Food & Drug Interactions

c2009Laurie Meyer MS RD CD
Medicines must be taken
properly to ensure they are
safe and effective
Drugs Interact With

Foods

Beverages

Alcohol

Caffeine

Over-the-counter medications

Nutritional supplements

Nicotine
Drug Interactions

Make the medication LESS effective

Make the medication MORE effective

Produce dangerous side effects
DIABETES
Diabetes Drugs

Diabinase
Take before meals

Glipizide
Depletes Vitamins B12 &

Glyburide B6, folic acid, zinc,

Glucophage potassium, magnesium

Avandia
Take multivitamin

ACTOS
Take CoQ10

May cause weight gain

Avoid alcohol
INFECTIONS
Antibiotics

Penicillin
– Amoxicillin, Ampicillin

Cephalosporins
– Cefaclor, Duricef, Suprax,
– Keflex, Cefzil

Macrolides
– Zithromax, Biaxin,
Erythromycin

Sulfonamides
– Bactrim, Septra

Take on an empty stomach 1
hr before or 2 hr after meals

Take with food if upsets
stomach

Drink plenty of water

Take probiotic 3 hours away
from antibiotics

Depletes calcium,
magnesium, potassium,
vitamin K

Take multivitamin
Antibiotics

Quinolones
Take on an empty stomach 1

– Cipro, Levaquin, Floxin,
Trovan

Tetracycline
– Sumycin, Minocin,
Doxycycline
hr before or 2 hr after meals

Avoid dairy foods & calcium

Avoid iron

Avoid antacids

Avoid caffeine

Drink plenty of water

Take probiotic 3 hours away
from antibiotics
Antibiotics

Nitroimidazole
Avoid all alcohol while

– Metronidazole using & for 3 days after
– Flagyl – Headache
– Flushing
– Nausea
– Vomiting
– Abdominal cramps

Drink plenty of water

Take probiotic 3 hours
away from antibiotics
Antifungals

Diflucan
Avoid dairy products

Nizoral
Avoid antacids

Sporanox
Avoid all alcohol during

Nystatin and for 3 days after

Drink plenty of water

Take probiotics
STOMACH CONDITIONS
Histamine Blockers

Tagamet
Avoid alcohol

– Irritate stomach

Pepcid
Take with or without food

Zantac
Avoid caffeine

Axid – Irritate stomach

Avoid cigarette smoking

Drink plenty of water

Depletes vitamin D & B12,
calcium, iron, folic acid

Impairs protein digestion

Take multivitamin
CARDIOVASCULAR DISORDERS
Diuretics

Lasix
Include potassium,

Dyazide calcium, magnesium-rich
foods

Maxzide
Take multivitamin

Hydrodiuril
Take CoQ10

Bumex
Avoid

Zaroxolyn – Aloe
– Cascara sagrada
– Senna
– Licorice
Diuretics – Potassium Sparing

Triamterene
Avoid excess potassium-

Dyrenium rich foods
– Banana, citrus, green
leafy vegetables, potatoes
– Salt substitutes

Avoid
– Aloe
– Cascara sagrada
– Senna
– Licorice
Beta Blockers

Atenolol
Avoid alcohol

Propranolol – Lowers blood pressure too
much

Lopressor

Take CoQ10

Corgard

Depletes melatonin
Angiotensin Converting Enzyme Inhibitors

Capoten
Take 1 hour before or 2

Vasotec hours after meals

Zestril
Depletes zinc

Prinivil
Eat adequate protein

Accupril
May increase potassium

Univasc levels
– Limit banana, spinach,
citrus, baked potato
HMG-CoA Reductase Inhibitors

STATINS
Avoid alcohol

Lipitor – Increase liver damage

Zocor
Take with evening meal

Mevacor to enhance absorption

Lescol
Take multivitamin

Baycol
Take CoQ10
– Prevent muscle damage

Pravachol
Anticoagulants

Coumadin
Avoid vitamin K

Warfarin – Increase clotting

Avoid vitamin E
supplements
– Increase bleeding

Avoid ginko biloba

Avoid feverfew

Avoid bromelain
THYROID
Thyroid Replacement

Levothyroxine
Take on empty stomach 1

hour before breakfast

Synthroid

Depletes calcium

Levoxyl
Take calcium 3 hours after

Armour thyroid
Take iron 3 hours after

Take multivitamin 3 hours
after

Avoid antacids

Antidepressants reduce
effectiveness
ALLERGIES
Antihistamines

Allegra
Take on an empty

Claritin stomach

Zyrtec
Avoid alcohol
– increase drowsiness

Hismanal
– slow mental & motor skills

Dimetane

Drink plenty of water

Benadryl

Vitamin C enhances

Tavist effectiveness

Chlor-trimeton
PAIN
Analgesic

Acetaminophen
Take on empty stomach

Tylenol to increase absorption

Tempra
Avoid alcohol
– increases liver damage
– increases stomach
bleeding
Non-Steroidal Anti-Inflammatory

Aspirin
Take with food or milk due to
– Bayer, Ecotrin stomach irritation

Avoid alcohol

Ibuprofen – Liver damage
– Motrin, Advil – Stomach bleeding

Naproxen
Avoid ginko biloba & ginseng
– Aleve, Naprosyn
Fish oil enhances

Ketoprofen effectiveness
– Orudis
Depletes folic acid, iron,
vitamin C

Nabumetone
Take multivitamin
– Relafen
Corticosteroids

Prednisone
Take with food or milk to

Prednisolone decrease stomach upset

Medrol
Avoid Ginseng

Cortef
Take multivitamin
Narcotic Analgesics

Codeine
Avoid alcohol

Tylenol #2 #3 #4 – Increases sedative effect

Percocet
Drink plenty of water

Demerol

Vicodin

Lorcet
MOOD DISORDERS
Antidepressants

Prozac
Take with or without food

Paxil
Avoid alcohol

Zoloft
Avoid St. John’s Wort

Avoid SAMe

Fish oil enhances
effectiveness

Depletes folic acid,
melatonin

Take multivitamin
Anti-Anxiety

Xanax
Avoid alcohol

Valium – Impair mental & motor skill

Ativan
Avoid caffeine
– nervousness &
hyperactivity

Avoid kava

Avoid valerian

Take multivitamin

Depletes melatonin
Monoamine Oxidase Inhibitors

Nardil
Rapid & potentially fatal

increase in blood pressure

Parnate

Avoid alcohol
– Beer, red wine, liquor

Avoid non-alcoholic
beverages
– Non-alcohol & reduced
alcohol beer & red wine
products

Avoid chocolate

Avoid tyramine foods
Tyramine Containing Foods
– Cheese: processed, American, cheddar, blue, brie,
mozzarella, Parmesan
– Yogurt, sour cream
– Beef or chicken liver, cured meats, salami, sausage
– Game meat
– Dried fish, caviar
– Avocado, banana, raisins, fava beans
– Yeast extract, sauerkraut, soy sauce, miso
– Caffeine: cola, chocolate, coffee, tea
– Ginseng
ASTHMA
Bronchodilators

Theophylline
High fat meals may increase

High carbohydrate meals may

Albuterol decrease

Epinephrine
Depletes potassium

Take multivitamin

Avoid caffeine

Avoid alcohol – increase side
effects
– Nausea
– Vomiting
– Headache
– irritability
GRAPEFRUIT
Grapefruit and grapefruit juice
contain chemicals that interfere
with enzymes that metabolize
various drugs
Avoid Grapefruit & Juice

Amiodarone
Excessively high levels

BuSpar in the blood

Zoloft
Potentially serious side

Carbatrol effects

Cyclosporine
Ask your doctor or

Procardia pharmacist

Nifedipine

Zocor

Lipitor
Avoid Foods that React Like Grapefruit

Pomelos

Seville oranges

Tangerines

Orange marmalade
These foods must be avoided –
waiting even 24 hours will not
prevent a drug interaction
Medication Safety Rules

Read medication labels carefully

Keep medications in original containers

Ask doctor or pharmacist questions

Use one pharmacy for all prescriptions

Check with doctor before taking OTC or
nutritional supplements

Keep a list of all medications, OTC and
nutritional supplements