Interactions of drugs and functional food components: probiotics, resveratrol and organosulfur compounds

Funkcionalne sastavnice hrane mogu potencijalno imati značajan utjecaj na brzinu i stupanj apsorpcije lijeka, distribuciju, metabolizam i eliminaciju, kao i na njegovu farmakodinamiku. Ove interakcije se iz kliničke perspektive smatraju značajnim ukoliko mijenjaju terapijski odgovor ili utječu na nutritivni status. Pacijenti koji boluju od kroničnih bolesti i imaju više lijekova u terapiji (posebice uske terapijske širine), djeca, stariji, kao i pacijenti sa genetskim varijacijama u metabolizmu lijekova, smanjenim radom nekog od organa, ili slabim nutritivnim statusom su posebno podložni javljanju mogućih interakcija. Međutim, za razliku od interakcija lijek-lijek, premalo pažnje je posvećeno interakcijama hrana-lijek. Zbog toga je potreban konzistentniji pristup u utvrđivanju tih interakcija, kako bi se procijenio utjecaj nutritivnog statusa, hrane ili specifičnih nutrijenata na farmakokinetiku i farmakodinamiku lijeka, kao i utjecaj lijeka na cjelokupni status specifičnog nutrijenta. Ovaj diplomski rad pruža pregled različitih tipova funkcionalne hrane, najznačajnijih bioaktivnih sastavnica funkcionalne hrane i njihovih učinaka, kao i do sada poznatih mehanizama djelovanja, odnosno stupanja u interakcije s lijekovima koji su svakodnevna, kronična terapija mnogih pacijenata. Posebno žarište stavljeno je na tri sastavnice funkcionalne hrane s kojima većina populacije često dolazi u kontakt – probiotici koji se konzumiraju kroz jogurt i druge mliječne proizvode, kao i dodatke prehrani, resveratrol iz grožđa i crvenog vina, te organosumporni spojevi prisutni u luku i češnjaku. Rad daje pregled i analizu do sada provedenih studija o interakcijama ovih sastavnica sa konvencionalnim lijekovima, i daje upute za prilagođavanje terapije, promjene režima prehrane, ili neophodno praćenje potencijalno opasnih interakcija.Functional food components can significantly influence the rate and degree of drug absorption, its distribution, metabolism and elimination, as well as its pharmacodynamic effects. From a clinical perspective, these interactions are considered relevant if they alter the therapy response or influence the nutritive status. The following categories of patients are especially susceptible to possible adverse interactions: patients suffering from chronic diseases who take multiple drugs as part of their therapy (in particular narrow-spectrum therapy), children, seniors, patients with genetic variations affecting drug metabolism, patients with organ dysfunctions and patients with poor nutritive status. However, in spite of the possible seriousness of the food-drug interactions, not enough focus has been put on them yet. A more comprehensive approach to determining and researching these interactions is needed in order to assess the influence of nutritive status, food and specific nutrients on the drugs' pharmacokinetics and pharmacodynamics, as well as the effects of drugs on the overall status of a specific nutrient. This thesis presents an overview of different types of functional food, important bioactive components of functional food and their effects, as well as known interaction mechanisms with conventional drugs used to treat chronic conditions of patients world wide. The scope of the thesis is, in particular, focused on the following three functional food components frequently consumed by the general population: probiotics (ingested through yogurt, fermented dairy products and food supplements), resveratrol (naturally occurring in grapes and red wine) and organosulfur compounds (found in onion and garlic). A review and analysis of existing studies related to these three functional food components and their interactions with conventional drugs is performed, and a set of recommendations for therapy, diet adjustment and interaction monitoring is given