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            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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