It is a difficult and complex problem to accurately determine the effects of food and nutrients on a particular drug. There are many dramatic results or problems caused by food-drug, drug-drug and alcohol-food-drug interactions. The following table is designed to help the reader become more knowledgeable about drug interactions and their effect on food, a nutrient or another drug that may produce unexpected results or cause additional health problems.
Generic drugs often are substituted for brand-name counterparts. They usually are more economical than brand-name drugs. Possible exceptions might be enteric-coated aspirin.
Patients may have concerns about the quality, efficacy, potency or consistency of generic drugs. Generics are therapeutically equivalent to brands approved and rated by the Food and Drug Administration. Many are made by major brand-name companies.
| Table 1: Food and Drug Interactions. |
| |
|
Use |
Interactions/ Guidelines |
Examples1 |
| ALLERGIES |
Antihistamine |
To relieve or prevent the symptoms of
colds, hay fever and allergies. |
FOOD: Take prescription on an
empty stomach to increase its effectiveness. ALCOHOL: Avoid
alcohol because it increases the sedative effects of the medications. |
Diphenhydramine/ BENADRYL Fexofenadine/ALLEGRAL
oratadine/CLARITIN Cetirizine/ZYRTEC |
| ARTHRITIS and PAIN |
Analgesic/ Antipyretic |
To treat mild to moderate pain and fever. |
FOOD: For rapid relief, take on
empty stomach.
ALCOHOL: Avoid or limit the use of
alcohol because chronic alcohol use can
increase the risk of liver damage or
stomach bleeding. |
Acetaminophen/TYLENOL TEMPRA |
| Non-Steroidal AntiInflammatory Drugs
(NSAIDS) |
To reduce, pain, fever and inflammation. |
FOOD: Take with food or milk because
medications can irritate the stomach. ALCOHOL: Avoid or limit
the use of alcohol because chronic alcohol use can increase the risk
of liver damage or
stomach bleeding. |
Aspirin/BAYER, ECOTRIN Ibuprofen/MOTRIN,
ADVIL Naproxen/ANAPROX, ALEVE, NAPROSYN |
| Corticosteroids |
• To relieve inflamed areas of the
body.
• To reduce swelling and itching.
• To help relieve allergies, rheumatoid arthritis, and
other conditions. |
FOOD: Take with food or milk to
decrease stomach upset. |
Methyprednisolon/ MEDROL Prednisone/DELTASONE
Prednisolone/PEDIAPRED, PRELONE
Cortisone acetate/CORTEF |
| Narcotic Analgesic |
To provide relief for moderate
to severe pain. |
ALCOHOL: Avoid alcohol
because it increases the sedative effects of the medication. |
Codeine combined with acetaminophen/TYLENOL
Morphine/ROXANOL, MS CONTIN |
| ASTHMA |
Bronchodilators |
To treat the symptoms of bronchial asthma,
chronic bronchitis and emphysema. |
FOOD: High-fat meals may increase
the amount of theophylline in the body, while high-carbohydrate meals
may decrease it. It is important to check with the pharmacist about
which form you are taking because food can have different effects
depending on the dose form.
CAFFEINE: Avoid eating or drinking large amounts of foods and
beverages that contain caffeine.
ALCOHOL: Avoid alcohol because it can
increase the risk of side effects such as
nausea, vomiting, headache and irritability. |
Theophylline/SLO-BID, THEO-DUR, UNIPHYL
Albuterol/VENTOLIN, PROVENTIL, COMBIVENT Epinephrine/PRIMATENE MIST |
| CARDIO-VASCULAR DISORDERS |
Diuretics |
To help eliminate water, sodium and chloride
from the body. |
FOOD: Some diuretics cause loss
of potassium, calcium and magnesium. Triamterene is known as a “potassium
sparing” diuretic. When taking triamterene avoid eating large
amounts of potassium-rich foods such as bananas, oranges and green
leafy vegetables or salt substitutes. |
Furosemide/LAXID Triamterene/ hydrochlorothiazide/
DYAZIDE, MAXZIDE Hydrochlorothiazide/ HYDRODIURIL Trimterene/DRYENIUM
Bumetamide/BUMEX Metolazone/ZAROXOLYN |
| Beta Blockers |
To decrease the nerve impulses to blood
vessels. |
ALCOHOL: Avoid drinking alcohol
with propranolol/INDERAL because these drugs lower blood pressure
too much. |
Atenolol/TENORMIN Metoprolol/LOPRESSOR
Propranolol/INDERAL Nadolol/CORGARD |
| Nitrates |
To relax blood vessels and lower the
demand for oxygen by the heart. |
ALCOHOL: Avoid alcohol because
it may add to the blood vessel-relaxing effect of nitrates and result
in dangerously low blood pressure. |
Isosorbide dinitrate/ ISORDIL, SORBITATE
Nitroglycerin/NITRO, NITRODUR, TRANSDERM-NITRO |
| Angiotension Converting Enzyme (ACE Inhibitors) |
To relax blood vessels by preventing
angiotension II, a vasoconstrictor, from being formed. |
FOOD: Take one hour before or
two hours after meals. May increase the amount of potassium in the
body. Too much potassium can be harmful. Avoid eating large amounts
of potassium-rich foods such as bananas, oranges and green leafy vegetables
or salt substitutes. |
Captopril/CAPOTEN Enalapril/VASOTEC Lisinopril/PRINIVIL,
ZESTRIL Quinapril/ACCUPRIL Moexipril/UNIVASC |
| HMG-CoA Reductase Inhibitors |
Known as “statins”
• To lower cholesterol.
• To reduce the production rate of LDL (bad) cholesterol. |
FOOD: Lovastatin
(mevacor) should be taken with the evening meal to enhance absorption.
ALCOHOL: Avoid drinking large amounts of alcohol because it
may increase the risk of liver damage. |
Atorvastatin/LIPITOR Cerivastatin/BAYCOL
Fluvastatin/LESCOL Lovastatin/MEVACOR Pravastatin/PRAVACHOL Simvastatin/ZOCOR
|
| Anticoagulants |
To prevent the formation of blood clots. |
FOOD: Vitamin K produces blood-clotting
substances and may reduce the
effectiveness of anticoagulants.
High doses of vitamin E (400 IU or more)
may prolong clotting time and increase the
risk of bleeding. |
Warfrin/COUMADIN |
| INFECTIONS |
Antibiotics and Antifungals |
To treat infections caused by bacteria
and fungi. |
GENERAL GUIDELINES: Tell the doctor
if
Antifungals by bacteria and fungi. you experience skin rashes or diarrhea.
If you are using birth control, consult with
your health care provider because some
methods may not work when taken with
antibiotics. Be sure to finish all of your
medication even if you start feeling better.
Take medication with plenty of water. |
|
| Antibacterials/ Penicillin |
To treat infections caused by bacteria
and fungi. |
FOOD: Take on an empty stomach
unless it upsets your stomach, then take with food. |
Penicillin V/VEETIDS Amoxicillin/TRIMOX,
AMOXIL Ampicillin/PRINCIPEN, OMNIPEN |
| Quinolones |
To treat infections caused by bacteria
and fungi. |
FOOD: Take on empty stomach one
hour before or two hours after meals. If your stomach gets upset,
take with food. CAFFEINE: Taking these medications with caffeine-containing
products may increase
caffeine levels, leading to excitability and
nervousness. |
Ciprofloxacin/CIPRO Levofloxacin/LEVAQUIN
Ofloxacin/FLOXIN Trovafloxacin/TROVAN |
| Macrolides |
To treat infections caused by bacteria
and fungi. |
FOOD: Take on empty stomach one
hour before or two hours after meals. If your stomach gets upset,
take with food. |
Azithromycin/ ZITHROMAX Clarithromycin/BIAXIN
ERYTHROMYCIN/ E-MYCIN, ERY-TAB, ERYC
Erythromycin + sulfisoxazole/ PEDIAZOLE |
| Sulfonamides |
To treat infections caused by bacteria
and fungi. |
FOOD: Take on empty stomach one
hour before or two hours after meals. If your stomach gets upset,
take with food. |
Sulfamethoxazole + trimethoprim/BACTRIM,
SEPTRA |
| Tetracyclines |
To treat infections caused by bacteria
and fungi. |
FOOD: Avoid taking tetracycline
with dairy products, antacids, and vitamin supplements containing
iron because they can interfere with the medication’s effectiveness. |
Tetracycline/ ACHROMYCIN, SUMYCIN Doxycycline/VIBRMYCIN
Minocycline/MINOCIN |
| Nitromidazole |
To treat infections caused by bacteria
and fungi. |
ALCOHOL: Avoid drinking alcohol
and taking medications that contain alcohol while taking metronidazole
and for at least
three days after you finish the medication. |
Metronidazole/FLAGYL |
| Antifungals |
|
FOOD: It is important to avoid
taking these medications with dairy products.
ALCOHOL: avoid drinking alcohol and taking medications that
contain alcohol while taking keroconzole and for at least
three days after you finish the medication. |
Fluconazole/DIFLUCAN Griseofulvin/GRIFULVIN
Ketoconazole/NIZORAL Itraconazole/SPORANOX |
| MOOD DISORDERS |
Monoamine Oxidase (MAO) Inhibitors |
To treat depression, emotional and anxiety
disorders. |
FOOD: These medications have many
dietary restrictions and people taking them need to follow the dietary
guidelines and
physician’s instructions very carefully.
A rapid, potentially fatal increase in blood
pressure can occur if foods or alcoholic
beverages containing tyramine are
consumed while taking MAO inhibitors.
ALCOHOL: do not drink beer, red wine,
other alcoholic beverages, non-alcoholic
and reduced alcohol beer and red-wine
products. |
Phenelsine/NARDIL Tranycypromine/PARNATE |
| Anti-Anxiety Drugs |
To treat depression, emotional and anxiety
disorders. |
CAFFEINE: may cause excitability,
nervousness and hyperactivity and lessen the anti-anxiety effects
of the drugs. ALCOHOL: may impair mental and motor
performance. |
Lorasepan/ATIVAN Diazepam/VALIUM Alprazolam/XANAX
|
| Antidepressant Drugs |
To treat depression, emotional and anxiety
disorders. |
FOOD: these medications can be
taken with or without food.
ALCOHOL: although alcohol may not significantly interact with
these drugs to
affect mental or motor skills, people who are
depressed should not drink alcohol. |
Paroxetine/PAXIL Sertraline/ZOLOFT Fluoxetine/PROZAC |
| STOMACH CONDITIONS |
Histamine Blockers |
To relieve pain, promote healing and
prevent irritation from returning. |
FOOD: these mediations can be
taken with or without food.
CAFFEINE: caffeine products may irritate the stomach. |
Cimetidine/TAGAMET Famotidine/PEPCID
Ranitidine/ZANTAC Nizatadine/AXID |
1The generic name for each drug is stated first. Brand
names are in all capital letters and represent only some examples
of those medications.
References: Food and Drug Interactions, 1998, U.S. Food and Drug Administration,
National Consumers League.
|
Aspirin, acetaminophen and ibuprofen all have analgesic (pain control) and antipyretic (fever control) properties. Only aspirin and ibuprofen also contain anti-inflammatory properties. Acetaminophen does not produce the stomach or intestinal irritation or allergic reactions that aspirin can. Gastrointestinal side effects observed with aspirin are greatly reduced with ibuprofen, although patients with aspirin hypersensitivity can have similar reactions.
To reduce stomach upset from ibuprofen, take it with food or an antacid. Avoid alcohol or aspirin with ibuprofen.
Naproxen sodium, which has analgesic, antipyretic and anti-inflammatory
properties, is indicated for the same conditions as aspirin, ibuprofen
and acetaminophen but should not be taken with them. Anyone who generally
has three or more alcoholic drinks per day should consult a physician
on when and how to take naproxen sodium and other pain relievers.
| Table 2: Aspirin vs. Acetaminophen vs. Ibuprofen |
|
Aspirin |
Acetaminophen |
Ibuprofen |
| Classification |
NSAID, ANALGESIC, ANTIPYRETIC, ANTIARTHRITIC |
ANALGESIC, ANTIPYRETIC |
NSAID, ANALGESIC, ANTIARTHRITIC |
| Use |
• pain relief and fever reduction
in adults-relieves mild itching
• reduces swelling and inflammation
• used to treat arthritis, many
other conditions and injuries |
• mild pain relief
• reduces fever |
• pain relief
• reduces fever
• reduces inflammation |
| Cautions |
Caution is advised if you:
• get stomach irritation when taking aspirin-are allergic to
aspirin
• are taking blood thinning medication
• have a hang-over
A person should not take aspirin if he/she has:
ulcers, gout, asthma, hearing loss.
|
• High doses or regular,
long-term use can cause liver damage, especially if used with alcohol.
• Should not be used to treat fever over 103.1° F for more
than three days.
• Should not be used to treat fevers that keep coming back.
• Should not be used on a regular basis by people who suffer
from: anemia or liver or kidney disease |
Caution is advised if you have:
• asthma and nasal polyps
• a stomach or intestinal disorder
• a skin condition called “angioedema”
• an allergic reaction to other antiinflammatory medications
• liver or kidney disease
• a blood clotting disorder
• heart failure
• Not to be used with aspirin, alcohol or steroids. |
| Dietary Recommendations |
• Insure adequate fluid intake/hydration
• Increase foods high in vitamin C and
folic acid with long-term, high dosage use
• Avoid or limit garlic, ginger and Gingko |
|
• Take with meals or
milk. |
| Remarks |
Children and teenagers should not take
aspirin because it is associated with a rare disorder called Reye’s
Syndrome in these age groups. |
Works will for people who can’t
take aspirin because of aspirin-related allergic reactions, stomach
irritation, or ringing in the ears. |
• Less irritating to the stomach
than aspirin for some.
• Does not cause ringing in the ears like aspirin.
• Does not cause liver damage like acetaminophen. |
| Known Brands |
Aspirin, Ascriptin, Bufferin, Ecotrin |
Aspirin Free Anacin, Aspirin Free, Excedrin,
Tylenol, Panadol, Tempra, |
Advil, Midol IB, Motrin |
| Pregnant women should consult a doctor prior
to taking any over-the-counter medication. Other people, including
persons with medical conditions, are advised to read product labels
carefully and consult a pharmacist if they have any questions about
proper use. |
| Reference: Audio Health Library Topic 2001, Aspirin
vs. Acetaminophen vs. Ibuprofen. 1996. http://www.yourhealth.com/ahl/2001.html. |
