Food and Drug Interactions
Brochure: 1989
Developed jointly by: American Pharmaceutical Association,
Food and Drug Administration, Food Marketing Institute,
National Consumers League
INTRODUCTION
Physicians and pharmacists recognize that some foods and drugs, when taken during the same period of time, can alter the body's ability to utilize a particular food or drug, or cause serious side effects. This brochure is designed to help you decide if your diet should be changed in any way to adjust to the effects of medicine you are using. It covers the interactions - that is, what can occur between foods and drugs - of the more commonly used medications, both prescription and nonprescription (or over-the-counter).
This brochure should not be used in place of advice from a family physician or family pharmacist. Make sure your doctor knows about every drug you are taking, including drugs you obtain without a prescription order. If you have any problems related to medication, call your physician or pharmacist immediately. One drug may interact with another, in some cases creating serious medical problems. This brochure does not cover the interaction of one medicine with another.
Interactions will vary according to the dosage, your age, sex and your overall health. Although alcohol is actually a drug rather than a food, its interaction with drugs is covered in this brochure because alcohol, when consumed while taking certain medications, can be extremely dangerous. It is a good rule of thumb to avoid consuming alcohol while taking any drug unless a physician or pharmacist indicates that the combination is acceptable.
Cigarettes can also diminish the effectiveness of medication or create added hazards with certain medications. Caffeine, which is found in coffee, tea, soft drinks and chocolate and some medications, can also affect the action of some drugs. Medication should never be taken during pregnancy without the advice of your physician.
In this brochure, the generic (nonproprietary) name for each drug is stated first. Brand names are capitalized and represent only some examples.
ALLERGIES, ASTHMA, COLDS* AND COUGHS
Antihistamines-Antihistamines are used to relieve or prevent the symptoms of colds and hay fever and other types of allergy. They act to limit or block histamine which is released by the body when we are exposed to substances that cause allergic reactions. Some commonly used antihistamines:
- brompheniramine/Dimetane, Bromphen
- chlorpheniramine/Chlor-Trimeton, Teldrin
- diphenhydramine/Benadryl, Benaphen
INTERACTION-Avoid taking with alcoholic beverages because antihistamines combined with alcohol may cause drowsiness and slowed reactions.
Bronchodilators-Bronchodilators are used to treat the symptoms of bronchial asthma, chronic bronchitis and emphysema. These medicines relieve wheezing, shortness of breath and troubled breathing. They work by opening the air passages of the lungs. Some commonly used bronchodilators:
- aminophylline/Phyllocontin, Somophyllin
- theophylline/Slo-Phyllin, Theo-Dur
INTERACTION-Avoid eating or drinking large amounts of foods or beverages which contain caffeine because both bronchodilators and caffeine stimulate the central nervous system.
*Many over the counter cold remedies contain aspirin in combination with other active ingredients. See Aspirin under Arthritis and Gout.
ARTHRITIS AND GOUT
Aspirin-Aspirin reduces pain, fever and inflammation. Aspirin is available in many brands.
INTERACTION-Because aspirin can cause stomach irritation, avoid alcohol. To avoid stomach upset, take with food. Do not take with fruit juice.
Corticosteroids-Cortisone-like drugs are used to provide relief to inflamed areas of the body. They lessen swelling, redness, itching and allergic reactions. Some commonly used steroids:
- betamethasone, dexamethasone, hydrocortisone,
- methylprednisolone, prednisone, triamcinolone
INTERACTION-Avoid alcohol because both alcohol and corticosteroids can cause stomach irritation. Also avoid foods high in sodium (salt). Check labels on food packages for sodium. Take with food to prevent stomach upset.
Ibuprofen and Other Anti-Inflammatory Agents-Ibuprofen relieves pain and reduces inflammation and fever. Some commonly used anti-inflammatory agents:
- ibuprofen/Advil, Haltran, Medipren, Motrin, Nuprin
- naxproxen/Naprosyn
INTERACTION-These drugs should be taken with food or milk because they can irritate the stomach. Avoid taking the medication with those foods or alcoholic beverages which tend to bother your stomach.
Indomethacin-This medication is used to treat the painful symptoms of certain types of arthritis and gout by reducing inflammation, swelling, stiffness, joint pain and fever. A commonly used brand name:
INTERACTION-This drug should be taken with food because it can irritate the stomach. Avoid taking the medication with the kinds of foods or alcoholic beverages which tend to irritate your stomach.
Piroxicam-This medication is used to treat pain, inflammation, redness, swelling and stiffness caused by certain types of arthritis. A commonly used brand name:
INTERACTION-This medication should be taken with a light snack because it can cause stomach irritation. Avoid alcohol because it can add to the possibility of stomach upset.
HEART AND CIRCULATORY DISEASES
Diuretics-Diuretics increase the elimination of water, sodium and chloride from the body. Some commonly used diuretics:
- furosemide/Lasix
- triamterene/Dyrenium
- hydrochlorothiazide (HCTZ)/Esidrix, Hydrodiuril
INTERACTION-Diuretics vary in their interactions with nutrients. Loss of potassium, calcium, and magnesium occurs with some diuretics. Your doctor may prescribe a potassium supplement. With some diuretics, potassium loss is less significant. Consult with your doctor or pharmacist.
Vasodilators-Vasodilators are used to relax veins and/or arteries to reduce work of the heart. Some commonly used vasodilators:
- nitroglycerine/Nitrogard, Nitrostat
INTERACTION-Use of sodium (salt) should be restricted for medication to be effective. Check labels on food packages for sodium.
Anti-Hypertensives-Anti-hypertensives relax blood vessels, increase the supply of blood and oxygen to the heart and lessen its work load. They also regulate heart beat. Some commonly used anti-hypertensives:
- atenolol/Tenormin
- captopril/Capoten
- hydralazine/Apresoline
- methyldopa/Aldomet
- metoprolol/Lopressor
INTERACTION-Use of sodium (salt) should be restricted for medication to be effective. Check labels on food packages for sodium.
Anticoagulants-Anticoagulants are used to reduce clotting of the blood. A commonly used anticoagulant:
- warfarin/Coumadin, Panwarfin
INTERACTION-Moderation in consumption of foods high in vitamin K is recommended because vitamin K produces blood-clotting substances. Such foods include spinach, cauliflower, brussel sprouts, potatoes, vegetable oil and egg yolk.
INFECTIONS
Erythromycin-Erythromycin is an antibiotic used to treat a wide variety of infections, including those of the throat, ears and skin. Some commonly used erythromycin products:
- erythromycin/E-Mycin
- erythromycin estolate/Ilosone
- erythromycin ethylsuccinate?E.E. S., E-Mycin E
INTERACTION-Erythromycins vary in their reactions with food; consult your doctor or pharmacist for instructions.
Methenamine-Methenamine is used to treat urinary tract infections. Some commonly used brand names;
INTERACTION-Cranberries, plums, prunes and their juices help the action of this drug. Avoid citrus fruits and citrus juices. Eat foods with protein, but avoid dairy products.
Metronidazole-This agent is an anti-infective which is used to treat intestinal and genital infections due to bacteria and parasites. Commonly used brand name:
INTERACTION-Do not take alcohol while using this drug, because it may cause stomach pain, nausea, vomiting, headache, flushing or redness of the face.
Penicillins-Penicillins are antibiotics used for treatment of a wide variety of infections. Some commonly used penicillins:
- amoxicillin, ampicillin, bacampicillin,
- penicillin G and penicillin V
INTERACTION-Amoxicillin and bacampicillin may be taken with food; however, absorption of other types of penicillins is reduced when taken with food.
Sulfa Drugs-Sulfa drugs are anti-infectives which are used to treat stomach and urinary infections. Some commonly used sulfa drugs:
- co-trimoxazole/Bactrim, Septa
- sulfisoxazole/Gantrisin
INTERACTION-Avoid alcohol, as the combination may cause nausea.
Tetracyclines-Tetracyclines are antibiotics that are used to treat a wide variety of infections. Some commonly used brand names:
- tetracycline hydrochloride/Achromycin,
- Sumycin, Panmycin
INTERACTION-These drugs should not be taken within two hours of eating dairy products such as milk, yogurt or cheese, or taking calcium or iron supplements.
PAIN
Aspirin-(See aspirin under Arthritis and Gout)
Codeine-Codeine is a narcotic that is contained in many cough and pain relief medicines. Codeine suppresses coughs and relieves pain, and is often combined with aspirin or acetaminophen in medications. Some commonly used brand names:
- Aspirin with Codeine, Tylenol with Codeine.
INTERACTION-Do not drink alcohol with this medication because it could increase sedative effect of medication. Take with meals, small snacks or milk because this medication may cause stomach upset.
Other Narcotic Analgesics-Narcotics are used for the relief of pain.
- Some commonly used narcotic analgesics;
- meperidine, morphine, oxycodone, pentazocine,
- propoxyphene
INTERACTION-Do not drink alcohol because it increases sedative effect of the medications. Take these medications with food, because they can upset the stomach.
Ibuprofen and Other Anti-Inflammatory Agents-(See Ibuprofen under Arthritis and Gout)
PSYCHIATRIC OR EMOTIONAL PROBLEMS
Most medications for psychiatric or emotional disturbances interact with alcohol in a dangerous manner.
Lithium Carbonate-Lithium regulates changes in hormone levels in the brain, balancing excitement and depression.
INTERACTION-Follow the dietary and fluid intake instructions of your physician to avoid very serious toxic reactions.
MAO Inhibitors-MAO Inhibitors are used primarily to treat depression. Some commonly used MAO Inhibitors:
- isocarboxazid/Marplan
- phenelzine/Nardil
- tranylcypromine/Parnate
INTERACTION-A very dangerous, potentially fatal interaction can occur with foods containing tyramine, a chemical in alcoholic beverages, particularly wine, and in many foods such as hard cheeses, chocolate, beef or chicken livers. Be sure to follow physician's instructions.
SLEEP DISTURBANCES
Do not use alcohol with any sleep medications.
STOMACH AND INTESTINAL PROBLEMS
Cimetidine, Famotidine, Ranitidine-These medications are prescribe to treat ulcers. They work by reducing the amount of acid in the stomach. Some commonly used brand names:
- cimetidine/Tagamet
- famotidine/Pepcid
- ranitidine/Zantac
INTERACTION-Follow the diet your doctor orders.
Laxatives-Some laxatives stimulate the action of muscles lining the large intestine. Other types of laxatives soften the stool, or add bulk or fluid to help food pass through the system.
INTERACTION-Most laxatives are available without prescriptions. Excessive use of laxatives can cause loss of essential vitamins and minerals and may require replenishment of potassium, sodium and other nutrients through diet. Mineral oil can cause poor absorption of some vitamins. Discuss the use of laxatives with your doctor or pharmacist.
Other National Consumers League (NCL) publications on drug safety include:
- When Medications Don't Mix: Preventing Drug Interactions
- Guide to Warning Labels on Nonprescription Medications
Single copies are free from NCL members, $1 for non-members. Spanish editions and bulk rates are available. NCL is a nonprofit membership organizations working to promote fairness at the marketplace and workplace. $20 annual membership includes a subscription to our consumer bulletin and discounts on publications.
Write:
NCL
National Consumers League
815 15th Street, N.W. Suite 928-N
Washington, D.C. 20005
NCL would like to thank the following:
APhA
American Pharmaceutical Association
2215 Constitution Avenue, N.W.
Washington, D.C. 20037
FDA
Food and Drug Administration
5600 Fishers Lane
Rockville, MD 20857
FMI
Food Marketing Institute
1750 K Street, N.W., Suite 700
Washington, D.C. 20006
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