Patients under enteral nutritional therapy and prevalence of drug-nutrient interactions in the hospital environment
DOI:
https://doi.org/10.33448/rsd-v9i3.2680Keywords:
Enteral nutrition; Drug-food interactions; Nutrition therapy; Drug-related side effects and adverse reactions.Abstract
To determine the prevalence of possible drug-nutrient interactions in hospitalized patients undergoing enteral nutritional therapy and to analyze the clinical risk. Observational, analytical and retrospective study with medical records of 104 patients undergoing enteral nutritional therapy, admitted to a university hospital in a capital of southern Brazil. Information was collected in the electronic medical record Tasy®, from patients hospitalized from July to December 2018, who received enteral nutritional therapy. The drugs used were classified according to the Anatomical Therapeutic Chemical Code. Drug-nutrient interactions were determined using the Micromedex 2.0® program. Of the 112 medications used by patients, 28.6% of potential prevalence of drug-nutrient interactions was observed, with 6.25% of potential for drug interaction with food in general and 2.7% of potential for interaction with enteral nutritional therapy, of moderate severity (n = 19; 59.4%), with a good level of evidence (n = 17; 53.2%) and of immediate onset (n = 22; 68.7%). The drugs involved were mainly phenytoin, levothyroxine and warfarin. Patients undergoing enteral nutritional therapy have a small but harmful risk of drug-nutrient interactions, mainly related to the treatment of seizure crises, thyroid, and blood clotting. It is suggested that protocols be implemented in order to ensure nutritional and drug safety for hospitalized patients.
References
Barbosa, D, L., Miguel, S. S.; Cornélio, R. C. A. C.; Alvin, M. M.; Paiva, C. F.; Caputo, L. S. (2018). Interações fármaco-nutrição enteral em unidade de terapia intensiva: determinação de prevalência e significância clínica. Braspen J. 33(1):49-53.
Basso, A. P.; Pinheiro, M. S. (2014). Avaliação dos medicamentos prescritos para pacientes submetidos à terapia nutricional enteral no CTI. Rev Bras Farm Hosp Serv Saúde. 5(1):12-18.
Bonnici, A.; Ruiner, C. E.; St-Laurent, L.; Hornstein, D. (2010). An interaction between levodopa and enteral nutrition resulting in neuroleptic malignant-like syndrome and prolonged ICU stay. Ann Pharmacother. 44(9):1504-7.
Bushra, R.; Aslam, N.; Khan, A. Y. (2011). Food Drug Interactions. Oman Med J. 26(2), 77–83.
Castro, M. G.; Ribeiro, P. C.; Souza, I. A. O.; Cunha, H. F. R.; Silva, M. H. N.; Rocha, E. E. M.; et al. (2018). Diretriz Brasileira de terapia nutricional no paciente grave. Braspen J. 33(supl 1):2-36.
Chan, L. N. (2013). Drug-Nutrient Interactions. J Parenter Enteral Nutr. 37(4):450–459.
Drugdex system. (2019). Micromedex® healthcare series. Greenwood Village: Thompson MICROMEDEX. Acesso em 30 junho, em https://www.micromedexsolutions.com/micromedex2/librarian/deeplinkaccess?institution=COMMHOS%5eCOMMHOS%5e33486.
Ekincioğlu, A. B.; Demirkan, K. (2013). Clinical nutrition and drug interactions. Ulus Cerrahi Deg. 29:177-186.
Fernandes, I. S. N.; Mezzomo, T. R. (2017). Estado nutricional de participantes de um Centro de Atividades para Idosos em Colombo, PR. Rasbran. 8(1):46-51.
Joss, E.; Mehuys, E.; Remon, J. P.; Van Winckel, M.; Boussery, K. (2016). Analysis of drug use in institutionalized individuals with intellectual disability and tube feeding. Acta Clin Belg. 71(2): 76-80.
Lopes, E. M.; Carvalho, R. B. N.; Freitas, R. M. (2010). Análise das possíveis interações entre medicamentos e alimento/nutrientes em pacientes hospitalizados. Einstein. 8(3 Pt 1):298-302.
Nascimento, R. C. R. M.; Álvares, J.; Guerra Junior, A. A.; Gomes, I. C.; Silveira, M. R.; Costa, E. A.; et al. (2017). Polifarmácia: uma realidade na atenção primária do Sistema Único de Saúde. Rev Saúde Pública. 51(suppl 2):1-12.
Neves SJF, Marques APO. (2016). Prevalence and predictors of potential drug-food interactions among the elderly using prescription drugs. J Chem Pharm Res. 8(4):965-72.
Reis, A. M. M.; Cassiani, S. H. B. (2011). Prevalence of potential drug interactions in patients in an intensive care unit of a university hospital in Brazil. Clinics. 66(1):9-15.
Reis, A. M. M.; Carvalho, R. E. F. L.; Faria, L. M. P.; Oliveira, R. C.; Zago, K. S. A.; Cavelagna, M. F.; et al. (2014). Prevalência e significância clínica de interações fármaco-nutrição enteral em Unidades de Terapia Intensiva. Rev Bras Enferm. 67(1):85-90.
Santos, A. P. L.; Claudino, L. M.; Pistori, M. E. S.; Mezzomo, T. R. (2018). Indicadores de qualidade em terapia nutricional em uma unidade de terapia intensiva de trauma, Curitiba, PR, Brasil. Nutr clín diet hosp.38(1):149-155.
Silva, R. F.; Novaes, M. R. C. G. (2014). Interactions between drugs and drug-nutrient in enteral nutrition: A review based on evidences. Nutr Hosp. 30(3):514-518.
Souza, J.; Silva, J. A. C.; Langaro, E.; Zanchim, M. C.; Silva, A. P. (2017). Interação fármaco-nutrientes em unidade de terapia intensiva. Braspen J. 32(3):226-230.
Teles, J. S.; Fukuda, E. Y.; Feder, D. (2012). Varfarina: perfil farmacológico e interações medicamentosas com antidepressivos. Einstein. 10(1):110-5.
Tucker, A.; Ybarra, J.; Bingham, A.; Blackmer, A.; Curtis, C.; Mattox, T.; et al. (2015). American Society for Parenteral and Enteral Nutrition (ASPEN) standards of practice for nutrition support pharmacists. Nutr Clin Pract. 30(1):139-46.
Vinagre, A. L. M.; Souza, M. V. L. (2011). Interferências na absorção de levotiroxina e dificuldades no manuseio de pacientes com hipotireoidismo na unidade de terapia intensiva: relato de dois casos e revisão de literatura. Rev Bras Ter Intensiva. 23(2):242-248.
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
