ISSN 0974-3618
(Print) www.rjptonline.org
0974-360X (Online)
REVIEW ARTICLE
A
Review on Pharmacist’s Role in Mitigation of Food- Drug Interactions
Partha Pratim Mahata1, Abhimanyu
Thakur2*, Samprita Chakraborty1, Dr. Nripendra Nath Bala1
1BCDA College of Pharmacy and Technology,
Kolkata, India
2 Dept. of Pharmacy and
Technology, Birla Institute of Technology, Mesra, Ranchi, India
*Corresponding Author E-mail: abhithakurmanyu@gmail.com
ABSTRACT:
Medicines, both prescription and over-the-counter, are used every day
to treat sudden, short-term and long-term illness. The medicine based
importance of food-drug interactions can be altered. Food-drug interactions can
lead to a loss of medically helpful effectiveness or poisonous effects of drug
therapy. It can help people live healthy lives for a lengthy period. Food and the
nutrients they contain can interact with medicines. This can cause unwanted
effects. A food-drug interaction happens when a food or on of its parts,
interferes with the way a drug is used in the body. In some events, the
interaction may have a helpful effect by increasing the drug effectiveness or
reducing possible side effects. Most food-drug interactions happen through
three methods: reduced rate or extent of concentration, increased rate or
extent of concentration or through chemical/ pharmacological effects. Here an
attempt has been made to briefly outline the common food-drug and drug-nutrient
interactions which may be useful in combating the possible happenings of
interactions. Along with this, the importance of consultation with a doctor or
pharmacist prior to any sort of medication has been explained to gain maximum
benefits from medicines.
KEYWORDS: Food-drug interactions, Herb-drug interactions,
Pharmacokinetics, ADME.
INTRODUCTION:
A
prevailing notion which exists among human beings is that herbs and foods being
natural are safe but here can be interactions between herbs and drugs taken and
can lead to serious adverse reactions. Drugs and food when taken at the same time
can interact and can lead to reduced effectiveness of the drug and reduced
absorption of food nutrients. Drug-food interaction occurs when the food
interferes with the ingredients of administering medicine. Elderly people and
patients with diabetes, hypertension, depression, high cholesterol, and
congestive heart failure are more prone to food drug interactions1-4.
The success of a drug for certain treatments can be influenced by food-drug
interaction at the same time influencing the profile associated with drug’s
safety.
Received on 25.02.2015 Modified on 15.03.2015
Accepted on 19.03.2015 © RJPT All right reserved
Research J. Pharm. and Tech.
8(4): April, 2015; Page 423-431
DOI: 10.5958/0974-360X.2015.00071.2
These
interactions can sometimes prove to be efficacious as it can minimize adverse
effects and improve drug absorption. Recent focus has been made for these types
of interactions, especially interactions associated with grapefruit5-8.
Presence of food in the stomach may sometimes delay or decrease the absorption
of a drug whereas some drugs have increased tolerability in the presence of
food. Clinical effects of most of the drugs are correlated with
bioavailability; an important pharmacokinetic parameter. Evaluation of clinical
relevance of food, drug interaction can be done by quantification of the impact
of food intake on clinical effects of a drug9,10. A significantly
reduced bioavailability in fed state can be a major reason of treatment failure
with the interactions playing a potential role in it as chelation with
components in food occurs. Also, physiological responses like gastric acid
secretion may increase or decrease the bioavailability of a drug. The way food
is prepared for e.g., charcoal boiling beef leading to the production of compounds
which changes the way body uses certain drugs and protein intake in diet can be
the cause of interaction 11, 12.
Food and certain nutrients when taken simultaneously
with a drug can affect the overall bioavailability, pharmacokinetics, pharmacodynamics
and therapeutic efficacy of the drug. Presence or absence of certain nutrients
in the gastrointestinal tract or blood can enhance or impair the rate of drug
absorption and metabolism. Also, interactions may occur both with prescription
medicines or OTC drugs. So, drug interactions are a widely acclaimed and under
recognized source of medication errors 13.
Agents having a larger
surface area upon which the drug can absorb, bind or chelation can affect the
gastrointestinal absorption of various drugs. A
reduction in the extent of absorption is clinically more significant at
subtherapeutic serum levels than the extent of absorption14, 15. A very
frequent and hidden occurrences encountered in clinical practice is the
interaction of natural product and drug. The basic principle is same behind
drug-drug interaction and natural product-drug interaction, i.e.,
pharmacokinetic and pharmacodynamic principle. Fruits and berries contain
agents that affect drug metabolizing enzyme. Grape fruit, pommel and orange contain
agents that inhibit cyt p450 3A4, an important enzyme in drug metabolism16.
The easy accessibility of information is associated with
drug-drug interaction unlike food-drug interaction where it is quite difficult
to accurately determine the effect of food and nutrients on a drug. This
article basically aims at helping healthcare professional (e.g., doctor and
pharmacist) and patients to have a thorough understanding of drug and food
interaction. An electronic literature search was done for a period of two
months where all original research and review articles were included in the
study. Review and selection of drug were based on their utility and the need
for reporting their interaction with different dietary supplements for better
therapeutic use of these drugs within the prescribed dosage17-19.
Mechanism of food- drug
interaction:
Pharmacokinetics
Interactions:
Absorption:
Drug
absorption in the GI tract is affected by food through altering gastric pH, GI
motility and transit time. The result can be changed at the rate of absorption,
extent of absorption or both, e.g., azithromycin absorption decreases when
taken along with food resulting in a 43 % reduction in bioavailability.
Sustained release theophylline when taken with fatty foods can result in dose
dumping20-23. The overall exposure of drug is not affected by
delaying absorption wherein AUC may be equivalent and is not affected by how a
drug is taken. A decreased rate of absorption can be useful in reducing the
side effects of the drug e.g., ibuprofen without any reduction in
bioavailability. Bioavailability can be enhanced by food, acid environment is
necessary for absorption of ketoconazole. Fenofibrate, mebendazole, tamsulosin,
carbamazeoine, labetalol is the drugs that have better absorption rates when
taken with food24-28.
Fenofibrate,
mebendazole, isotretinoin, tamsulosin, carbamazpine and labetalol drug
absorption may not directly be related to drug efficacy, patients on digoxin
should avoid bran fibre, bulk forming laxatives, pectin containing foods as
they can bind to digoxin and decrease its absorption also decreased serum
concentration of digoxin and therapeutic effectiveness. Potassium supplements,
ferrous sulphate, NSAIDs, estrogen, nitrofurantoin are drugs which can cause GI
irritation and nausea, if not taken along with food. Lovastatin, a cholesterol
lowering agent should be taken with food to increase bioavailabilty and GI
absorption whereas simvastatin, pravastatin, fluvastatin are not affected by
food intake29-39.
Metabolism:
Hepatic
metabolism of certain drugs can be effected by food, when concentrated
grapefruit juice is administerd with antihypertensive drug e.g., felodipine;
the bioavailability of felodipine may increase. In a study conducted, the mean
felodipine bioavailability with grapefruit juice was 284 % (range 164-469 %)
which is larger than that of water so lower diastolic pressure and increased
heart rate was observed in the male volunteers. Adverse effects, e.g.,
headaches, facial flushing, lightheadedness was more common with ingestion of
grapefruit juice (250 ml)40-42. With nifidipine the bioavailability
was found to be 134% (range 108 -169 %) when compared with water. No such
observations were made when orange juice was administered, a postulation was
made based on the study that grapefruit juice concentrate inhibited p-450
metabolism of felodipine and nifidipine. Patients should be well aware of these
possible interactions as citrus juices are often consumed at breakfast by most
people. First pass metabolism of metoprolol and propranolol is decreased when
taken along with food43-55.
Drug
levels and therapeutic efficacy may be increased due to this interaction.
Monoamine oxidase (MAO) inhibitors are known to interact with foods containing
tyramine. Tyramine is normally inactivated by the enzyme monoamine oxidase and
this prevents tyramine from accumulating in the body. Monoamine oxidase
inhibitors cause increased levels of tyramine, which can lead to a hypertensive
crisis. Patients taking monoamine oxidase inhibitors should avoid foods high in
tyramine, such as aged cheeses, pickled fish, yeast extracts, red wine, some
types of beer (including nonalcoholic beer), fava beans and fermented products.
High protein foods that have been aged, fermented, pickled, smoked or
bacterially are unsafe for patients taking MAO inhibitors. Foods considered
safe when used fresh and in moderation include sour cream, yogurt, meat
extracts, chopped liver, dry sausage and alcoholic beverages56-59.
Excretion:
Urinary
pH can be altered by food which directly or indirectly affects the activity of
certain drugs also half –lives of certain drugs can be changed by alternation
in urinary pH. Acidic drug being in a unionized form in acidic urine its half
life gets extended. Foods like milk, vegetables, citrus fruits can alkalanize
urine where as meats, fish, cheese, eggs can acidify urine. Renal excretion of
some drugs get altered for example a high salt diet causes more lithium to be
excreted whereas low salt diet causes decreased lithium excretion thereby
increasing serum lithium levels60-63.
Pharmacodynamic
Interactions:
Foods
may interact with medications by altering their pharmacological actions. Diets
high in vitamin K may cause antagonism of warfarin and decreased therapeutic
efficacy of the anticoagulant. Foods rich in vitamin K include green leafy
vegetables (kale, turnip greens, spinach, broccoli and brussels sprouts),
cauliflower, chick peas, green tea, pork liver and beef liver. Alcoholic
beverages may increase the central nervous system depressant effects of medications
such as benzodiazepines, Antihistamines, antidepressants, antipsychotic, muscle
relaxants, narcotics or any drug with sedative actions.3 an example of a food
potentiating the effect of a medication is coffee, as caffeine has additive
effects of theophylline. It has been reported that caffeine increased serum
theophylline levels by 20%–30% and increased the half-life of theophylline by
decreasing clearance. Patients may complain of nervousness, tremor or insomnia.
Caffeine has some bronchodilatory effects, which may enhance the effects of
theophylline. A lower dosage of theophylline may be necessary for those
patients who consume excessive quantities of coffee (more than 6 cups daily).
Phenomenom:
The
relationship between food and drug interaction are gaining recognition in the
healthcare and medical field as they affect the overall bioavailability,
pharmacokinetics, pharmacodyanmics and
therapeutic efficacy of medications. Also therapeutic efficacy of many drugs
depends on nutritional status of the individual. Drug food interactions can
happen with both prescription and over-the-counter medicines, including
antacids, vitamins and iron pills. Foods containing active substances that
interact against certain medications can produce unexpected or adverse effects.
Pharmacist can give the information of such interactions to the patients.
Nutrients include food, beverages and dietary supplements60-62.
Consumption of these substances may alter the effects of drugs the patient takes.
For example:
Food:
Like
food, drugs taken by mouth must be absorbed through the lining of the stomach
or the small intestine. Consequently, the presence of food in the digestive
tract may reduce absorption of a drug. Often, such interactions can be avoided
by taking the drug one hour before or two hours after eating. Dietary fiber
also affects drug absorption. Pectin and other soluble fibers slow down the
absorption of acetaminophen, a popular painkiller. Bran and other insoluble
fibers have a similar effect on digoxin, a major heart medication. Certain
vitamins and minerals impact on medications too. Large amounts of broccoli,
spinach and other green leafy vegetables high in vitamin K, which promotes the
formation of blood clots, can counteract the effects of heparin, warfarin and
other drugs given to prevent clotting63-65.
Dietary
Supplements:
Dietary
supplements are products that contain supplements including vitamin, mineral,
herb intended as a supplement to the normal diet. Since they are considered as
food supplements so they are not tested comprehensively, but they may interact
with prescription or OTC drugs. Interactions can be avoided if there is a good
communication between the person taking a dietary supplement and doctors or
pharmacists. Asthma patients on theophylline contain xanthines found in tea,
coffee, chocolate, etc. Hence consuming large amounts of these substances
during theophylline medication may increase the risk of drug toxicity66-68.
Alcohol:
Alcohol
affects body processes and interacts with many drugs. Alcohol is a drug that
interacts with almost every medication, especially antidepressants and other
drugs that affect the brain and nervous system. For example, taking alcohol
with metronidazole can cause flushing, headache, palpitations, nausea and
vomiting. Foods containing active substances that interact against certain
medications can produce unexpected or adverse effects. Pharmacist can give the
information of such interactions to the patients69-76.
Factors
affecting the extent of interaction between foods and drugs :
Factors
like dosage of drug, persons age, size, state of health directly or indirectly
affects the impact of food-drug interaction. apart from factors the duration at
which food and drug is consumed plays an important role. Avoidance of drug and
food cannot be a solution to prevent drug interactions for e.g., in case of
tetracycline and dairy products they should be taken at different intervals
rather than eliminating either of the two. Proper information about dosage
regimen, medication and food intake can prove to be effective in avoidance of
drug interaction77-79.
Effect of drug-food
interactions;
Not
all medicines are affected by food, but many medicines can be affected by the
food and its time. For example, taking some medicines at the same time with
food may affect the absorption of the medicine. The food may delay or decrease
the absorption of the drug. This is why some medicines should be taken on an
empty stomach. On the other hand, some medicines are easier to tolerate when
taken with food. It is always advised to ask the doctor or pharmacist whether
it is correct to take the medicine with a snack or a meal or whether it should
be taken on an empty stomach80-83.
Table 1: Mechanism of various drugs5,
15, 16
DRUG |
MECHANISM |
SUGGESTION |
Carbamazepine |
Increased bile production, enhanced
dissolution and absorption. |
|
Dicumerol |
Increased bile flow, delayed gastric
emptying permits dissolution and absorption |
Take with food. |
Erythromycin |
unknown |
|
Griseofulvin |
Drug is lipid soluble, enhanced
absorption with high- fat foods |
Take with high- fat foods. |
Nitrofurantoin, Phenytoin and Propoxyphene |
Delayed gastric emptying improves
dissolution and absorption. |
|
Propranolol |
Food may reduce first-pass extraction
and metabolism. |
Take with food |
Spironolactone |
Delayed gastric emptying permits
dissolution and absorption, bile may solubilize the drug. |
|
Acetaminophen |
High pectin foods
act as adsorbant and protectant. |
Take on empty
stomach if not contraindicated |
Digoxin |
High–fiber, high–pectin
foods bind drug. |
Take drug same time
with relation to food, Avoid taking with high-fiber foods. |
Glipizide |
Mechanism unknown. |
Affects blood
glucose; more potent when taken half hour before meals |
Isoniazide |
Food raises gastric
pH preventing dissolution and absorption. |
Take on empty
stomach if tolerated |
Levodopa |
Drug competes with
amino acids for absorption transport. |
Avoid taking drug
with high–protein foods |
Methyldopa |
Competitive absorption. |
Avoid taking with
high- protein foods |
Nafcillin |
Mechanism unknown |
Take on empty
stomach. |
Penicillamine |
May form chelate
with calcium or iron. |
Avoid taking with
dairy products or iron–rich foods or supplements. |
Quinidine |
Possibly protein binding |
May take with food
to prevent gastrointestinal upset |
Sulfonamides |
Mechanism unknown |
Taking with meals
may prolong gastric emptying |
Tetracyclines |
Binds with calcium
ions or iron salts forming insoluble chelates. |
Take one hr before
or two hr after meals; do not take with milk |
Table 2: Examples of various drug-food interactions [35, 36, 57,
58]
CONDITION |
DRUG |
INTERACTIONS |
EXAMPLES |
Allergies |
Antihistamines |
Food: Take with water, if GI distress occurs consume with food. Exception: Fexofenadine/ALLEGRA |
Loratadine, Cetirizine, Diphenhydramine |
Arthritis
and pain |
Analgesic, Antipyretic |
Food:
For
rapid relief, take on an empty stomach Caffeine: May increase the rate of absorption |
Acetaminophen |
Arthritis and pain |
NSAID |
Food: Take with food, water, or milk to decrease stomach upset. With a high dose of this drug, one
may need, to increase consumption of vitamin C, vitamin K, and folate. Caffeine: Limit intake. Supplements: Limit or avoid products that affect
blood coagulation (garlic, ginger, gingko, ginseng, or horse. |
Aspirin,
Ibuprofen |
Asthma |
Bronchodilators |
Food: Take with food if stomach upset occurs. High-fat meals may increase the amount of theophylline
in the body while high-carbohydrate meals may decrease it. Different foods may
have varying effects depending on the dose form. Caffeine:
Avoid eating or
drinking large amounts of foods and beverages that Contain caffeine |
Theophylline/Slo-Bid,
Theodur, Uniphyl Albuterol/Ventolin, Proventil, Combivent |
Cardiovascular disorders |
Diuretics |
Food: Take on an empty stomach since food reduces drug availabilityTake
with food or milk if stomach upset occurs. Since some diuretics cause
loss of potassium, calcium, and magnesium, supplementation of
these HYDRODIURIL minerals may be necessary. Trimterene is known as a
“potassium sparing” diuretic. When taking triamterene avoid eating large
amounts of potassium-rich foods such as bananas, oranges and green leafy
vegetables or salt substitutes. Avoid natural liquorice |
Fuorsemide/Lasixtriamterene/
Dyazide, Maxzide
Trimterene/ Dryenium Bumetamide/ Bumex Metolazone/Zaroxolyn |
Cardiovascular disorders |
Beta blockers |
Food: Take with food to increase bioavailability. Take separately from
orange juice, and avoid natural liquorice. It may be necessary
to decrease dietary calcium and sodium, which may decrease absorption. Supplements:
Take 2 hours
before or 6 hours after calcium supplement or antacids. |
Atenolol/Tenormin Metoprolol/Lopressor Propranolol/ Inderal Nadolol/Corgard |
Cardiovascular disorders |
Nitrates |
Food: Take on an empty stomach with water to increase absorption, 1 hour before
meals or 2 hours after |
Isosorbide
dinitrate/ Isordil Sorbitate Nitroglycerin/
Nitro, Nitrodur, Transderm-Nitro |
Cardiovascular disorders |
HMG-Coa reductase |
Food: Avoid grapefruit/related citrus with atorvastatin/LIPITOR, lovastatin/MEVACOR,
and simvastatin/ ZOCOR. Lovastatin/MEVACOR should betaken with the evening
meal to enhance absorption. Decrease dietary fat and cholesterol while taking these medications.
Supplements: Avoid St. John’s wort |
Atorvastatin/Lipitor
Fluvastatin/ Lescol
Lovastatin/Mevacor and Altoprev Pitavastatin/Livalo Pravastatin/Pravachol Rosuvastatin/Crestor
Simvastatin/Zocoruse |
Cardiovascular disorders |
Anticoagulant |
Food: Limit foods with vitamin K, since it produces blood-clotting substances that reduce
the effectiveness of anticoagulants. Do not exceed the upper limit for
vitamin E and A. High doses of vitamin E (400 IU or more) may prolong
clotting time and increase the risk of bleeding. Supplements: Avoid
garlic, ginger, ginko saw palmetto, and horse chestnut. Other drugs: Do not
take with Cordarone (intended for abnormal heart rhythms |
Warfarin/Coumadin |
Infections |
Penicillin |
Food: Take on an empty
stomach, or 1 hour before or 2 hours after food. If upset stomach occurs,
take with food. Avoid guar gum. Supplements: Use
caution when taking vitamin K. |
PenicillinV/ Veetids Amoxicillin/ Trimox, Amoxil Ampicillin/Principen, Omnipen |
Infections |
Quinolones |
Food: Take on an empty
stomach 1 by bacteria and fungi. Hour before or 2 hours after meals. if upset stomach occurs, take with
food, but not with dairy or
calcium-fortified products alone. Caffeine: Taking these
medications with caffeine-containing products may increase caffeine levels,
leading to excitability and nervousness. |
Ciproflaxacin/ Cipro
Levoflaxacin/ Levaquin Ofloxacin/ Floxin Trovafloxacin/Trovan |
Infections |
Cephalosporins |
Food: Take on an empty
stomach 1 hour before or 2 hours after
meals. If upset stomach results, take
with food. Take 1 hour before antacid
supplement |
Cefaclor/Ceclor Ceclor .CD Cefradroxil/ Duricef Cefixime/ Suprax
Cefprozil/Cefzil Cephalexin/Keflex, Keftab |
Infections |
Macrolides |
Food: May take with
food if stomach upset occurs. Exceptions: Zmax should
be taken on an empty stomach one hour before or 2 hours after food.
Avoid taking with citrus foods, citrus
juices, and carbonated drinks |
Azithromycin/Zithromax
(Z-Pak, Zmax) Clarithromycin/Biaxin
Erythromycin (Ery-Taberyce |
Infections |
Sulphonamides |
Food: Take with food and at least 8 ounces of water |
Sulfamethoxazole +
trimethoprim/ Bactrim, Septra |
Infections |
Tetracyclines |
Food: Take on an empty stomach with 8 ounces of water. Avoid taking
tetracycline with dairy products,
antacids, and vitamin supplements containing iron because they can interfere
with the medication’s effectiveness |
Tetracycline/
Achromycin, Sumycin Doxycycline/Vibrmycin Minocycline/ Minocin |
Infections |
Nitromidazole |
Food: May take with
food to decrease stomach upset, but food decreases bioavailability. |
Metronidazole/
Flagyl |
Mood disorders |
Antifungals |
Food: Take with food to increase absorption. Do not take
itraconazole/ SPORANOX with grapefruit or related citrus |
Fluconazole/
Diflucan Ketoconazole/ Nizoral
Sporanox Itraconazole/ Sporanox |
Mood disorders |
Monoamine Oxidase
(MAO) Inhibitors |
Food: These medications
have many dietary restrictions and those taking Inhibitors disorders. them should follow
the dietary guidelines and physician instructions very carefully. A rapid,
potentially fatal increase in blood pressure can occur if foods or alcoholic
beverages containing tyramine are consumed while taking MAO inhibitors. Avoid
foods high in tyramine and other pressor amines during drug use and for 2
weeks after discontinuation. These include aged cheeses, aged meats, soy
sauce, tofu, miso, fava beans, snowpeas, sauerkraut, avocadoes, bananas,
yeast extracts, raisins, ginseng, liquorice, chocolate, and caffeine. |
Phenelzine/ Nardil Tranycypromine/ Parnate |
Mood disorders |
Anti-anxiety
drugs |
Food: May take with
food if upset stomach Limit grapefruit
and citrus disorders. consumption. Caffeine: May cause
excitability, nervousness, and hyperactivity and lessen the anti-anxiety
effects of the drugs. Supplements: Use
caution with sedative herbal products such as chamomile, kava, or stimulants such
as caffeine, guarana, or mate. |
Lorazepan/Ativan Diazepam/ Valium Alprazolam/Xanax |
Mood disorders |
Anti-depressant
drugs |
Food: These medications
can be with or without food. |
Sertraline/Zoloft Paroxetine/ Paxil Fluoxetine/Prozac |
Mood disorders |
Stimulant |
Food: Take with or
without meals. Limit caffeine, and ensure adequate calcium intake |
Methylphenidate/Ritalin |
Mood disorders |
Depressant |
Food: Do not take with
food, or immediately after a meal |
Zolpidem/Ambien |
Stomach |
Histamine
Blockers |
Food: These medications
can be with or without food, with 8 ounces of water. A bland diet is recommended. Take drug 2 hours before an
iron or antacid supplement is consumed. May decrease iron and vitamin B12
absorption. Caffeine: Caffeine
products may irritate the stomach. |
Food: These medications
can be with or without food, with 8 ounces of water. A bland diet is recommended. Take drug 2 hours before an
iron or antacid supplement is consumed. May decrease iron and vitamin B12
absorption. Caffeine: Caffeine products
may irritate the stomach. |
Seizuress |
Anti-convulsant/
antiepileptic therapy |
Food: Take with food or
milk to decrease stomach upset. Avoid grapefruit or related citrus fruits,
star fruits, or pomegranate juice. Supplement with calcium and vitamin D. |
Tegretol/Carbamazepine.
EquetroCarbatrol |
Pains |
Analgesic |
Increases risk for liver
toxicity |
Avoid alcohol |
Bacterial Infection |
Antibiotic |
Decreases drug absorption Decreases drug absorption Decreases GI distress,
slows drug absorption |
Do not take with milk. Take 1
hour before or 2 hours after food/milk. Take 1 hour before or
2 hours after meals. Take with food or milk |
Blood clotting problem |
Anticoagulant |
Decreases drug effectiveness |
Limit foods high in
Vitamin K: liver, broccoli, spinach, kale, cauliflower, and Brussels sprouts |
seizers |
Anticonvulsants |
Causes increased
drowsiness Decrease in drug effectiveness |
Avoid alcohol Avoid excess
vitamin C |
Fungal infection |
Antifungal |
Increases drug absorption |
Take with high-fat
meal |
Neurological adverse condition |
Antihistamine |
Increased drowsiness |
Avoid alcohol |
Drug absorption problem |
Antihyperlipemic |
Enhances drug
absorption |
Take with food |
Hyper tension |
Antihypertensive |
Increases drug absorption |
Consult physician
or Pharmacist before changing diet. |
Inflammation |
Anti-inflammatory |
Decreases GI
irritation ,Damage or stomach bleeding |
Avoid alcohol Take with food or
milk |
Kidney problems |
Diuretic |
Decreases GI
irritation |
Take with food |
Psychotic condition |
Psychotherapeutic |
Foods high in
tyramine: aged cheeses, Chianti wine, pickled herring, Brewer’s yeast, fava
beans Risk for hypertensive crisis. |
Avoid foods high in tyramine |
Table 3: Examples of various
drug-nutrient interactions
Drug |
Nutrient |
Interactions |
Alendronate |
beverages (other than water) |
If you take alendronate with
food or with any drink other than water, your body will not absorb all of the
alendronate and the drug will not work as well |
Allopurinol |
1) Avoid low protein diet 2) Lack of fluids is not good |
1) Eating a low protein diet
while on this medication will result in higher blood levels of this
medication. 2) You should drink plenty of
fluids while taking this medication. |
Amprenavir |
Avoid high fat
meals |
Decreased effectiveness of the
drug amprenavir |
Atovaquone |
Avoid taking on an empty
stomach |
High protein meals may lead to
a decrease in the neutralizing capacity of the antacid |
Calcium channel
blockers |
Avoid grapefruit
juice |
By drinking grapefruit juice
with this medication you may have higher than desired blood levels of the
medications you are taking. |
Carbamazepine |
Avoid grapefruit
juice |
By drinking grapefruit juice
with this medication you may have higher than desired blood levels of the
medications which you are taking. These higher levels may actually be harmful
and cause adverse effects. |
Cisapride |
Avoid grapefruit
juice |
By drinking grapefruit juice
with this medication you may have higher than desired blood levels of the
medications which you are taking. These higher levels have been shown to
potentially cause serious heart rhythm problems. |
Cyclosporine |
Avoid grapefruit
juice |
By drinking grapefruit juice
with this medication you may have higher than desired blood levels of the
medications which you are taking. These higher levels may actually be harmful
and cause adverse effects. |
Disulfiram |
Avoid alcoholic Beverages |
When ingesting alcohol with
this medication you can develop a very severe reaction called a “disulfiram
reaction”. This adverse effect is characterized by flushing, vomiting,
increased breathing and heart rate. |
Iron |
Do not take dairy products together with iron. |
1) You may enhance the amount
of iron your body absorbs by eating/drinking foods/drinks high in vitamin C 2) When taken with food, the
amount of iron your body absorbs may be reduced. |
Table
4: Example of various drug-vitamin interactions
Drug |
Vitamin |
Interactions |
Suggestion |
Acid Blocker ranitidine (Zantac),
cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid) |
Vitamin B12 |
Decrease vitamin absorption |
Consult your physician regarding B12 supplementation |
Antihyperlipemic cholestyramine (Questran),
colestipol (Colestid) |
Fat soluble vitamins (A, D, E, K) |
Decreases vitamin absorption |
Include rich sources of these vitamins in the diet |
Antineoplastic methotrexate |
Folic acid, vitamin B12 |
Decreases vitamin absorption |
Consult your physician regarding supplementation |
Diuretic furosemide (Lasix),
hydrochlorothiazide (HCTZ) |
Many minerals |
Increases mineral loss in urine |
Include fresh fruits and vegetables in the diet |
Table
5: Beneficial effects of drug-food interaction
Drug |
Effect |
Acetaminophen |
Reduced
rate of absorption; chronic alcohol ingestion increases hepatotoxicity |
Acetaminophen/ butalbital +/- caffeine |
Increased
sedation with alcohol |
Acetaminophen/Codeine |
Reduced
side effects with food; increased sedation with alcohol |
Acetaminophen/Hydrocodone |
Reduced
side effects with food; increased sedation with alcohol |
oxycodone |
Reduced
side effects with food; increased sedation with alcohol |
Acetohexamide |
Altered
glycemic control with alcohol |
Alendronate |
Reduced
absorption |
Alfentanil |
Chronic
alcohol use reduces sensitivity to alfentanil |
Allopurinol |
Reduced
side effects; reduced clearance of active metabolite with protein-poor |
Alprazolam |
Increased
sedation with alcohol;clearance may be inhibited by grapefruit juice |
Role
of pharmacist:
Pharmacists
in each aspect should be vigilant enough to monitor food-drug interactions
which is one of the means is to advise the patients about food or beverages
that they should avoid when taking certain medications. These counselling
sessions can be effective if the pharmacists are well aware of the potential
food-drug interactions, especially the marketed new drugs, drug-food
interaction can lead to delays, decreased or enhanced absorption of a drug also
bioavailability, metabolism and excretion of certain medications can be
affected by food as well. Patients can experience adverse effect, toxicity or
decreased therapeutic effectiveness of the drug. As per joint commission on the
accreditation of health care organization (JCAHO), a patient’s medication
profile should contain potential food-drug interaction so that the pharmacist
can call up the prescriber in case of any event of interaction, such as
documentation of communication should be done with follow up on prescription
and before being discharged the patient should be given a clear explanation on
the potential food-drug interaction. Elderly patients are at a greater risk as
they consume a wide variety of medications because of their chronic illness
[84-96].
CONCLUSION:
The
success and failure of treatment associated with a drug are significantly
influenced by food-drug interaction. A balanced role is played by the factor
called food intake as it may affect drug therapy by causing serious side
effects, toxicity or therapeutic failure at the same time it can improve drug
absorption or minimize adverse effects. So, this review is a potential approach
as it has highlighted the consequences of common food-drug interactions, there
are suitable reference publications for food-drug interaction, such as the
British National Formulary as it is quite impossible for a pharmacist to
remember all the clinically relevant food-drug interactions. In the recent
years new drug approval has occurred at a rapid rate, resulting in very less
information about its adverse effects and interactions. Pharmacists can play a
major role by providing effective counseling sessions to patients and guiding
them at their level best.
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