Gut Microbiota–Drug Interactions: Impact on Drug Metabolism, Efficacy, Toxicity, and Pharmacokinetics
DOI:
https://doi.org/10.55544/jrasb.5.5.6Keywords:
Bioactivation Drug, Microbiota interactions, Pharmacokinetics, Therapeutic efficacyAbstract
Human health, metabolism, and medicine absorption are all greatly influenced by the complex and dynamic gut flora. Pharmacokinetics, efficiency, toxicity, and patient-to-patient differences in reaction to medication treatment have been found to be highly susceptible to being influenced through microbial-chemical interaction, based on increasing evidence. Through reduction, hydrolysis, deconjugation, dealkylation, deamination, and decarboxylation, gut bacteria can affect the drug through direct metabolism into toxic or inactive metabolites. In addition to that, indirect action on the drug through host transporters, barrier properties, pathways, and enzymes can be accomplished through microbial enzymes. All processes related to drug absorption, bioavailability, distribution, metabolism, and elimination can be influenced by those systems. The inactivation of the drug by the microbe may reduce its efficiency while the bioactivation of pro-drugs through the microflora might help in improving its properties. Some of these interactions are represented by microbial inactivation of digoxin mediated by Eggerthella lenta, bacterial activation of sulfasalazine, and reactivation of irinotecan metabolites by β-glucuronidase, which have been associated with the development of toxicity in the gastrointestinal tract. Variability in drug response might also be due to the variations in microbial properties and metabolism, which are determined by nutritional, pathophysiological, therapeutic, life-style factors, and personal features of the organism. Strategies being developed to control the impact of microbes on pharmacotherapy involve manipulation of diet, probiotic, prebiotic, fecal microbiota transplantation, administration of selective antibiotics, bacteriophages, and microbial enzyme inhibitors. While great strides have been achieved in this direction, several issues should be considered for further advancement in this area including clinical validation, standardization, mechanism comprehension, and development of personalized medicine.
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Copyright (c) 2026 Dwipannita Mukherjee, Soumyadip Sahu, Tamal Basu, Riddhita Banerjee, Soumyadeep Sarkar, Anish Maiti, Sagnik Chakraborty, Sayan Tarafder
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