Food-Drug Interactions PDF

Food-Drug Interactions  Definition of Terms Drug-nutrient interaction drug alone safe Not together nutrient alone safe safe  Definition of Terms Food-...

Food-Drug Interactions  Definition of Terms Drug-nutrient interaction drug alone safe Not together nutrient alone safe safe  Definition of Terms Food-drug interaction drug alone safe Not together nutrient alone safe safe + the effect of a medication on nutritional status  Definition of Terms Drug-nutrient interaction: the result of the action between a drug and a nutrient that would not happen with the nutrient or the drug alone Food-drug interaction: a broad term that includes drug-nutrient interactions and the effect of a medication on nutritional status  Definition of Terms Examples  Drug –Nutrient Interaction- Zantac (Ranitidine) & Vitamin B12- Decreases Nutrient absorption  Drug–FoodInteraction Tetracycline's & Dairy products - Decreases drug absorption Patients at Risk for Food-Nutrient Interactions  Patient with chronic disease  Elderly  Foetus  Infant  Pregnant woman  Allergies or intolerances  Food and Pharmacokinetics Absorption Food components and nutritional supplements can interfere with absorption, especially if the drug is taken orally. Absorption of iron from supplements ↓↓ 50% when taken with food Best absorbed when taken with 8 oz of water on empty stomach Food may ↓↓ GI upset If take with food, avoid bran, eggs, fiber supplements, tea, coffee, calcium supplements  Food and Pharmacokinetics Absorption Ciprofloxacin and Tetracycline form insoluble complexes with calcium in dairy products or foods; also zinc, calcium, magnesium, zinc or iron supplements; aluminum in antacids Stop unnecessary supplements during drug therapy or give drug 2 hours before or 6 hours after the mineral  Food and Pharmacokinetics Metabolism  Foods or dietary supplements that increase or inhibit these enzyme systems can change the rate or extent of drug metabolism Grapefruit  Food and Pharmacokinetics Distribution 1 Lower doses often recommended for persons with low albumin  Food and Pharmacokinetics Distribution 2  Food and Pharmacokinetics Distribution Body composition: obese or elderly persons have a higher ratio of adipose tissue; fat soluble drugs may accumulate in the body ↑ risk of toxicity  Food and Pharmacokinetics Excretion  Patients at Risk for Food- Nutrient Interactions Patient with chronic disease Elderly Fetus Infant Pregnant woman Allergies or intolerances  Foods containing mucilage Line seeds ‫الكتان‬ Psyllium ‫سيلليوم‬ Aloe vera ‫الصبار‬ Okra ‫بامية‬ Figs ‫تين‬ Agar agar (algae) ‫الطحالب‬ Fenugreek ‫نبات الحلبة‬ Marshmallow root ‫جذر الخطمي‬  Foods containing mucilage Warning internal administration of mucilage must be accompanied by suffecient intake of liquids (1.5 to 2 liters dially), otherwise flatulence may occur.  Contraindications Linseed should not be used in cases of intestinal obstruction Should not be used for children under the age of 12 Interactions with other drugs As with any mucilage-containing drug or food, an inhibition of the absorption of other drugs (iron, lithium,….etc.) in the gastrointestinal tract (GIT) is possible. Therefore, linseed preparation should be taken half an hour to one hour before or after administration of other 17 drugs. Grapefruit  CYP3A4 Grapefruit Blood levels of the drug may rise Grapefruit  Grapefruit juice decreases the activity of the cytochrome P450 3A4 (CYP3A4) enzymes that are responsible for breaking down many drugs and toxins.  Grapefruit contains compounds known as furanocoumarins that block the CYP3A4 enzymes. When grapefruit juice is consumed, the enzyme’s ability to break down the drug for elimination is decreased.  Blood levels of the drug may rise, resulting in the risk for new or worsened side effects. Grapefruit and Antibiotic  A 2001 study published in the "European Journal of Clinical Pharmacology" studied the effects of grapefruit juice in six male subjects taking a full course of erythromycin at a 400 mg daily dose. The results of the study confirmed that the medication effects were amplified by the grapefruit juice. Grapefruit and Antibiotic A 2007 study published in the "British Journal of Clinical Pharmacology" found that the antibiotic clarithromycin in 250 mg daily doses also interacted with grapefruit juice and had the added effect of raising blood glucose levels in study subjects. Grapefruit juice - Drug Interactions Terfenadine (antihistamine) Almost complete meta-bolism by CYP3A4 Large dose Grapefruit  The effects of grapefruit juice on certain medications can last for over 24 hours. So, even if the medicine is taken only once per day, grapefruit and grapefruit juice should still be avoided for the entire treatment drug/ grapefruit interaction note Drugs that can react with orange, apple or grapefruit juice include some antibiotics, chemotherapy drugs and beta-blockers. According to the researchers, if you're taking medications and want to drink these juices, you need to leave a gap of four hours either side of taking your pills.  Orange and apple juice  have a different effect. They contain bioflavonoids called hesperidin which can block organic anion transport protein (OAT-P), a membrane-bound transport protein in the gut wall that pumps compounds into hepatocytes on their way to the systemic circulation. So When these bioflavonoids block OAT-P, serum levels of drugs will decline  hesperidin block (OAT-P) serum levels of drugs will decline Orange and apple juice erythromycin penicillin clarithromycin acyclovir methotrexate TEA and DRUG INTERACTION Contraindications  Pregnancy and breast-feeding: If you are pregnant or breast-feeding, drinking black tea in small amounts is POSSIBLY SAFE. Do not drink more than 3 cups a day of black tea. This amount of tea provides about 200 mg of caffeine. Consuming more than this amount during pregnancy is POSSIBLY UNSAFE and has been linked to an increased risk of miscarriage, increased risk of sudden infant death syndrome (SIDS), and other negative effects, including symptoms of caffeine withdrawal in newborns and lower birth weight.  breast-feeding, drinking more than 3 cups a day of black tea is POSSIBLY UNSAFE and might cause your baby to become more irritable and have more bowel movements. TEA and DRUG INTERACTION Contraindications  Bleeding disorders: There is some reason to believe that the caffeine in black tea might slow blood clotting, though this hasn't been shown in people. Use caffeine cautiously if you have a bleeding disorder.  Heart problems: Caffeine in black tea can cause irregular heartbeat in certain people. If you have a heart condition, use caffeine with caution.  Diabetes: The caffeine in black tea might affect blood sugar. Use black tea with caution if you have diabetes.  Glaucoma: Drinking caffeinated black tea increases the pressure inside the eye. The increase occurs within 30 minutes and lasts for at least 90 minutes. TEA and DRUG INTERACTION Contraindications osteoporosis: Drinking caffeinated black tea can increase the amount of calcium that is flushed out in the urine. This might weaken bones. Don't drink more than 300 mg of caffeine per day (approximately 2-3 cups of black tea). Taking extra calcium may help to make up for calcium losses. Older women who have a genetic condition that affects the way they use vitamin D, should use caffeine with caution. TEA and DRUG INTERACTION Nicotine Interaction Rating: Moderate Be cautious with this combination. Talk with your health provider.  Black tea contains caffeine. Caffeine can stimulate the heart. Nicotine can also stimulate the heart. Taking caffeine with nicotine might cause too much stimulation and cause heart problems, such as increased heart rate or blood pressure. TEA and DRUG INTERACTION Antibiotics (Quinolone antibiotics)  Interaction Rating: Moderate Be cautious with this combination. Talk with your health provider.  The body breaks down caffeine to get rid of it. Some antibiotics might decrease how quickly the body breaks down caffeine. Taking these antibiotics along with black tea can increase the risk of side effects including headache, increased heart rate, and other side effects. Some antibiotics that decrease how quickly the body breaks down caffeine include ciprofloxacin (Cipro), enoxacin (Penetrex), norfloxacin (Chibroxin, Noroxin), sparfloxacin (Zagam), trovafloxacin (Trovan), and grepafloxacin (Raxar). TEA and DRUG INTERACTION Benzodiazepines Interaction Rating: Moderate Be cautious with this combination. Benzodiazepines are drugs that have calming effects. Black tea contains caffeine. Caffeine is a stimulant. Taking black tea along with benzodiazepines might block the calming effects of can benzodiazepines. Some benzodiazepines include alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan), and others. TEA and DRUG INTERACTION Carbamazepine (Tegretol) Interaction Rating: Moderate Be cautious with this combination. Carbamazepine is a drug used to treat seizures. Caffeine in black tea can decrease the effects of carbamazepine. Taking black tea with carbamazepine might decrease the effects of carbamazepine and increase the risk of seizures in some people. TEA and DRUG INTERACTION Cimetidine (Tagamet)  Interaction Rating: Moderate Be cautious with this combination.  Black tea contains caffeine. The body breaks down caffeine to get rid of it. Cimetidine (Tagamet) can decrease how quickly your body breaks down caffeine. Taking cimetidine (Tagamet) along with black tea might increase the chance of caffeine side effects including headache, fast heartbeat, and others. TEA and DRUG INTERACTION Ephedrine also ginsing Interaction Rating: Moderate Be cautious with this combination.  Stimulant drugs speed up the nervous system. Black tea contains caffeine. Caffeine and ephedrine are both stimulant drugs. Taking black tea along with ephedrine might cause too much stimulation and sometimes serious side effects and heart problems. Do not take caffeine containing products and ephedrine at the same time. TEA and DRUG INTERACTION Estrogens Interaction Rating: Moderate Be cautious with this combination. The body breaks down the caffeine in black tea to get rid of it. Estrogens can decrease how quickly the body breaks down caffeine. Taking estrogen pills and drinking black tea can cause, headache, fast heartbeat, and other side effects. If you take estrogen pills, limit your caffeine intake. Some estrogen pills include conjugated equine estrogens (Premarin), ethinyl estradiol, estradiol, and others. TEA and DRUG INTERACTION Lithium Interaction Rating: Moderate Be cautious with this combination. Your body naturally gets rid of lithium. The caffeine in black tea can increase how quickly your body gets rid of lithium. If you take products that contain caffeine and you take lithium, stop taking caffeine products slowly. Stopping caffeine too quickly can increase the side effects of lithium. TEA and DRUG INTERACTION Medications for asthma (Beta-adrenergic agonists Interaction Rating: Moderate Be cautious with this combination. Black tea contains caffeine. Caffeine can stimulate the heart. Some medications for asthma can also stimulate the heart. Taking caffeine with some medications for asthma might cause too much stimulation and cause heart problems. Some medications for asthma include albuterol (Proventil, Ventolin, Volmax), metaproterenol (Alupent), terbutaline (Bricanyl, Brethine), and isoproterenol (Isuprel). TEA and DRUG INTERACTION Medications that change the liver (Cytochrome P450 1A2 (CYP1A2) inhibitors)  Interaction Rating: Moderate Be cautious with this combination.  Some medications that change the liver include cimetidine (Tagamet), ciprofloxacin (Cipro), fluvoxamine (Luvox), and others. These medications that change the liver might decrease how fast caffeine in black tea is broken down in the body. This might increase the effects and side effects of caffeine in black tea. TEA and DRUG INTERACTION (Anticoagulant / Antiplatelet drugs)  Interaction Rating: Moderate Be cautious with this combination.  Caffeine might slow blood clotting. Taking black tea along with medications that also slow clotting might increase.  Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), diclofenac (Voltaren, Cataflam, others), ibuprofen (Advil, Motrin, others), naproxen (Anaprox, Naprosyn, others), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin), and others. TEA and DRUG INTERACTION Warfarin  Interaction Rating: Moderate Be cautious with this combination.  Warfarin is used to slow blood clotting.  Large amounts of black tea might decrease how warfarin activity.  It is unclear why this interaction might occur. Be sure to have your blood checked regularly. The dose of your warfarin might need to be changed. TEA and DRUG INTERACTION METFORMIN (Glucophage) Interaction Rating: Minor Be cautious with this combination. Black tea contains caffeine. The body breaks down caffeine to get rid of it. Metformin (Glucophage) can decrease how quickly the body breaks down caffeine. Taking black tea along with metformin might cause too much caffeine in the body, and increase the effects and side effects of caffeine. TEA and DRUG INTERACTION Medications for diabetes (Antidiabetes drugs) Interaction Rating: Minor Be cautious with this combination. Black tea contains caffeine. Caffeine might increase blood sugar. Diabetes medications are used to lower blood sugar. By increasing blood sugar, black tea might decrease the effectiveness of diabetes medications. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed. Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others. TEA and DRUG INTERACTION Phenobarbital Interaction Rating: Moderate Be cautious with this combination. Talk with your health provider. Phenobarbital is a drug used to treat seizures. Caffeine in black tea can decrease the effects of phenobarbital. Taking black tea with phenobarbital might decrease the effects of phenobarbital and increase the risk of seizures in some people. TEA and DRUG INTERACTION Phenytoin Interaction Rating: Moderate Be cautious with this combination. Talk with your health provider. Phenytoin is a drug used to treat seizures. Caffeine in black tea can decrease the effects of phenytoin. Taking black tea with phenytoin might decrease the effects of phenytoin and increase the risk of seizures in some people. TEA and DRUG INTERACTION Theophylline Interaction Rating: Moderate Be cautious with this combination. Talk with your health provider. Black tea contains caffeine. Caffeine works similarly to theophylline. Caffeine can also decrease how quickly the body gets rid of theophylline. This might cause increased effects and side effects of theophylline. TEA and DRUG INTERACTION Medications for depression (Tricyclic antidepressants) Interaction Rating: Minor Be cautious with this combination. Talk with your health provider. Black tea contains chemicals called tannins. Tannins can bind to many medications and decrease how much medicine the body absorbs. To avoid this interaction, avoid black tea 1 hour before and 2 hours after taking medications for depression called tricyclic antidepressants. Some medications for depression include amitriptyline (Elavil) or imipramine (Tofranil, Janimine). TEA and DRUG INTERACTION Fluconazole (Diflucan) Interaction Rating: Minor Be cautious with this combination. Talk with your health provider. Black tea contains caffeine. The body breaks down caffeine to get rid of it. Fluconazole (Diflucan) might decrease how quickly the body gets rid of caffeine. This could cause caffeine to stay in the body too long and increase the risk of side effects such as nervousness, anxiety, and insomnia. TEA and DRUG INTERACTION Birth control pills (Contraceptive drugs) Interaction Rating: Minor Be cautious with this combination. Talk with your health provider. Black tea contains caffeine. The body breaks down caffeine to get rid of it. Birth control pills can decrease how quickly the body breaks down caffeine. Taking black tea along with birth control pills might cause jitteriness, headache, fast heartbeat, and other side effects. Some birth control pills include ethinyl estradiol and levonorgestrel (Triphasil), ethinyl estradiol and norethindrone and others. TEA and DRUG INTERACTION Medications for depression (MAOIs) Interaction Rating: Moderate Be cautious with this combination. Talk with your health provider. The caffeine in black tea can stimulate the body. Some medications used for depression can also stimulate the body. Drinking black tea and taking some medications for depression might cause too much stimulation of the body and serious side effects including fast heartbeat, high blood pressure, nervousness, and others. Some of these medications used for depression include phenelzine (Nardil), tranylcypromine (Parnate), and others.  Foenugreek It lowering blood glucose in people with diabetes  might increase the effectiveness of diabetes medications. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed  Liquorice Glycyrrhizin (triterpenoid saponin), responsible for the sweetness of Liquorice Adrenal agent: it stimulates the production of hormones from the adrenal gland and reduces the breakdown of steroids by the liver and the kidney. It has an action similar to hydrocortisone and other corticosteroid hormones. Therefore, it is has an anti- inflammatory and anti-arthritic. Also used in low adrenal function or adrenal insufficiency.  Side effects: Most of the side effects are due to its glucocorticoid-like action. It causes water retention, sodium retention, loss of potassium and hypertension. Precautions: Not to be used in hypertensive individuals or in. pregnancy  Drug interactions: Do not combine with corticosteroids.  Ginger Precautions: Not to be used in cases of peptic ulcer as it is believed to has an effect on the production of acid in the stomach. Side effects: Only very large doses of ginger could heartburn.  Ginger Anti-coagulant Increase effect of Some medications that slow blood clotting include , warfarin, aspirin, clopidogrel (Plavix), diclofenac (Voltaren, Cataflam, others), ibuprofen (Advil, Motrin, others), naproxen (Anaprox, Naprosyn, others), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin  Curcuma (Turmeric) Anti-coagulant Increase effect of Some medications that slow blood clotting include , warfarin, aspirin, clopidogrel (Plavix), diclofenac (Voltaren, Cataflam, others), ibuprofen (Advil, Motrin, others), naproxen (Anaprox, Naprosyn, others), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin), and others.  garlic Anti-coagulant Increase effect of Some medications that slow blood clotting include as, warfarin, aspirin, clopidogrel (Plavix), diclofenac (Voltaren, Cataflam, others), ibuprofen (Advil, Motrin, others), naproxen (Anaprox, Naprosyn, others), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin), and others.  gensing Side effects: hypertension Caution: Avoid caffeine while taking ginseng, this may lead to nervousness, sleeplessness and hypertension (due to over stimulation). Anthraquinone Glycosides  True about on Anthraquinones Anthraquinones take about 10hours to produce an effect (take overnight) Should not be used for more than 10 days. Should not be used by children, pregnant and lactating women.  True about on Anthraquinones Cause griping pain. Anthraquinones = phenolic glycosides, used as an irritating laxative  Cinnamon Bark Contraindications  not to be used in case of stomach or intestinal ulcers due to its stomachic effect.  Avoid during pregnancy due to this herb's emmenagogue effects.  Avoid with nursing mothers as this herb may cause allergic hypersensitivity  Side effects:  In large dose; sleepiness and depression followed by tachycardia and increased intestinal peristalsis, respiration and perspiration  Gastro-intestinal irritation may result where large amounts of the pure essential oil are ingested, causing violent vomiting and possible kidney irritation.  , Seafood Cold and egg Flu Hepatitis Heart Liver milk food food kidney, heart, liver, spinach, broccoli, and yeast extract Alpha-lipoic acid ALA 8 organosulfur compound derived from octanoic acid Alpha-lipoic acid is an antioxidant that your body makes and is also available as a supplement Seafood  good source of selenium, which contribute to the production of white blood cells that fight off flu viruses. Lower than normal selenium levels may be associated with an increased risk for liver cancer in people with hepatitis B and/or C. Seafood  rich in zinc, an important element for cell functions and your immune system. Zinc prevents infections, acting against viruses and bacteria and stimulating immune system response. Seafood  good source of iron, protein and vitamin B, which are all vital for immune system. good source of essential omega-3 fatty acids in Fish such as salmon, herring ‫رنجه‬and mackerel which help to protect your respiratory system from common cold and flu. Seafood . omega-3 fatty acids  Chicken Soup  good source of cysteine  Garlic and onion, which are often added to the chicken soup have immune-boosting effect.  Cysteine (N-acetyl-L-cysteine [NAC]) Antioxidant that is helpful against viruses Supplementation with N-acetyl-cysteine helps the body produce glutathione at more beneficial levels. Glutathione is often considered the body’s most important antioxidant It helps in detoxification of the harmful substances in the body.  Preliminary evidence suggests that NAC supplements may help in treatment of hepatitis C when combined with standard medical therapy.  Yogurt Eating yogurt with live bacteria when you have cold or flu is a good way to improve your health. bacteria stimulate the production of white blood cells, which fight off the diseases. People, who ate yogurt with live bacteria on a regular basis, had higher levels of immune system T cells, which keep our body from disease-causing germs. Bacteria in yogurt also help to absorb many nutrients, which are important for our immune system. Green tea Catechin, may help treat viral infection. Antioxidant that is about 25-100 times more potent than vitamins C and E. Vitamin K, also found in broccoli, can decrease the effect of warfarin  Drug Side Effects that Affect Nutritional Status Appetite changes  Oral taste and smell  Nausea  Dry mouth  Gastrointestinal effects  Organ system toxicity  Glucose levels Examples of Drug Categories that may affect Appetite Decrease Appetite Antiinfectives Antineoplastics Bronchodilators Cardiovascular drugs Stimulants Increase Appetite Anticonvulsants Hormones Psychotropic drugs —Antipsychotics — Drugs Affecting Oral Cavity, Taste and Smell  Taste changes: cisplatin, captopril (anti- hypertensive) amprenavir (antiviral) phenytoin (anti-convulsive), clarithromycin (antibiotic)  Mucositis: antineoplastic drugs such as interleukin-2, paclitaxel, carboplatin  Dry mouth: Anticholinergic drugs (tricyclic antidepressants such as amytriptyline, antihistamines such as diphenhydramine, antispasmodics such as oxybutynin Drugs that Affect the GI Tract  Alendronate (Fosamax) anti-osteoporosis drug—patients must sit upright 30 minutes after taking it to avoid esophagitis  Aspirin or other NASAIDs –can cause GI bleeding, gastritis  Orlistat – blocks fat absorption, can cause oily spotting, fecal urgency, incontinence  Narcotic agents cause constipation Drugs That May effect Glucose Levels Decrease glucose levels  Antidiabetic drugs (acarbose, glimepiride, glipizide, glyburide, insulin, metformin, miglitol, neteglinide, pioglitizone, repaglinide, roiglitizone  Drugs that can cause hypoglycemia: ethanol, quinine, disopyramide (antiarrhythmic) and pentamidine isethionate (antiprotozoal)  Drugs That May effect Glucose Levels Increase glucose levels  Antiretrovirals, protease inhibitors(amprenavir, nelfinavir, ritonavir, saquinavir)  Diuretics, antihypertensives (furosemide, hydrochlorothiazide, indapamide)  Hormones (corticosteroids, danazol, estrogen or estrogen/progesterone replacement therapy, megestrol acetate, oral contraceptives)  Niacin (antihyperlipidemic) baclofen, caffeine, olanzapine, cyclosporine, interferon alfa-2a