Interaction between drugs and the gut microbiome

• Published in: Gut Vol. 69; no. 8; pp. 1510 - 1519
• Main Authors: Weersma, Rinse K, Zhernakova, Alexandra, Fu, Jingyuan
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.08.2020; BMJ Publishing Group
• Subjects: Animals; Antibiotics; Antineoplastic Agents, Immunological - therapeutic use; Bacteria; Bioavailability; Biological activity; Digestive system; Drug interaction; Drug-Related Side Effects and Adverse Reactions; Drugs; Ecosystems; Gastrointestinal Microbiome - drug effects; Gastrointestinal Microbiome - physiology; Humans; Hypoglycemic Agents - pharmacology; Immune Checkpoint Inhibitors - therapeutic use; Immune System Phenomena - physiology; Immunotherapy; Inflammatory bowel disease; Intestinal microflora; Irritable bowel syndrome; Laxatives; Metabolism; Metformin - pharmacology; Microbiomes; Microbiota; Pharmaceutical Preparations - metabolism; Pharmacology; Polypharmacy; Proton Pump Inhibitors - pharmacology; Recent Advances in Basic Science; Studies; Toxicity; United Kingdom > UK; intestinal microbiology; proton pump inhibition; drug metabolism; immunotherapy
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2019-320204

The human gut microbiome is a complex ecosystem that can mediate the interaction of the human host with their environment. The interaction between gut microbes and commonly used non-antibiotic drugs is complex and bidirectional: gut microbiome composition can be influenced by drugs, but, vice versa, the gut microbiome can also influence an individual’s response to a drug by enzymatically transforming the drug’s structure and altering its bioavailability, bioactivity or toxicity (pharmacomicrobiomics). The gut microbiome can also indirectly impact an individual’s response to immunotherapy in cancer treatment. In this review we discuss the bidirectional interactions between microbes and drugs, describe the changes in gut microbiota induced by commonly used non-antibiotic drugs, and their potential clinical consequences and summarise how the microbiome impacts drug effectiveness and its role in immunotherapy. Understanding how the microbiome metabolises drugs and reduces treatment efficacy will unlock the possibility of modulating the gut microbiome to improve treatment.