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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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Antihistamines
Eg: Allegra, Claritin,

Hismanal, Zyrtec

Analgesics/Antipyretics
Eg: Acetominphen

(Tylenol)

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?)

Analgesics/Antiinflammatories/Antipyretics
Eg: NSAIDS
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

Corticosteroids
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

Naringen
Metabolized by enteral bacteria to

NARINGENIN, which is a specific CYP3A4 inhibitor

Furanocoumarins
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

Caffeine
Lethal dose is 10 g

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

Theophylline
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?

Keep

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

Vitamin

Also

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

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

alprazolam (Xanax)

Clients should avoid CAFFEINE


May increase excitability, lessen therapeutic

effects

DRUG
Coumadin blood thinner Dilaritin anti-seizure

NUTRIENT/FOOD
Vitamin K Vitamin D and Folate Deficiency

Norvasc anti-hypertension
Aspirin/Anti-inflammatory Oral Contraceptives

Sodium
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