Drugs can impact nutrition intake by creating gastrointestinal problems or changing appetite and taste. Many medicines include nausea and vomiting as side effects that make it difficult to eat. Changes in appetite are common side effects of several medicines. Amantadine, digoxin, fluoxetine, levodopa, lithium, metformin, and penicillamine are examples of appetite-suppressing medications, while cyproheptadine, MAOI, tricyclic antidepressants, and valproate are examples of appetite-inducing medications. A prescribed medicine could be one of the causes of a patient’s lack of appetite. Several medicines have been linked to changes in taste perception. Chemosensory nerves react to activatory chemicals by attaching directly to receptors, opening ion channels or second messenger channels with nucleotides or phosphorylated inositol, and so on. Disrupting these biological mechanisms with drugs can result in taste loss or distortion.
A dry mouth can also cause a change in taste perception. Reduced production of saliva changes the concentration of ions in saliva and plasma, leading to a loss of taste experience.
Drugs can influence nutrition absorption in a variety of ways. Reduced stomach acid production, which can be caused by the use of proton pump inhibitors (e.g., omeprazole) and histamine H2 antagonists (e.g., cimetidine and ranitidine), might affect intrinsic factor secretion and vitamin B12 absorption. These medications and antacids alter gut pH, which has been linked to poor Fe absorption (iron). Fe is absorbed especially in the ferrous form, but if the intestine’s pH rises, the insoluble ferric form precipitates. Drugs can affect emptying of the stomach and gastrointestinal motility, which can decrease nutrition absorption. Laxatives, metoclopramide, opioids, and antimuscarinics can all affect gastrointestinal motility. Motility is reduced by antimuscarinics and opioids but increased by laxatives and metoclopramide. Although a decrease in motility is improbable to affect nutritional assimilation, a surge in motility may limit nutritional absorption. Long-term use of laxatives (such as bisacodyl and senna) can produce mineral depletion, while liquid paraffin promotes fat-soluble vitamin malabsorption. Chronic laxative usage has also been linked to lower vitamin B12 levels in the elderly. Drugs may also impact nutrient absorption that affects enzymes in the mucosa and transporters in the gastrointestinal tract. For example, phenytoin inhibits intestine conjugases, which divide dietary folates that are polyglutamate-based to the absorbable form, monoglutamate.
Some medications have antivitamin effects. Isoniazid, MAOI, methotrexate, phenytoin, and more drugs fall into this category. Isoniazid disrupts pyridoxine metabolism and can lead to peripheral neuropathy, especially in people who already have diabetes, alcoholism, chronic renal failure, malnutrition, or HIV infection. Pyridoxine (10 mg/d) must be given from the commencement of treatment in these cases. Prolonged phenytoin and other anticonvulsants can disrupt vitamin D and calcium metabolism, potentially leading to osteomalacia. Supplementing folic acid can lower serum phenytoin levels because phenytoin inhibits folic acid function. Women who take phenytoin at the time of pregnancy or those who are planning a pregnancy, are frequently prescribed a daily folic acid supplement of 5 mg. Several vitamin metabolisms like vitamin A, vitamin C, vitamin B6, and folic acid are affected by oral contraceptives.
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