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Impact of malnutrition on drugs' action

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Author(s): Małgorzata Trocha | Anna Merwid-Ląd | Dorota Ksiądzyna | Marta Szandruk | Adam Szeląg

Journal: Polish Gastroenterology
ISSN 1232-9886

Volume: 17;
Issue: 1;
Start page: 11;
Date: 2010;
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Keywords: malnutrition | drugs | pharmacokinetic

ABSTRACT
Impaired nutritional status may be an important reason for ineffective treatment of patients, especially those with many severe concomitant diseases. The severe forms of malnutrition are divided clinically into kwashiorkor, marasmus, and mixed-type. These states may lead to many pathophysiological changes which may subsequently influence pharmacokinetics and pharmacodynamics of drugs. In malnutrition, alteration of nutrient transport, mucosal and villous atrophy, modification of permeability of the intestinal mucosa, and altered activity of small-intestine enzymes could be a reason for drug absorption disturbances. Malnutrition is accompanied by changes in the fat/lean body mass ratio. Changes in body composition may also lead to an alteration of drug distribution, which could also be altered by decreased protein-binding capacity. Reduced plasma protein, mainly albumin, causes an increase in the free drug concentration and subsequently augments the drug's toxicity. Additionally, liver dysfunction in malnutrition is the main reason for the altered metabolism of drugs and impaired renal function, especially in dehydration, significantly influences drug excretion. The treatment of malnourished patients is very difficult and therefore more studies on larger groups of patients are necessary to broaden our knowledge and subsequently treat our patients successfully.
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