Drug-phytochemical interactions

Changes in dietary habits favouring diets rich in fruits and vegetables, and a meteoric rise in the consumption of dietary supplements and herbal products have substantially increased human exposure to phytochemicals. It is, therefore, not surprising that diet and herbal remedies can modulate drug-metabolising enzyme systems, such as cytochromes P450, leading to clinically relevant drug-phytochemical interactions. Phytochemicals have the potential to both elevate and suppress cytochrome P450 activity. Such effects are more likely to occur in the intestine, where high concentrations of phytochemicals may be achieved, and alteration in cytochrome P450 activity will influence, in particular, the fate of drugs that are subject to extensive first-pass metabolism as a result of intestinal cytochrome P450-mediated biotransformation. Moreover, it is becoming increasingly apparent that phytochemicals can also influence the pharmacological activity of drugs by modifying their absorption characteristics through interaction with drug transporters. Clearly, phytochemicals have the potential to alter the effectiveness of drugs, either impairing or exaggerating their pharmacological activity.