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Can Celiac Disease Impair Drug Therapy in Patients?

Can celiac disease interfere with various types of drug therapies?


Photo: CC--Cody Jung

Celiac.com 04/27/2017 - Celiac disease is associated with numerous chronic conditions, such as anemia and malabsorption of some critical vitamins. Changes in the gastrointestinal tract, rates of gastric emptying, and gastric pH are responsible for impaired vitamin and mineral absorption.

Intestinal CYP3A4 levels may also be disrupted, which may have implications in first-pass metabolism for some drugs that are substrates for this drug metabolizing enzyme.

This has led some researcher to investigate the potential impact of celiac disease on drug absorption. This would be of interest to pharmacists, since altered drug absorption can have pharmacokinetic consequences, along with the potential to impact overall drug therapy.

A comprehensive review on this topic was published in 2013 by Tran et al. Another review was published in 2014. The review by Tran, et al., considered absorption studies in subjects with celiac disease, and the authors focused on a handful of drugs, including acetaminophen, aspirin, propranolol, levothyroxine, methyldopa, and some antibiotics.

They reported that some reports show an altered gastrointestinal environment and sharp differences between drug absorption in patients with celiac disease, while other reports showed no absorption differences between those with and without the disease. The authors concluded that the drugs could potentially alter absorption in celiac patients, and that healthcare professionals should bear that in mind when starting drug therapy.

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The 2014 review of the potential impact of celiac disease on cardiovascular drug absorption considered many of the same medications previously explored by Tran et al, with a focus on cardiovascular agents. The authors warned that numerous cardiovascular drugs may alter absorption in celiac disease, but noted few published studies with strong, comprehensive data. The authors also stressed the need for more studies on celiac patients, as well as caution when initiating cardiovascular drug treatments.

Available research indicates that patients with celiac disease can have altered absorption of many different drugs. Unfortunately, there still isn't much good data on altered drug absorption and disposition in celiac patients.

More study will likely help illuminate the influence of celiac disease on drug disposition. The early evidence suggests that celiac disease may alter drug absorption, but studies don't yet tell us how much, or how often.

The team is recommending that doctors and pharmacists consider possible absorption issues when prescribing drug treatments for people with celiac disease, and that they review the available literature on specific drugs, when possible. They also recommend increased monitoring for efficacy and adverse effects when beginning a new drug treatment regimen for celiac patients.

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1 Response:

 
Elvwnk
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said this on
02 May 2017 3:02:13 AM PDT
Interesting topic. The link doesn't clarify if the malabsorption is over or under absorption, or if the subjects were GF. Will watch for more on this topic.




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Welcome to the forum. Be sure to browse through the DH section for advice and tips. Glad your wife is gluten free. My hubby was gluten free some 12 years before my diagnosis. Sure makes it a bit easier!

As I am sitting here, I am wearing a retainer. Yep, had a tooth extracted a few months ago. To keep the space open for a future transplant, my dentist ordered a retainer. I read that PUB MED study. One kid. Not very scientific at all! Gluten Free Watchdog agrees that the odds of this kid being glutened by her retainer is slim and none. Like my PCV sprinklers lines, retainers probably do not last a lifetime. Ask your dentist how long they should last. No one wants to eat plastic!

I've had them about six or seven times at several different Starbucks locations. My sister has, also. Neither one of us have had any signs of getting glutened. They are served in a parchment paper bag that should be handed to you straight from the oven sealed. I've heard many internet complaints about the bags being dusty, too many ingredients, unhealthy, etc., but honestly, they are pretty darned tasty! And, when you are traveling and hungry, they are even tastier. They sell out quickly at most Starbucks, but I've been able to purchase one as late at 6 p.m.

I wish they didn't use " gluten" as a headline. People abuse and starve children for a variety of " reasons". gluten-free was just one they picked, it could have been paleo or kosher or whatever...

Ugh! This again..... first ...it was one person...not a study... just someone's speculation. if I am remembering correctly - no one actually tested the retainer. The kid was a 12-16 yr old an drew could have gotten caught eating gluten, etc, etc, etc. And then those internet folks who love to spread " bad news" or use that stuff to further their purpose, jumped on it. And then let's talk to a chemist or plastic scientist - if the plastic leaches our actual proteins, like gluten, wouldn't the plastic piece break down after a while? welcome to the world of Celiac internet myths. adding - none of the Celiac Centers, Associations, etc have warned people not to use a retainers.