Polypharmacy and Food–Drug Interactions Among Older Persons: A Review

Abstract

Polypharmacy is generally defined as the use of 5 or more prescription medications on a regular basis. The average number of prescribed and over-the-counter medications used by community-dwelling older adults per day in the United States is 6 medications, and the number used by institutionalized older persons is 9 medications. Almost all medications affect nutriture, either directly or indirectly, and nutriture affects drug disposition and effect. This review will highlight the issues surrounding polypharmacy, food-drug interactions, and the consequences of these interactions for the older adult.

KEYWORDS:

• drug–nutrient interaction
• older adult
• polypharmacy

Notes

^*Milton JC, Hill-Smith I, Jackson SH. BMJ. 2008; 336(7644):606–9.

^§Maggiore RJ, Gross CP, Hurria A. Oncologist. 2010;15(5):507–22.

^†Stratton MA. Consult Pharm. 2009; 24(2):90, 92.

^¶Sorodoc V, Jaba IM, Lionte C, Mungiu OC, Sorodoc L. Hum Exp Toxicol. 2011;30(12):1896–903.

^∫Slabaugh S, Maio V, Templin M, Abouzaid S. Drugs Aging. 2010:27(12):1019–28.

^‡ Rocchiccioli JT, Sanford J, Caplinger B. J Gerontol Nurs. 2007 Jul; 33(7):19–24.

^¥Viktil KK, Blix HS, Moger TA, Reikvam A. Br J Clin Pharmacol. 2007; 63(2):187–95.

**Chan DC, Hao YT, Wu SC. Drugs Aging. 2009;26(4):345–54.

***Bushardt RL, Massey EB, Simpson TW, Ariail JC, Simpson KN. Clin Interv Aging. 2008;3(2):383–9.

^∧Junius-Walker U, Theile G, Hummers-Pradier E. Fam Pract. 2007; 24(1):14–9.

^∧∧Lopez-Picazo JJ, Ruiz JC, Sanchez JF, Ariza A, Aguilera B, Lazaro D, et al. Eur J Gen Pract. 2010;16(2):92–9.

^†Shi S, Mörike K, Klotz U. Eur J Clin Pharmacol. 2008; 64(2):183–99.

^‡McLachlan AJ, Bath S, Naganathan V, Hilmer SN, Le Couteur DG, Gibson SJ, Blyth FM. Br J Clin Pharmacol. 2011;71(3):351–64. doi:10.1111/j.1365-2125.2010.03847.x.

^§Merle L, Laroche ML, Dantoine T, Charmes JP. Drugs Aging. 2005; 22(5):375–92.

^¥Parikh AO. J Indian Med Assoc. 2007; 105(5):282, 284. ∫Jesson B. Nurs Older People. 2011;23(4):14–20.*Pugh MJV, Vancott AC, Steinman MA, Mortensen EM, Amuan ME, Wang C-P, et al. J Am Geriatr Soc. 2010;58(3):465–71.

**Ginsberg G, Hattis D, Russ A, Sonawane B. Environ Health Perspect. 2005; 113(9):1243–9.

*American Geriatrics Society 2012 Beers Criteria Update Expert Panel. J Am Geriatr Soc. 2012; 60(4): 616–31. Pronsky ZM. Food–Medication Interactions. 17th ed. Crowe JP Sr, ed. Birchrunville, PA: Food–Medication Interactions; 2012.

^a Centers for Medicare and Medicaid Services [Internet]. Baltimore, MD: U.S. Department of Health and Human Services [updated 24 May 2012; cited 30 May 2012]. Research, Statistics, Data, and Systems. Available from: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Dashboard/View-Dashboards-Items/CMS1238817.html

^b Pronsky ZM. Food–Medication Interactions. 17th ed. Crow JP Sr, ed. Birchrunville, PA: Food–Medication Interactions; 2012.

^a Boullata J. Natural health product interactions with medication. Nutr Clin Prac. 2005; 20(1):33–51.

^b Tachjian A, Maria V, Jahangir A. Use of herbal products and potential interactions in patients with cardiovascular diseases. J Am Coll Cardiol. 2010; 55(6):515–25.

^c Lee AH, Ingraham SE, Kopp M, Foraida MI, Jazieh AR. The incidence of potential interactions between dietary supplements and prescription medications in cancer patients at a veterans administration hospital. Am J Clin Oncol. 2006; 29(2):178–82.

^d Loya AM, Gonzalez-Stuart A, Rivera JO. Prevalence of polypharmacy, polyherbacy, nutritional supplement use and potential product interactions among older adults living on the United States–Mexico border: a descriptive, questionnaire-based study. Drugs Aging. 2009; 26(5):423–36.

^a Salazar JA, Poon I, Nair M. Expert Opin Drug Saf. 2007;6(6): 695–704.

^b Cheymol G. Clin Pharmacokinet. 2000;39(3): 215–31.

^c Jacques KA, Erstad BL. Am J Health Syst Pharm. 2010;67(22): 1948–50.

^d Green B, Duffull SB. Br J Clin Pharmacol. 2004;58(2): 119–33.

^e Bushra R, Aslam N, Khan AY. Oman Med J. 2011;26(2): 77–83.

^f Akamine D, Filho MK, Peres CM. Curr Opin Clin Nutr Metab Care. 2007;10(3):304–10.

^a Bushra R, Aslam N, Khan AY. Food–drug interactions. Oman Med J. 2011;26(2): 77–83.

^b Boullata J. Natural health product interactions with medication. Nutr Clin Prac. 2005;20(1): 33–51.

^c Dresser GK, Bailey DG, Leake BF, Schwarz UI, Dawson PA, Freeman DJ, et al. Fruit juices inhibit organic anion transporting polypeptide-mediated drug uptake to decrease the oral availability of fexofenadine. Clin Pharmacol Ther. 2002;71(1): 11–20.

^d Custodio JM, Wu CY, Benet LZ. Predicting drug disposition, absorption/elimination/transporter interplay and the role of food on drug absorption. Adv Drug Deliv Rev. 2008;60(6): 717–33.

^e Bonnici A, Ruiner CE, St-Laurent L, Hornstein D. An interaction between levodopa and enteral nutrition resulting in neuroleptic malignant-like syndrome and prolonged ICU stay. Ann Pharmacother. 2010;44(9): 1504–7.

^f Rodriguez-Fragoso L, Martinez-Arismendi JL, Orozco-Bustos D, Reyes-Esparza J, Torres E, Burchiel SW. Potential risks resulting from fruit/vegetable-drug interactions: effects on drug-metabolizing enzymes and drug transporters. J Food Sci. 2011;76(4): R112–24.

^g Cermak R. Effect of dietary flavonoids on pathways involved in drug metabolism. Expert Opin Drug Metab Toxicol. 2008;4(1): 17–35.

^h Said HM, Redha R, Nylander W. Biotin transport in the human intestine: inhibition by anticonvulsant drugs. Am J Clin Nutr. 1989;49(1): 127–31.

ⁱ Mock DM, Dyken ME. Biotin catabolism is accelerated in adults receiving long-term therapy with anticonvulsants. Neurolog. 1997;49(5): 1444–7.