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Mindset Mastery

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David Torres
David Torres

Food Medication Interactions ((TOP))

Anytime you take more than one medication, or even mix it with certain foods, beverages, or over-the-counter medicines, you are at risk of a drug interaction. Most drug interactions are not serious, but because a few are, it is important to understand the possible outcome before you take your medications.

Food Medication Interactions

Checking for a drug interaction before it occurs can drastically lower your chance of a problem. Usually, your doctor and pharmacist will have already done this with your prescription medications, but it's a good idea to double check and learn about these medications yourself. If you use any over-the-counter (OTC) medicine, including vitamins, herbal or food supplements, be sure to review these products for interactions with your prescription medications, too. Ask your pharmacist or doctor for advice if you are confused by the medical jargon.

Major drug interactions that are life-threatening are not common, but are of serious concern. Most drug interactions listed in package labeling may be theoretical based on a drug's pharmacology. However, if you can avoid a possible drug interaction by selecting a different medication, that is always your best bet.

Since most people do not know if two or more drugs could interact, it's important to check the status of drug interactions with each new drug. In fact, for some drugs, stopping the medication could also affect the levels of other drugs in your system. Being proactive in your own health, checking for drug interactions, and discussing concerns with your healthcare provider can be a life-saving task.

Don't forget that alcohol, caffeine, and illegal drugs of abuse can lead to serious drug interactions, too. For example, taking a pain medication such as hydrocodone-acetaminophen (Vicodin) with alcohol can cause additive drowsiness, may dangerously decrease your breathing rate, and in large doses may be toxic to the liver due to the combination of acetaminophen (Tylenol) and alcohol.

Communication with your healthcare provider is key in helping to prevent drug interactions. Keep an up-to-date list of your medications, over-the-counter products, vitamins, herbals, and medical conditions. Share this list with your doctor, pharmacist, and nurse at each visit so that they can also screen for drug interactions.

Review the Medication Guide, prescription information, warning labels, and Drug Facts Label with each new prescription or OTC product. Labeling may change as new information is learned about medications, so it's important to review the information frequently.

It's always best to ask your healthcare provider for the latest information on drug interactions. However, you can also use our online drug interaction checker to learn more about possible drug interactions, too. This tool explains what the interaction is, how it occurs, the level of significance (major, moderate, or minor) and usually a suggested course of action. It will also display any interactions between your chosen drug(s) and food, beverages, or a medical condition.

Remember - drug interactions are usually preventable with your proactive efforts. However, if you discover you are at risk for a possible drug interaction, call your doctor or pharmacist as quickly as you can. They will understand the significance of the interaction, and will be able to recommend the next best steps you should take. Do not stop your medication without talking to your healthcare provider first.

Many medicines have powerful ingredients that interact with the human body in different ways. Diet and lifestyle can sometimes have a significant impact on drugs. A drug interaction is a situation in which a substance affects the activity of a drug, i.e. the effects are increased or decreased, or they produce a new effect that neither produces on its own. Typically, interactions between drugs come to mind (drug-drug interaction). However, interactions may also exist between drugs and foods (drug-food interactions), as well as drugs and herbs (drug-herb interactions).

Major side-effects of some diet (food) on drugs include alteration in absorption by fatty, high protein and fiber diets.2 Bioavailability is an important pharmacokinetic parameter which is correlated with the clinical effect of most drugs. However, in order to evaluate the clinical relevance of a food-drug interaction the impact of food intake on the clinical effect of the drug has to be quantified as well.

The most important interactions are those associated with a high risk of treatment failure arising from a significantly reduced bioavailability in the fed state. Such interactions are frequently caused by chelation with components in food. In addition, the physiological response to food intake, in particular, gastric acid secretion, may reduce or increase the bioavailability of certain drugs.3,4

Drug interactions can alter the pharmacokinetics and/or pharmacodynamics of a drug. The pharmacodynamic interaction may be additive, synergistic, or antagonistic effects of a drug. Drug interactions (DIs) represent an important and widely under recognized source of medication errors.5 The gastrointestinal absorption of drugs may be affected by the concurrent use of other agents that,1 have a large surface area upon which the drug can be absorbed,2 bind or chelate,3 alter gastric pH,4 alter gastrointestinal motility, or affect transport proteins such as P-glycoprotein. A reduction only in absorption rate of a drug is seldom clinically important, whereas a reduction in the extent of absorption will be clinically important if it results in sub therapeutic serum levels.5

Factors such as nonspecific binding, atypical kinetics, poor effector solubility, and varying ratios of accessory proteins may alter the kinetic behavior of an enzyme and subsequently confound the extrapolation of in vitro data to the human situation.6 Coenzyme Q-10 (CoQ10) is very widely consumed by humans as a food supplement because of its recognition by the public as an important nutrient in supporting human health. It interferes with intestinal efflux transporter P-glycoprotein (P-gp) and as result food-drug interactions arise.7

The interaction of natural products and drugs is a common hidden problem encountered in clinical practice. The interactions between natural products and drugs are based on the same pharmacokinetic and pharmacodynamic principles as drug-drug interactions. Several fruits and berries have recently been shown to contain agents that affect drug-metabolizing enzymes.8 Grapefruit is the most well-known example, but also sevillian orange, pomelo and star fruit contain agents that inhibit cytochrome P450 3A4 (CYP3A4), which is the most important enzyme in drug metabolism.9

The study of drug-drug, food-drug, and herb-drug interactions and of genetic factors affecting pharmacokinetics and pharmacodynamics is expected to improve drug safety and will enable individualized drug therapy. Drugs can show their efficacy only if administered in appropriate quantity with appropriate combination of drugs and foods and at appropriate time.

In contrast to the easy access to information on drug-drug interactions, the information about food-drug interaction is not always available conveniently. It is a difficult and complex problem to accurately determine the effects of food and nutrients on a particular drug. This article aims to help the healthcare professionals specially physicians and pharmacists and patients to become more knowledgeable about drug and food interactions.

Numerous reports have documented drug interactions with GFJ that occur via inhibition of CYP3A enzymes.10 Furanocoumarins present in GFJ inhibit the intestinal CYP 3A4 and have been shown to increase the oral bioavailability of medications that are CYP 3A4 substrates like Felodipine, midazolam, cyclosporine and raise their concentrations above toxic levels.11

Cholesterol-lowering agent lovastatin should be taken with food to enhance gastrointestinal absorption and bioavailability. The absorption of rosuvastatin, another anti-hyper lipidemic agent, was significantly decreased in the fed state compared with the fasting state, which suggests that rosuvastatin should be administered on an empty stomach.18

Eating charbroiled food may decrease warfarin activity, while eating cooked onions may increase warfarin activity.25 Soy foods have been reported both to increase and to decrease warfarin activity.25 The significance of these last three interactions remains unclear. The combination of warfarin administration and cranberry juice ingestion appeared to be associated with an elevated INR without bleeding in elderly patient.

A number of studies give evidence that fluoroquinolones forming slightly soluble complex with metal ions of food show reduced bioavailability.46 Casein and calcium present in milk decrease the absorption of ciprofloxacin.47 The effect of interaction of five fruit juices on the dissolution and absorption profiles of ciprofloxacin tablets were determined. It was found that the absorption of ciprofloxacin (500 mg) tablets can be reduced by concomitant ingestion of the GFJ.48 Therefore, to avoid drug therapeutic failures and subsequent bacterial resistance as a result of sub-therapeutic level of the drug in the systemic circulation, ingestion of the juice with ciprofloxacin should be discouraged.48 Azithromycin absorption is decreased when taken with food, resulting in a 43% reduction in bioavailability.39 Tetracycline should be taken one hour before or two hours after meals, and not taken with milk because it binds calcium and iron, forming insoluble chelates, and influencing its bioavailability.39,49,50 The effect of milk added to coffee or black tea on the bioavailability of tetracycline was evaluated in healthy individuals. Results showed that even a little quantity of milk containing extremely small amounts of calcium severely impair the absorption of the drug, so that the presence of this metal ion should be carefully controlled in order to avoid decreasing the available tetracycline.51 041b061a72


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