Drug - Nutrient Considerations in Patients Receiving Parenteral and Enteral Nutrition NUTRITION ISSUES IN GASTROENTEROLOGY , SERIES # 19

39 Interactions between drugs and nutrients often occur and can have a detrimental impact on patient outcome (1). The risk of pharmacologic-nutritional interactions continues to grow as specialized nutrition support (i.e., enteral and parenteral nutrition) is initiated earlier and the use of multiple medications increases. Recognition of clinically significant interactions can assist with prevention or early treatment of adverse consequences arising from drug-nutrient interactions. This article will focus on basic knowledge needed for identification and appropriate management of drug-nutrient interactions in patients requiring enteral nutrition (EN) and parenteral nutrition (PN). Drug-nutrient interactions will be divided into four categories based upon their mechanisms: 1) ex vivo biopharmaceutical inactivations; 2) interactions a ffecting absorption; 3) interactions affecting systemic/physiologic dispositions; and 4) interactions a ffecting elimination/clearance (2). Each category will be discussed separately and examples will be given to illustrate the use of alternative methods to assure safe drug administration.