NUTRIENT AND DUG INTERACTION

Modern medicines can treat and cure many health problems and save our lives. Taking medicine is a normal routine for many people. The management of many diseases require long-term care and drug therapy, involving use of multiple drugs. Food can prevent medicine from working the way it should and can cause several side effects, this is called food – drug interaction. Food-drug interactions can produce negative effects in safety and efficacy of drug therapy, as well in the nutritional status of the patients. The foods we eat can interfere with the medications we take. Some drugs work faster, slower, better or worse on an empty stomach while others can cause adverse reactions. ?Patients may not recognize that otherwise healthy foods can have severe consequences when mixed with certain drugs.

Drugs can show their efficacy only if administered in appropriate quantity with appropriate combination of drugs and foods and at right time. Therefore, it is important to know how to avoid or minimize these food-drug interactions. Getting knowledge about it will go a long way in ensuring medications have the intended effects, minimizing disease complications and side effects, having faster recovery and reducing cost of health services.

There are a variety of foods and drug interaction that can occur, but here is a small list of common drugs and food, how they affect the way they are used in the body.

Interaction problems most often occur with the use of diuretics, oral antibiotics, anti-coagulant (blood thinning) drugs, anti-hypersensitive drugs, thyroid and sodium compounds and alcohol.

·????????Dairy products such as milk, yogurt and cheese decrease the absorption of antibiotics such as tetracycline, doxycycline and ciprofloxacin. These antibiotics may bind to calcium in milk, forming an insoluble substance in the stomach and upper small intestine that the body is unable to absorb. So, these foods should not be taken at the same time this drug is taken, so that the full dosage of drug is available for adequate treatment of the infection. Do not take antibiotics with milk or milk products or calcium supplements.

·????????Besides calcium other minerals in foods like Iron can complex with drugs to alter the gut environment and affect normal absorption of drugs and minerals. Drugs such as thyroxine and captopril (prescribed in high BP & heart problems) also form complexes with iron thus decreasing the bioavailability of the drug.

·????????MAO inhibitors are used to treat depression and high blood pressure. Pickled, cured and fermented foods, aged cheese and cured meats, avocados, bananas, chocolate, red wine contain tyramine which is a vasoconstrictor associated with raising blood pressure. If taken together can cause severe increase in blood pressure that can even lead to a severe headache, and even brain hemorrhage. So, care should be taken not to eat such foods with these drugs.

·????????When taking Warfarin-a blood thinning medicine to treat and prevent blood clots, avoid eating spinach, kale, lettuce, cabbage, broccoli, parsley, green tea and other leafy vegetables in large quantity in your diet as they are rich in vitamin K, which help promote blood clotting. Vitamin K is vital for the production of clotting factors that help prevent bleeding but anticoagulants like warfarin inhibits the effect of vitamin K. So, eating green leafy vegetables which are rich in vitamin K will prevent or decrease the working of drug warfarin. Therefore, to achieve an optimal level of coagulation a balance must be maintained between the dose of the drug and ingestion of vitamin K. Increase in anticoagulation effects of warfarin may lead to serious bleeding problems.

·????????Moderate pain reliever drugs with acetaminophen should not be taken with coke, alcohol because it can cause increased absorption thereby increase the risk of side effects and may cause liver damage or stomach bleeding. Antihistamines, like Benadryl should not be taken with alcohol because it will increase the side effects like drowsiness.

·????????Alcohol affects insulin or oral diabetic medicines. Alcohol prolongs the effect of these drugs, which may lead to low blood sugar (hypoglycemia), which is quite risky. Alcohol is used in many syrups and elixirs. It reduces the absorption of magnesium, potassium and zinc.

·????????High protein intake with levodopa medications prescribed in Parkinson’s disease may reduce the drug’s effectiveness. Research results suggest that increased pyridoxine? (vitamin B6) intake during treatment with levodopa may increase its metabolism and decrease its therapeutic effect.?

·????????Calcium channel blockers medicines are usually prescribed for high blood pressure. They work by decreasing the activity of hormone called angiotensin2 which increases blood pressure and changing the way your blood vessels use calcium, relaxing the vessels and bringing blood pressure to normal. Medicines for hypertension should not be taken with grapefruit juice, as it can cause problems with the enzymes and transporters which metabolize these drugs, causing too much or too little drug in the body.

·????????Some drugs, like certain statins used to lower cholesterol, some anti-anxiety drugs, some corticosteroids that treat Crohn’s disease or ulcerative colitis are broken down by specific enzymes. Numerous studies have shown that Grapefruit juice possesses high interaction with almost all types of drugs. The juice modifies the body’s way of metabolizing the medications, affecting the liver’s ability to work the drug through a person’s system. It can block the action of these enzymes, increasing the amount of drug in the body and may cause more side effects. So, patients are advised to avoid drinking grapefruit juice within 1-2 hrs. of taking anticonvulsant medicines. Avoid eating orange marmalade too with the medicine as it might have the same effect as grapefruit juice. The severity of the interaction can be different depending on person, the drug and the amount of grapefruit juice one drinks along with the drug. Better to avoid taking medicines with fruit juices.

·????????However, suspensions and solutions are much less affected by food and nutrients because they do not depend on the rate of dissolution and can move from stomach to small intestine more easily.?

Some Guidelines to help use Drugs Wisely

1.?????When the doctor prescribes a medicine, make sure to mention every other drug you are taking including over the counter medicines such as aspirin, antacids and laxatives.

2.?????Understand well, when and how to take the medicines for example with meals, before meals or after meals. Stick labels to remind you when and how the drug is to be taken.

3.?????Tell your doctor immediately about any side effects or unusual symptoms that you feel after eating certain foods. Do not wait for next visit.

4.?????Taking medicine with full glass of plain water is the safest.

5.?????Do not take medicines with hot drinks as heat from drink may lessen or destroy the effectiveness of the drug.

6.?????Do not take vitamin pills at the same time as taking the medications: as vitamins and minerals can interact with some drugs.

7.?????Do not stir medicine into your food.

8.?????Do not take medicines with cold drink, fruit juices and alcohol.

9.?????If you are taking a medicine for a long time, ask your doctor if you need any vitamin and mineral supplements. For example, people with type 2 diabetes who take metformin usually develop low blood levels of vitamin B12.

10.?Do not take over the counter medications frequently on your own.

Finally use the minimum number of drugs possible and take them as directed by your doctor to reduce any chances of food-drug interaction.