ; Vardenafil Dihydrochloride

OBJECTIVETo evaluate the effect of additives on absorption of Coptis chinensis total alkaloid and their pharmacokinetics in mice.

METHODThe mice were fed with the mixture of C. chinensis total alkaloids and additives (1:1). And then the feces and orbital blood were taken to detect the content of total alkaloids by HPLC and their pharmacokinetics.

RESULTGlutin could make the absorption of jatrorrhizine, coptisine, berberine and total alkaloids increased by 30%. Tween 80 and arabic gum did not affect the absorption of berberine, but inhibit that of other alkaloids. There had no influence of lecithin on the absorption of alkaloids. The peak time of total alkaloids in blood were 2 h (Cmax 1=5.9 mg x L(-1)) and 5.0 h (Cmax 2=3.4 mg x L(-1)), respectively, AUC was 17.6 mg x h x L(-1), the elimination of Half-life t1/2 was 5.2 h. After addition of glutin, the peak time of total alkaloids in blood were 1.5 h (Cmax 1=7.6 mg x L(-1)) and 4.8 h (Cmax 2=8.5 mg x L(-1)), AUC was up to 31.1 mg x h(-1) x L(-1), the elimination of Half-life t1/2 was 6.2 h.

CONCLUSIONGlutin could accelerate the mice on the absorption of C. chinensis total alkaloids, to extend the elimination half-life, increase the blood concentration and bioavailability.

Absorption ; drug effects ; physiology ; Alkaloids ; blood ; pharmacokinetics ; Animals ; Berberine ; analogs & derivatives ; blood ; Chromatography, High Pressure Liquid ; Coptis ; chemistry ; Diterpenes ; pharmacology ; Drug Interactions ; Female ; Food Additives ; pharmacology ; Half-Life ; Male ; Mice