Cite this article:
Karmakar (2016). Food- Drug Interaction Could be of Clinical Concern. Journal of Ravishankar University (Part-B: Science), 29(1), pp.50.
GL-F04
Food- Drug
Interaction Could be of Clinical Concern
Sanmoy Karmakar
Department of Pharmaceutical
Tech, Jadavpur University, Kolkata-32. India
Corresponding author email:
sanmoykarmakare gmail.com
(Received:
12 January 2016)
Abstract: Drug
metabolism involves biochemical modification of lipophilic chemical compounds
(mainly drugs) by living organisms, usually through specialized enzymatic
systems so as to render them more hydrophilic and eventually be excreted.
Metabolism or biotransformation reactions are of two types, namely phase I and
phase II reactions. Phase-I biotransformation reactions are more prevalent in
most of the tissues, which expose functional groups thereby increasing the
polarity of the compound. In mammals this type of biotransformation reaction
enzymes are mainly located in the endoplasmic reticulum and mitochondria, and
are thus enriched in microsomal preparations. Phase I reactions are broadly
grouped into three categories, oxidation, reduction and hydrolysis. Cytochrome
P450 is an integral part of Phase-1. Several CYP450 isoforms are involved in
drug metabolism. The cytochrome P450 (CYP) enzyme family plays a dominant role
in the biotransformation of a vast number of structurally diverse drugs. There
are several factors that influence CYP activity directly or at enzyme
regulation level. Many drug interactions are often results of inhibition or
induction of CYP enzymes. Inhibition based drug interactions form a major part
of clinically relevant drug interaction. CYP3A4 isoenzyme is one of the most
predominant isoenzymes within liver and is involved in the metabolism of
approximately (30-40) % of the drugs. In human liver there are at least 12
distinct CYP enzymes. At present it appears that out of about 30 isozymes, only
06 isoenzymes from the familices CYP -1, 2 and 3, which are involved in the
hepatic metabolism of most of the drugs. These include CYPIA2, 3A4, 2C9, 2C19,
2D6 and PE13 Therefore, metabolic drug interactions are a matter of major
concern for the pharmaceutical industry with particular reference to regulatory
agencies and health care professionals. It has bcen estimated that drug
interactions may be the fourth or sixth leading cause of death among all
hospitalised patients in the United States. Besides drug-drug interactions
study, now a day’s another aspect involving Food/Herb drug interaction is
gradually becoming clinically relevant particularly in the context of wide
spread popularity of herbal preparation which also involves nutraceuticals.
Herb-drug interaction has been considered to be important with drugs often
advocated for long term therapy. Antipsychotics and antidepressants are one
such examples demanding serious clinical vigilance. Carbamazepine (CBZ), a drug
with a comparatively narrow therapeutic index, is a concern among healthcare
professionals because it may result in clinically significant drug
interactions. Therefore, bioavailability studies in the presence of other drugs
and food are becoming increasingly necessary to avoid toxic effects or clinical
failure. The present study was undertaken to investigate the food-drug
interaction of CBZ with Common fruit juices Igrape fruit juice, lime juice],
known to inhibit the cytochrome P450-3A4 and some widely consumed beverages
[milk, black tea). The effects of the beverages on the pharmacokinetics and
drug-induced toxicity of CBZ was observed after concomitant administration of
the both for a period of 28 days. CBZ is known to undergo biotransformation by
CYP 3A4 into carbamazepine-10,11- epoxide. In our study this particular
transformation has been perhaps inhibited as a consequence to CYP inhibition by
the beverages mentioned above. Thereby the plasma concentration of CBZ is
supposed to reach toxic limits.
Keywords: Food drug
interaction, Biotransformation, Cytochrome P450