Nutrition and drug interaction solution puzzle

Gina show

Many immunosuppressive drugs that are usually used in solid organs recipients know the interaction between nutrients and nutritional support. The ASPEN 2024 Nutrition Science & Practice Conference held in Tampa, Florida states that understanding these interactions and educating patients may be very useful for securing optimal results.

“Gennifer Gonmar, a BCPS clinical pharmacist at Duke University Hospital in Dallum, North Carolina, says that regimen and life are generally very complicated for these patients. 50 -piece strategic puzzle. I want to keep it as easy as possible. “

He pointed out that corticosteroids are the only major class drugs that affect nutritional support during the early induction of transplant immunosuppression. “Even a transplanted program that calls himself a” steroid -free “will take steroids in OR. “Even if they get one large amount, these high doses are still a big deal because they cause a large amount of bone volume. It is a transplant that may already be malnourished. This is a major problem for many of these patients.

Jeanette Hasse PHD, RD, and LD, a transplanted nutritional manager at Dallas University Medical Center, stated that the management of patients should be focused on proper intake for healing and recovery immediately after transplantation. 。 “Patient protein requirements usually increase significantly after acute technique, but the calories needs different,” said Dr. Hasse. “If they are malnourished, or have other problems such as cystic fibrosis, pancreatic deficiency, or need ECMO. [extracorporeal membrane oxygenation]Their needs increase. However, she pointed out that these needs decrease in hypothyroidism, lower muscle mass, and in/or non -active patients.

Other immunosuppressants used during guidance, such as monoclonal antibodies and polyclonal antibodies, usually do not usually affect nutritional support. However, the picture varies greatly depending on the maintenance agent. “Most patients take multiple drugs to prevent acute and chronic rejection forever or at least to prevent the life of transplantation,” said Dr. Gonmar. “These regimen backbones are calculinin inhibitors such as tacrolimus and cyclosporine. Many patients are receiving MTOR. [mammalian target of rapamycin] Inhibitor including Sirolimus and Everolimus. Anti -growth, such as AzachioPrin and mica phenolic acid. Alternatively, Belatacept, a new co -stimulation blocker [Nulojix, Bristol Myers Squibb]And most of them still have steroids. “

Due to hyperglycemic after transplantation, patients are often sent from the hospital from the hospital on the insulin correction scale that is often used when blood sugar is high.

General side effects from calculinin inhibitors include neurophyliosis, renal toxicity, and metabolic side effects such as hypertension and diabetes (high blood pressure and diabetes.Expert Opinion Drug SAF 2015; 14[10]: 1531-1546). “We are watching a lot [the latter conditions] She has these drugs and early electrolyte abnormalities such as hyperkalemia, hypothernemia, and high calcium. “

Dietary management of these side effects includes low potassium and diabetes meals. “The encouragement of foods containing magnesium can reduce the need for high -dose magnesium supply, and some patients have also pointed out that the gastrointestinal side effects of higher fiber intake are improved. Sometimes we can't overcome these problems by eating, and we need to help. “

She added that with no steroids, there could be a dysfunction after transplantation. “Calcinulin inhibitors are relevant to steroids, to reduce the survival of pancreatic beta cells, and can continue to suffer diabetes with up to 25 % of patients without steroids. If you can reduce the dose of the drug, you can see improvements. [hemoglobin] A1C “(Practitis Diab 2019; 36: 33-35).

Dr. Gomar said that the side effects of anti -metabolic products include neutrophils, platelets, anemia, gastritis, diarrhea, and hepatitis.COCHRANE DATABASE SYST REV 2015; 12: CD007746). Furthermore, “50 % or more people experience the side effects of GI.” She has the same GI side effects as oral products, so “Most patients are switching to formulas. It is unlikely to help. “

If the patient is weakening the side effects of GI, or if he has experienced other problems such as renal toxic or untrained hyperkalemia, switching to MTOR inhibitors can be an option. There is sex, but there is a unique problem. “This is a common option for patients with renal disorders, but since these drugs can damage wound healing, many transplanted programs use them early after transplantation. I don't think, “said Dr. Goma. “This is popular for many reasons because it has a significant part of the patient with oral ulcers, and up to 50 % of the drug -like metabolism, such as hyperlipidemia, hypertriglyceridemia, and pancreatitis. there is no”Transplant REV 2014; 28[3]: 126-133).

Belatacept is the only selective T cell -to -cells that have been approved by the FDA. This drug is shown in preventing organs refusal in adult patients receiving kidney transplantation. “the do not have She is shown in the transplant of liver, heart, or lungs. However, this drug has been expanded to non -adaptive use in non -kidney solid organs. “If you fail with all other drugs, it is a place to go. It is delivered in the vein and has no important nutritional side effects.”

Supplement warning

The manufacturer of these products “does not need to prove the effectiveness before it is sold, and does not need to study drug interactions and side effects, so all non -processed supplements will be avoided. I need it, “said Dr. Gonmar. “I know that St. John Zwart is guiding CYP3A4 [cytochrome P450 3A4]Increase metabolism and reduce the level of many drugs, including calculinin inhibitors and Mtor. Learn only about the drug interaction with the supplements for side effects and post -market reports. Someone takes something and has a bad event. “

Patients need to avoid ingesting substances such as grapefruit and grapefruit juice and avoid the provenly proven interaction with anti -FRE agents. “We know [grapefruit] Dr. Gomar emphasizes (dramatically increases the level of tacrolimus, cyclosporine, sirolimus, and Evarimus, “inhibits the intestinal and liver's CYP3A4 enzymes.Food 2020; 10[1]: 33).

She added that all of these drug absorption could be affected by food. “For many patients, high -fat foods reduce the absorption and peak level, but the consistency of how the patient takes medicine is really important unless there is a major problem that achieves a therapeutic drug level. We don't have to make their meals more difficult.

“The beauty of calculinin inhibitors and Mtor drugs can measure the amount of drugs in the blood,” she said. “I care that their lives are easy and they are taking medicine at the same time. If my patients haven't eaten breakfast for 10 years, I am taking the medicine they are taking. Do not say to them to start, and we will administer the medicine around. “

Dr. GOMMER has not reported the relevant financial disclosure. Dr. Hasse reported that she was at the Alcres Terapytics Speaker Bureau.

This article is from the print issue in July 2024.