Healthcare suppliers understandings & drug-food interactions


Drug and Meals Interactions (DFI) come up when specific vitamins in meals work together with medicine when consumed concurrently. The scientific significance varies for drug–drug interactions (DDIs), ie, main, average, minor, which are acknowledged as a significant issue for optimum healthcare provision. Equally, the identical may be utilized for DFI that are much more complicated problem.1 DFI might affect pharmacokinetics, together with the ADME course of (absorption, distribution, metabolism, and excretion), in addition to the pharmacodynamic properties of the remedy.2 Subsequently, DFI might lower or enhance the bioavailability of medicines, inflicting therapy failure and/or opposed occasions.3 Moreover, DFI are usually not been particularly addressed through the drug improvement section, aside from the results of entire meals and macronutrients on drug properties.4 DFIs symbolize the foremost danger for innocent and efficient pharmacotherapy; thus, figuring out the elemental mechanisms is crucial to keep away from these dangers to one of the best extent.5 The diploma of drug-food interplay is influenced by the bodily and chemical nature of the drug, formulation, meals sort, and time between the drug and meals.6 Clinically substantial DFI may be categorized into pharmaceutical, pharmacokinetic, and pharmacodynamic varieties, relying on the mechanisms of interplay.7 Pharmaceutical interactions embody physicochemical reactions that happen throughout drug supply gadgets, corresponding to enteral feeding tubes. Pharmacokinetic interactions happen when they’re related to drug absorption, distribution, metabolism, and excretion, which enormously fluctuate relying on the presence of meals.8 Examples of pharmacokinetic interactions embody dairy merchandise that comprise divalent cations that type a chelate with ciprofloxacin9 and grapefruit juice deterred CYP3A4 metabolism of simvastatin.10,11 Alternatively, pharmacodynamic interactions come up when meals modifies the scientific impact of the drug, leading to additive, synergistic, or antagonistic results. As an illustration, a vitamin Okay-enriched eating regimen antagonizes the anticoagulant therapeutic results of warfarin.12 The prevalence of DFI varies enormously between nations, starting from 6% to 70%.5 As a result of magnitude of the impact of meals on oral drug bioavailability, the US Meals and Drug Administration (FDA), adopted by the European Medicines Company (EMA), issued a regulation for preforming bioavailability in addition to bioequivalence experiments below fed situations. At the moment FDA and EMA tips necessitate the administration of a high-caloric and high-fat take a look at meal for the inquiry of meals actions on the oral remedy bioavailability. Moreover, aged people taking a number of drugs for power ailments are at an excellent increased danger of DFI; accordingly, geriatric sufferers must be scrutinized for DFI.13,14 The incidence and penalties of DFI have been verified by loads of proof; subsequently, information and understanding of DFI are indispensable for healthcare suppliers (HCPs) to discourage these interactions.15,16

Healthcare suppliers play an vital position in averting DFIs17 by way of recognizing in addition to providing ample data concerning possible DFIs. Subsequently, the HCPs’ information of DFIs is key. Nevertheless, research carried out in a number of components of the world, corresponding to Jordan,18 Palestine,19 and the US of America20 reported that HCPs exhibit inadequate details about DFI. Within the Kingdom of Saudi Arabia (KSA), a research evaluated the general public’s degree of data and consciousness of DFI in Jeddah. The Knowledge confirmed that the contributors had poor to intermediate ranges of data and consciousness of DFI.15 One other research carried out a survey amongst Pharmacy Faculty college students in Al-Jouf Area and demonstrated that college students had restricted consciousness of DFIs signifying the necessity for educating college students and updating their information about DFIs to enhance therapeutic efficacy, drug compliance, and sufferers security.21 Concerning HCPs, there’s a paucity of knowledge in regards to the HCPs’ information and recognition of DFIs in KSA. Subsequently, the present research designed to determine HCPs’ information of DFIs and their concomitant elements within the japanese area of Saudi Arabia.

Supplies and Strategies

Research Design and Setting

This descriptive cross-sectional research aimed to judge the information of HCPs concerning DFIs within the japanese area of KSA. The research individuals had been docs, pharmacists, nurses, and healthcare college students between Sep. to Oct. 2022.

Research Approval

This research was authorized by the Institutional Overview Board (IRB) of King Faisal College within the japanese area of Saudi Arabia (IRB approval quantity KFU-REC-2022-OCT-ETHICS211). Knowledgeable consent was obtained from every participant previous to knowledge assortment.

Pattern Measurement Calculation

The pattern dimension required for this research was estimated utilizing a pattern dimension calculator ( ), utilizing a confidence interval of 95% and a margin of error of 5%.

Knowledge Assortment

A self-administered on-line questionnaire was used to gather knowledge from the individuals. The questionnaire was distributed on social media. The questionnaire was tailored and modified from a earlier research that assessed the information of HCPs in the direction of DFIs.7 The questionnaire built-in questions for HCPs regarding demographic options together with gender, age, ethnic group, degree of schooling, occupation, and years of labor expertise. The second part was the information concerning DFIs part, which comprised 22 questions that evaluated the overall information of DFIs and information of particular meals and drug interactions.

Knowledge High quality Management and Knowledge Evaluation

A pretest was carried out on 5% of the full research inhabitants earlier than the beginning of knowledge assortment. Any errors discovered through the pretest had been corrected and modifications had been made to the ultimate model of the questionnaire. All of the collected knowledge had been examined for completeness and consistency throughout knowledge administration, storage, and evaluation.

Knowledge had been collected, reviewed, and fed into SSPS model 21. The statistical strategies used had been two-tailed with an alpha degree of 0.05, contemplating significance if the p-value was lower than or equal to 0.05. Concerning the HCPs’ information, every appropriate reply was given 1-point rating. The general information degree concerning DFIs and particular meals interactions was assessed by summing the discrete scores for the totally different appropriate information gadgets. The median rating with vary was calculated for every area and the general information rating. Descriptive evaluation was carried out by prescribing frequency distribution and proportion for research variables, together with individuals’ sociodemographic knowledge and occupation. As well as, individuals’ information concerning drug-food interplay was tabulated, whereas the general information rating was graphed utilizing a box-plot diagram displaying the median rating with vary. Associations between the general information scores and the collected pattern covariates (age, intercourse, qualification, specialty, and years of expertise) had been inspected utilizing the Mann–Whitney take a look at, and the Kruskal–Wallis take a look at was used to judge the affiliation between the general information scores and the very best diploma obtained by respondents.


Socio-Demographic Traits of Research Individuals

A complete of 401 HCPs accomplished the questionnaires. Individuals’ ages ranged from 18 to 45 years, with a imply age of 23.4 ± 11.9 years outdated. Concerning intercourse, 227 (56.6%) individuals had been feminine. Concerning {qualifications}, 230 (57.4%) had been undergraduate college students, 123 (30.7%) had a bachelor’s diploma, 20 (5%) had been residents, and 28 (7%) had a postgraduate diploma. A complete of 149 (37.2%) pharmacists, 42 (10.5%) nurses, and 38 (9.5%) physicians participated on this research. Contemplating years of expertise, 216 (53.9%) had no work expertise, 114 (28.4%) had work expertise of 1–4 years whereas 14 (3.5%) had greater than 20 years of expertise (Desk 1).

Desk 1 Socio-Demographic Traits of Well being Care Suppliers Participated

Data of Healthcare Suppliers Concerning Drug–Meals Interactions

The HCPs’ information was evaluated primarily based on their responses to questions on DFIs. Concerning questions on basic information about DFIs, 97% and 96% of the research individuals believed that consuming and meals, respectively, can have an effect on remedy effectiveness. Roughly 93% of the HCP acknowledged that the results of meals might intensify or lower the motion of medicines. Moreover, 92% of the responders recognized that some drugs may modify the dietary standing of the affected person (Determine 1).

Determine 1 Basic information of the HCPs about drug-food interplay, Saudi Arabia.

Data of Healthcare Suppliers Concerning Particular Meals and Medication Interactions

HCPs had been unable to determine quite a few particular meals varieties that might probably work together with sure drugs. Desk 2 illustrates the low degree of data concerning particular DFIs amongst HCPs in japanese Saudi Arabia.

Desk 2 Basic Data of the HCPs About Drug-Meals Interplay, Saudi Arabia

Moreover, 36% of HCPs believed that they lacked ample information of DFIs. Of the HCPs, 36% knew that DFIs are influenced by an individual’s age, well being standing, drug dosages from (tablets and capsules) and taking many drugs on the similar time. In distinction, 53% recognized that the geriatric inhabitants is the age group most vulnerable to DFIs. As well as, 83% of HCPs believed that DFIs can happen when medicine work together with sure gadgets, together with eating regimen, iron, vitamin dietary supplements, alcohol, and fruit juices (Desk 2). The general rating ranged from to 0–9 with a median rating of seven factors (Determine 2).

Determine 2 The general information rating amongst HCPs concerning DFIs within the japanese area in Saudi Arabia.

As an illustration, solely 25.7% and 37.7% recognized that sufferers taking theophylline ought to keep away from consuming massive quantities of drinks containing caffeine and sufferers on warfarin ought to keep away from inexperienced leaf lettuce, respectively. As well as, 28.7% of HCPs acknowledged that sufferers on antibiotics corresponding to tetracycline and fluoroquinolones ought to keep away from dairy merchandise. Merely put, 27.9% of the HCPs knew that sufferers on monoamine oxidase inhibitors ought to keep away from cheese, which is a detrimental drug-food interplay. Roughly 45.6% of the research respondents appropriately answered that acidic meals must be prevented in sufferers taking antibiotics. Solely 15.2% acknowledged that griseofulvin must be consumed with a low-fat eating regimen. Most HCPs can not exactly acknowledge examples of meals that work together with particular medicine. As an illustration, solely roughly 11.0% of HCPs knew that sufferers on levothyroxine ought to keep away from cauliflower, these taking digoxin ought to keep away from wheat bran, these taking lithium ought to keep away from cola, and people on heparin ought to keep away from calcium-rich meals. Moreover, 44.4% appropriately answered that meals must be prevented amongst sufferers taking antihypertensive medicine; for example, sufferers taking spironolactone ought to keep away from potassium-rich meals. The general rating for the information degree concerning particular DFIs ranged from to 0–10 with a median rating of three factors, signifying a low information degree concerning particular DFIs amongst HCPs within the japanese area of the KSA. The general information rating ranged from 1 to 19, with a median rating of 10 (Determine 2).

Components Related to Data of the Healthcare Suppliers

Desk 3 demonstrates the options related with HCPs’ information concerning DFIs in Saudi Arabia. Age had a big relationship with information about DFIs, information of interactions of particular meals and medicines, and general information, the place a better information degree was detected amongst HCPs aged > 25 years (P < 0.05). Gender showed an insignificant relationship with any type of knowledge or the overall knowledge level. Regarding qualifications, HCPs with a bachelor’s degree and postgraduate degree showed the highest knowledge level for all domains. Knowledge of the interactions between specific foods and drugs was significantly higher among pharmacists and among those with years of experience than among those with no experience (P= 0.001). In addition, overall knowledge was significantly higher for pharmacists and others with experience exceeding 5 years (P=0.002), as shown in Table 3. Table 3 Participants’ Personal Characteristics Affecting Their Knowledge Level Regarding Drug-Food Interaction, Saudi Arabia Discussion The existing study attempted to evaluate the knowledge of drug-food interactions (DFIs) among different groups of healthcare providers (HCPs), including physicians, nurses, pharmacists, dietitians, and undergraduate students, and to identify the factors affecting their knowledge and understanding. In KSA, the Saudi Food and Drug Administration (SFDA) established pharmacovigilance activities to oversee the risk–benefit balance of all registered products during their active marketing cycle in in Saudi Arabia.22 An earlier study performed on 211 primary healthcare (PHC) physicians in three cities, Dammam, Al-Khobar, and Qatif, revealed that PHC had low knowledge of DFIs. This study suggested that the cause of this low knowledge was that PHC were not adequately trained in DFIs.23 The existing study findings parallel those of earlier studies in which physicians, nurses, and pharmacists were described as having an inadequate understanding of DFIs in different places worldwide, such as Palestine,19 Ethiopia7 and South Africa.13 Designed for general knowledge questions, the majority of HCPs identified that food and drinks may interact with drugs, which can alter the nutritional status of a patient. Unfortunately, only a few HCPs distinguished that elderly patients (> 60 years) had been at a better danger of drug-food interactions. Aged sufferers are at an elevated danger of growing DFIs owing to modifications in physiological features related to getting older, quite a few illness situations, and polypharmacy.24,25 Data of the age group in danger for DFIs is indispensable to make sure that they’re prioritized for counselling, scrutinized for any doable DFIs, and develop the right drug prescription plan and dietary intervention.26

Within the present research, HCPs exhibited insufficient information of exact meals that will work together with sure drugs. Roughly 1 / 4 of the HCPs recognized that theophylline may work together with caffeine. The usage of caffeine whereas consuming theophylline may cause a number of opposed results together with nausea, vomiting, sleeplessness, tremors, restlessness, irregular coronary heart fee, and seizures. Thus. Drinks or meals that comprise caffeine, corresponding to espresso, tea, cola, and chocolate.27 Equally, solely 37.7% of individuals knew that the efficacy of warfarin was affected by inexperienced leaf lettuce consumption. The anticoagulant efficacy might be deterred by meals containing excessive quantities of vitamin Okay or by consuming massive quantities of avocado.28 As well as, 28.7% of HCPs acknowledged that sufferers taking antibiotics corresponding to tetracycline and fluoroquinolones ought to keep away from dairy merchandise. The chelation of medication with sure meals elements is among the most frequent drug-food interactions.29 As an illustration, tetracycline bioavailability is diminished by 46–57% when taken with meals, by 50–65% when taken with dairy merchandise, and by as much as 81% when taken with iron dietary supplements due to chelation, leading to therapy failure. Even the consumption of a small quantity of milk in tea or espresso might cut back tetracycline bioavailability by 49%.30 Equally, the cation content material (eg, calcium, iron, magnesium, and zinc) of sure enteral feeds might trigger chelation with quinolones.31 One other vital interplay is that the ingestion of tyramine-containing meals, particularly cheese, by sufferers on monoamine oxidase inhibitors (MAOIs) is related to a extreme hypertensive disaster, characterised by throbbing headache, palpitations, stiff neck, and nausea, which results in the event of strict dietary restrictions with MAOIs.32,33 Nevertheless, just a few HCP knew that sufferers taking MAOIs ought to keep away from cheese. Sadly, most HCPs can not precisely determine particular examples of DFIs. As an illustration, levothyroxine with cauliflower, digoxin wheat bran, lithium with cola, and heparin with calcium-rich meals haven’t been acknowledged by HCPs. A excessive fiber content material might cut back the bioavailability of sure medicine (eg, digoxin and lovastatin) due to drug binding to the fiber. The consumption of excessive dietary fiber-containing meals can cut back digoxin bioavailability by 16–32%. A high-fiber eating regimen might trigger digoxin therapy failure and necessitate dosage modification owing to the slim therapeutic index.34,35

Data of DFIs was significantly concomitant with the occupation. Pharmacists had the very best information scores for all segments when associated to different HCPs. Comparable outcomes had been described wherein the pharmacists exhibited the very best general information rating.13,36 The superior information of pharmacists highlights the potential of pharmacists to teach HCP about DFIs. As an illustration, the frequency of DFIs decreased in an Iranian hospital when scientific pharmacists educated nurses on DFIs.37 One other research carried out by Almazrou and Alaujan38 assessed the affect of interprofessional schooling (IPE) on pharmacy and scientific diet college students’ information of DFIs and their willingness for interprofessional studying. The research concluded that pharmacy and scientific diet college students’ information concerning DFIs upgraded subsequent to executing the IPE. IPE in healthcare specialties is crucial to reinforce affected person outcomes and form skilled photos for coordination and collaboration amongst HCPs.38 Moreover, HCPs with postgraduate levels had been extra more likely to be educated than these with different levels had been. Presuming a postgraduate diploma exposes HCPs to progressive information, advocating the dynamic want for continued schooling amongst HCPs. Gender confirmed insignificant relation with any sort of data nor with the general information. Age confirmed a big relationship with information about DFIs, information of interactions between particular meals and medicines, and general information, the place increased information ranges had been detected amongst HCPs aged > 25 years. In distinction to earlier research, and concluded that the age of the HCPs, years of expertise, and participation in coaching on DFIs weren’t considerably related to information of HCPs.13 Data of the interactions between particular meals and medicines was considerably increased amongst pharmacists with expertise than amongst these with no expertise. General information was considerably increased amongst pharmacists and others HCPs with greater than 5 years of expertise.

Integration of data about clinically vital DFIs amongst HCPs is crucial for the effectiveness of the therapeutic course of. Subsequently, efforts must be made to enhance HCPs’ information about potential DFIs and to determine the explanations behind the information gaps in addition to to implement methods for overcoming them. As an illustration, hospitals administration and the regional well being bureau ought to give extra consideration and efforts to enhance HCPs’ information of DFIs by offering extra academic programs and coaching.


In conclusion, the present research demonstrated a low degree of data concerning particular meals and drug interactions amongst HCPs in japanese Saudi Arabia. Lack of awareness of nutrient drug interactions might result in inappropriate drug efficacy and the incidence of opposed results. There’s a want to enhance the information and to lift the extent of consciousness of HCPs in regards to the potential meals drug interactions which are clinically related.

Limitations of the Research

One limitation of the present research is that outcomes are primarily based primarily on undergraduate college students. One other limitation is the choice bias on account of on-line survey and small pattern dimension relative to the full research inhabitants. Knowledge had been collected primarily from the japanese area of KSA, which limits the generalizability of the outcomes. Additional analysis with a bigger pattern dimension, masking extra cities, utilizing a random sampling methodology, and together with different well being professionals in academic interventions is really helpful.