Effect of nutrient-devices 
 on drugs
             
  • One of the most frequent drug-related 
   problems in patients receiving clinical 
   nutrition is drug interactions with enteral or 
   parenteral nutrition, and inappropriate drug 
   administration techniques 
 Effect of nutrient-devices 
 on drugs
         The problem (1)
   • Not much is known about drug and enteral or 
    parenteral feed incompatibilities. This is due 
    partly to the huge variability in composition of EN 
    and, especially, TPN solutions, and the range and 
    concentration of drugs which may be administered 
    simultaneously
 Effect of nutrient-devices 
 on drugs
         The problem (2)
   • One can find few things in current literature or in 
    the manufacturer’s product summary, therefore 
    most recommendations are theoretical 
   • Usually, drugs are not licensed for administration 
    in EN or PN, so pharmacists need to combine 
    theory with empiricism, knowing that in most 
    cases they cannot rely on published data to 
    confirm the safety of their actions. 
   Effect of nutrient-devices          European Association of 
                                        Hospital Pharmacists
   on drugs                               Amsterdam 2001
        General mechanisms of interactions 
           between nutrients and drugs (1)
      • stimulation of splachnic capillary blood flow 
        (increase in first-pass effect)
      • chelation of drug molecules by minerals such as 
        calcium and iron (eg. quinolones)
      • competing with the action of the drug                
        (eg. warfarin-vita K)
 Effect of nutrient-devices 
 on drugs
    General mechanisms of interactions 
     between nutrients and drugs (2)
   • changing the pH of the GI tract to increase or 
    decrease absorption 
   • inhibiting or enhancing drug metabolism 
   • changing GI motility to increase or decrease 
    absorption
   • enhancing drug solubility