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Probiotics can influence the absorption and metabolism of drugs by altering the composition and activity of the gut microbiota. By using probiotics or prebiotics to maintain a healthy gut microbiome, the efficacy and side effects of drugs may be improved. The first-pass metabolism of the gut microbiota can also play a role in the pharmacokinetics of oral drugs. The intake of probiotics may affect the absorption of drugs and using certain probiotic strains, such as Bifidobacterium lactis, may enhance the effects of drugs. Overall, maintaining a healthy gut microbiome may be important for minimizing the negative impact of medications on beneficial gut bacteria.

The impact of probiotics on drug metabolism varies depending on the category of drugs:

  1. Disease-Modifying Anti-Rheumatic Drugs (DMARDs): Probiotics, through their influence on azoreductase activity, can affect the metabolism of DMARDs such as sulfasalazine. The modulation of azoreductase activity by specific probiotic strains may lead to changes in the activation and metabolism of sulfasalazine.

  2. CNS Drugs: Probiotics may impact the metabolism of drugs such as benzodiazepines and L-DOPA. For example, nitroreductases produced by gut bacteria (e.g., Clostridium and Eubacterium spp.) play a role in the metabolism of benzodiazepines, and the gut microbiota can affect the conversion of L-DOPA to active dopamine within the CNS.

  3. Antidiabetic Drugs: Probiotics can alter drug bioavailability by modifying the expression of intestinal transporters involved in drug transport across the intestinal epithelium. Additionally, specific probiotic cocktails have been shown to influence the permeability and absorption of antidiabetic drugs such as gliclazide.

  4. Cardiovascular Drugs: Probiotics have been found to significantly influence the pharmacokinetics and bioavailability of drugs such as amiodarone, amlodipine, and nifedipine. Certain probiotic strains have been shown to increase the bioavailability of amiodarone and amlodipine, possibly through the modulation of transporters and ionization affecting drug uptake.

  5. Immunosuppressive Drugs: The presence of specific gut microbiota, influenced by probiotics, has been correlated with the metabolism and therapeutic response of immunosuppressive drugs like tacrolimus. This suggests that probiotics may affect the absorption and metabolism of immunosuppressive drugs.

  6. Oral Anticoagulants: Probiotics hold the potential to influence the metabolism of oral anticoagulants such as acenocoumarol through their enzymatic activities, ultimately affecting drug bioavailability in the gut.

  7. Anticancer Agents: The gut microbiota affected by probiotics have been implicated in modifying the pharmacokinetics and therapeutic responses of anticancer agents such as irinotecan through their involvement in the metabolism of active drug metabolites and impacting immune responses.

  8. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Probiotics can modulate the metabolism and drug-induced toxicity of NSAIDs, particularly by affecting the presence and activities of enzymes involved in drug metabolism, such as β-glucuronidase. Additionally, probiotics have been linked to reducing intestinal inflammation and protecting against NSAID-induced enteropathy.

In summary, the influence of probiotics on drug metabolism is diverse and multifaceted across different categories of drugs, involving mechanisms such as enzymatic activities, gut microbiota composition, and drug bioavailability.

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