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Types of Food-Drug Interactions

Effects of food on absorption Effects of food on metabolism

Specific food-drug Effects

It is primarily in two realms pharmacokinetics, and pharmacotherapeutics where we can have Food-Drug interactions The interactions can be general or specific:

General: whether a drug should be taken with or without food Specific: whether certain drugs are specifically affected by specific foods

Mainly a function of food BINDING to a drug

This can be considered a general effect

Can either or drug absorption across the

gut Dictates whether a drug should be taken on an EMPTY or FULL stomach Another important factor:
Whether a med irritates the GI tract
Eg: aspirin

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Eg: Allegra, Claritin,

Hismanal, Zyrtec

Eg: Acetominphen


Food generally DECREASES absorption Food will delay absorption

HMG-CoA Reductase Inhibitors

Eg: statins Atorvastatin (Lipitor), cerivastatin (Baycol) Mechanism of action These are difficult to absorb, so advise clients

to take with evening meal (why?)

Ibuprofen (Advil, Motrin) Indomethacin (Indocid) Naproxen (Anaprox, Alleve) Aspirin*

These cause stomach upset; food will help to buffer *Aspirin irritates the stomach and increases gastric bleeding; a buffered or entericcoated form of Aspirin may be given

Eg: methylprednisone Prednisone Prenisolone Cortisone acetate

These drugs can cause stomach upset They may also cause HYPERGLYCAEMIA

So what?

Lovastatin (Mevacor)
A statin we will speak of shortly This drugs is poorly absorbed without food, so

your client should take this with an evening meal

Decreases the activity of a specific cytochrome P450, called CYP3A3 This means that drugs metabolized by CYP3A3 during phase I will not be degraded as quickly Bottom line: a greater concentration of drug remains in the plasma

MOST prescription drugs do NOT show clinically-relevant interactions Which drugs should you watch-out for?

Antihistamines Anti-infectives Benzodiazepines Calcium Blockers Cholesterol Lowering Drugs Immune system suppressants Psychiatric Drugs

Alpraxolam Xanax Biaxin Digoxin Haloperidol

Pracochol Coumadin Verapamil Itraconazole Dilantin

Metabolized by enteral bacteria to

NARINGENIN, which is a specific CYP3A4 inhibitor

Also a CYP inhibitor

These drugs are used to treat bronchial diseases

Theophylline, Albuterol, Epinephrine

High-fat meals may theophylline in body High carbohydrate meals may theophylline The FORM of the drug is important:

Food has NO effect on Theo-dur and Slo-Bid Food Theo-24 and Uniphyl absorption Food Theo-Dur Sprinkles absorption in children

AVOID CAFFEINE: also stimulates CNS

Lethal dose is 10 g

(~100 cups) Withdrawal symptoms in people who routinely have more than 600 mg/day (~6 cups)

LOTS in tea

Many different types; eg:

Furosemide (Lasix) triamterene (Dyazide)

Dyazide is potassium-sparing
What does this mean?

Patients taking Triamterene should avoid patassium-rich food

Eg? Why?

Again, different types:

Captopril (Capoten), moexipril (Univasc)

The also the amount of potassium in the body So, what do you recommend? Also food interferes with absorption

Prevent blood-clot formation

Eg: Coumadin (Warfarin) a VITAMIN K antagonist

So, what would you tell your client to avoid if s/he were on coumadin?


intake of foods containing Vitamin K constant K is high in spinach, kale, turnip greens, cauliflower, broccoli, brussel sprouts and other leafy greens



dont take Vitamin K or E supplements

Take your pick:

Penicillins, Cephalosporins, Macrolides,

Sulfonamides, Tetracylines, Quinolones

In general, these can cause stomach upset Pay attention to two in particular:

Quinolones (eg: ciprofloxacin) Tetracyclines (eg: vibramycin, minocin) AVOID calcium-containing foods, minerals containg iron and antacids (they decrease drug concentration)

Antifungal agents
Fluconazole (Diflucan) Griseofulvin (Grifulvin)

Ketoconazole (Nizoral)

Again, dairy products inhibit absorption

These are a very powerful group of drugs which are used in the treatment of depression and anxiety disorder MANY DIETARY RESTRICTIONS

If taken with foods high in TYRAMINE, a rapid,

fatal increase in blood pressure may occur .

Proceesed cheese, cheddar, brie, mozarella, parmesan cheeses, yogurt, sour cream Beef or chicken liver, cured meats such as sausage and salami, game meat, caviar, dried fish Avocados, bananas, yeast extracts, rasins, sauerkraut, soy sauce, miso soup Broad (fava) beans, ginseng, caffeine

Eg: Lorazepam (Ativan), Diazapm (Valium),

alprazolam (Xanax)

Clients should avoid CAFFEINE

May increase excitability, lessen therapeutic


Coumadin blood thinner Dilaritin anti-seizure

Vitamin K Vitamin D and Folate Deficiency

Norvasc anti-hypertension
Aspirin/Anti-inflammatory Oral Contraceptives

Decrease Vitamin C Decrease Vitamin B and folate Decrease Potassium Calcium Antioxidants (Vitamin A, E, C)

Dyazide diuretic
Tetracycline Antiboitic Lipitor/Statin Cholesterol lowering Prednisone corticosteroid

Increase Appetite Lasix - diuretic Decrease Appetite