Pharmacology Review Sheets: Drug Interactions, p.

1
Drugs and Nutrition
Drug/Nutrient #1

Drug/Nutrient #2

Mechanism of Interaction

Effects

Penicillins
Food
Decreased gastric emptying
Decreased absorption
Captopril
Food
Decreased absorption
Verapamil
Food
Prolonged absorption
Propranolol
Food
Increased absorption
Levodopa
Food (protein)
Delayed absorption; decreases peak
levels
Theophylline, Antipyrine
High protein
Accelerated metabolism
Decreased levels
2+
2+
2+
Tetracyclines
Dairy foods
Chelation of Ca , Mg , Fe ; chelate not absorbed
Decreased absorption
2+
2+
2+
Ciprofloxacin
Dairy foods
Chelation of Ca , Mg , Fe ; chelate not absorbed
Decreased absorption
Digitalis
Bran fiber
Decreased absorption
Lovastatin
Bran fiber
Decreased absorption
Zidovudine
Fat
Decreased absorption (Clinical significance
undetermined)
Theophylline (Theo-24)
High fat
Increased absorption (to a toxic
level!) (Theo-Dur NOT affected by fat)
Griseofulvin
High fat
Increased absorption
Cyclosporine
Grapefruit juice
cytochrome p-450 metabolism in intestine
Increased absorption
Inhibition of P-glycoprotein (which pumps cyclosporine out of the cell)
Nitrendipine
Grapefruit juice
Increased plasma concentrations, HR,
BP
Quinidine
Grapefruit juice
Inhibition of quinidine metabolism
Increased serum levels (for
both)
Antacids
Increased reabsorption of quinidine (by alkalinizing the urine)
Phenacetin
Charcoal
CYP3A4 in intestine
Decreased absorption
Warfarin
Vitamin K ( ingestion)
Increased biotransformation of warfarin
Decreased activity
MAO Inhibitors
Tyramine
Hypertensive crisis (fatal) (Note:
Levels in particular foods are variable!)
Fat-soluble vitamins (A,D,E,K)
Cholestyramine, Colestipol Binding of resins to bile acids
Decreased absorption
Vitamin D
Phenytoin, Pyrimidine,
Anticonvulsants Vitamin D Worse risk of seizures
Decreased vitamin D;
risk of seizures

Ethosuxamide
Fat-soluble vitamins, Ca2+, Colchicine, Neomycin,
Decreased absorption (all interacting
drugs)
phosphate, K+, B12
Mineral oil
Vitamin K
Antibiotics
Killing intestinal flora that make Vitamin K ( production)
Decreased absorption
Vitamin B6 (pyridoxine)
Isoniazid, Hydralazine,
Penicillamine, Ethinyl estradiol
Folate
Phenytoin
pH enzyme conversion of polyglutamic folic acid to
Decreased absorption (all
interacting drugs)
monoglutamic folic acid (phenytoin only)
Phenobarbital
Anti-folates: Methotrexate,
Trimethoprim, Pyrimethamine
Oral contraceptives (estrogen)
Antacids
Large neutral amino acids
Levodopa
Competes for transport system
Decreased absorption
Calcium
Methotrexate
Decreased absorption
Decreased levels
Furosemide
Increased excretion
Decreased levels
Bumetanide
Increased excretion
Decreased levels
Phenytoin
Vitamin D ( metabolism of Vitamin D)
Decreased levels
Glucocorticoids
Vitamin D
Decreased levels
Thiazides
Increased renal reabsorption
Increased levels
Potassium
Diuretics
Increased excretion
Decreased levels
Magnesium
Diuretics
Increased excretion
Decreased levels
Phosphate
Aluminum hydroxide
Decreased absorption
Iron
NSAIDs
Blood loss
Decreased levels
Pharmacology Review Sheets: Toxicology, p.1
Toxins and antidotes
Drug/Treatment
Dimercaprol

Succimer

Toxin

Pharmacokinetics

Mercury
Admin: IM, IV
Lead
Arsenic
Lead (drug of choice)
Admin: Oral

Adverse Effects
Tachycardia

Hypertension

Possible hepatotoxicity

 Copper
Lead
Mercury
Arsenic
Calcium disodium edetate
Lead
(EDTA)
Deferoxamine
Iron
Penicillamine

Nitrites (give first)

Cyanide
Methylene blue (to take care
of methemoglobinemia)

Admin: Oral

Admin: IV
Admin: IM

Agranulocytosis
Aplastic anemia

Nephrotoxic (kills cells in proximal tubules)

Hypotension
Allergic effects