DRUG NUTRIENT INTERACTION LIST

DRUG USE INTERACTIONS

Bronchodilators They open (dilate) the airways  Take with food if stomach upset occurs
(bronchial tubes) of the lung by  High-fat meals may increase the amount of
Generic Names: relaxing bronchial muscles and theophylline in the body, while high-
Theophylline, Albuterol, allow people to breath better carbohydrate meals may decrease it.
Epinephrine  Avoid alcohol
Bronchodilators are used for  Limit caffeine intake
treating: Asthma, Chronic  Additionally, both oral bronchodilators and
Obstructive Pulmonary Disease caffeine stimulate the central nervous system
(COPD) and Allergic Reactions  Do not consume grape fruit juice when taking
theophylline, since it increases the
bioavailability and monitoring of plasma
theophylline levels in patients consuming grape
fruit juice
Anti-Hypertensive Drugs For treatment of Hypertension.  Restrict sodium
Antihypertensive therapy seeks  Propranolol serum levels may be increased if
Generic Names: to prevent the complications of taken with rich protein food
Furosemide, Bumetanide high blood pressure, such as  Smoking may decrease its plasma levels of by
Stroke and Myocardial increasing its metabolism
Infarction  Orange juice inhibits intestinal absorption of
celiprolol (beta-blocker). Hesperidin, present in
orange juice, is responsible for the decreased
absorption of celiprolol
 Grapefruit juice increases bioavailability
 A high intake of liquorice can cause
hypermineralocorticoidism with sodium
retention and potassium loss, edema, increased
blood pressure and depression of the renin-
angiotensin-aldosterone system
Antibiotics To destroy or slow down the  Avoid antibiotics with milk products which are
growth of bacteria. They are rich sources of divalent ions, such as calcium
Generic Names: used to treat Diseases Caused by and magnesium that complex with some
Ciprofloxacin, Azithromycin, Bacteria. Antibiotics cannot treat antibiotics and prevent their absorption
Tetracycline viral infections, such as cold, flu,  Avoid Grape fruit juice
and most coughs  Antibiotics can influence gut flora activities.
They can deplete nutrients- especially
micronutrients - minerals, vitamin k and B12
 Food components like fat, fiber and
carbohydrates digestion, absorption can be
affected
 Drug-meal spacing is important and fluid
allowance for antibiotics should be adequately
managed
Fluroquinolones To treat a variety of illnesses  Erythromycin interferes with absorption and
(Antibiotics) such as Respiratory and Urinary activity of calcium, folate, vitamin B₆, vitamin
Tract Infections B₁₂, can cause deficiency diseases if
administered for long. Erythromycin is best
absorbed on empty stomach
Generic Names:  Levofloxacin can cause side effects such as
Erythromycin, Levofloxacin, antibiotic-induced diarrhea. Magnesium rich
Ofloxacin, Moxifloxacin, foods, supplements, antacids, rich in magnesium
Azithromycin can reduce the intestinal absorption of
levofloxacin. Iron supplements, foods, also
reduce absorption and effectiveness of the drug
Beta-Lactams (Antibiotics) To treat a wide variety of  High fat meal can decrease absorption of
Infections penicillin up to 36%
Generic Names:  A high fiber and guar gum also reduces
Penicillin (Amoxicillin, penicillin absorption
Oxacillin, Nafcillin,  Bromelain, an enzyme found in pineapple might
Dicloxacillin) increase the effect of Penicillin
Cephalosporins (Cefaclor,  High and long term dose of penicillin might
Cefdinir, Cephalexin, disturb digestion and elimination
Cefepime, Ceftriaxone)  Supplementation of vitamin K, B-complex
vitamin, restoration of gut flora, consider serving
curd, buttermilk, lassi and other fermented foods
with each dose of the antibiotic
 Antibiotics should be taken 1-2 hrs before or
after meals
 Cephalosporins contribute to the malabsorption
of vitamin B and K with long term use as these
antibiotics kill bacteria, including beneficial
flora in the gut. Supplementation with
acidophilus or bifidus may aid in restoring the
flora balance
 Avoid alcohol, antacids, feverfew, ginkgo, garlic
and other Sulphur containing foods with
cephalosporins
Aminoglycosides For treatment of Severe  Amikacin decreases renal clearance levels of
(Antibiotics) Infections of Abdomen and magnesium present in any supplement form (Mg
Urinary Tract, as well as sulfate, citrate and hydroxide)
Generic Names: Bacteremia and Endocarditis.  Amikacin decreases the level of cyanocobalamin
Amikacin, Neomycin, They are also used for (B12) by inhibition of gastrointestinal synthesis
Gentamicin, Streptomycin Prophylaxis especially against and absorption
Endocarditis  Amikacin also reduces calcium absorption and
reabsorption by renal tubular process
 Monitoring and supplementing of magnesium,
potassium, calcium, vitamin B₁₂, vitamin K, etc.
is advised in critically ill patients who require
long term antibiotics prescription
 Gentamicin induced nephrotoxicity,
Supplementation through serving a high calcium,
magnesium and potassium rich diets
 Streptomycin can interact with calcium,
magnesium, sodium and biotin. Increase fluid
intake
Tetracyclines (Antibiotics) To treat infections caused by  Avoid tetracyclines with laxatives, antacids
bacteria including Pneumonia  Avoid food containing magnesium, calcium,
Generic Names: and other Respiratory Tract iron, etc
Tetracycline, Infections; certain infections of  Avoid giving 1-2 hours before or after foods,
Chlortetracycline, Skin, Eye, Lymphatic, Intestinal, have with plenty of oral fluids
Oxytetracycline, Genital and Urinary Systems;  Supplementations can be done, if assessed for
Demeclocycline and certain other infections potassium, folic acid, vitamin K depletion
spread by Ticks, Lice, Mites and
Infected Animals
Analgesics and Antipyretic, Analgesics are used to relieve  Analgesics should be taken with food. A full
NSAID’s pain. They are also known as stomach lowers the risk for stomach irritation.
Pain Relievers or Painkillers  Avoid Alcohol
Generic Names: that provide relief from pain  When taking aspirin avoid or at least limit garlic,
Aspirin, Paracetamol, without putting you to sleep or ginger and gingko, increase vitamin C intake
Morphine, Oxymorphone, making you lose consciousness  Aspirin should not be taken by those with ulcers,
Buprenorphine, Ibuprofen asthma, gout or hearing problems
Antipyretic is a substance that  Whilst ibuprofen must be avoided with several
reduces Fever. Antipyretics conditions such as nasal polyps, asthma, heart
cause the hypothalamus to failure, plus liver or kidney problems
override a prostaglandin-induced  Frequent use of these drugs lowers the
increase in temperature. The absorption of folate and vitamin C. Increase fiber
body then works to lower the and water intake to avoid constipation
temperature, which results in a  Coca-Cola cause gastrointestinal issues or poor
reduction in fever performance of pain reduction due to the slow
absorption of the drug within 2-4 hours of intake
of Ibuprofen
 NSAID’s take with food, water, or milk to
decrease stomach upset. With a high dose of this
drug, one may need to increase consumption of
vitamin C, vitamin K, and folate
 Limit caffeine intake
 Limit or avoid products that affect blood
coagulation (garlic, ginger, gingko, ginseng, or
horse chestnut)
Antihistamines To relieve or prevent the  It is best to take prescription antihistamines on
symptoms of Hay Fever and an empty stomach to increase their effectiveness
Generic Names: other types of Allergy. They  They may also increase the appetite, which can
Fexofenadine, Loratadine, work by preventing the effects of lead to weight gain
Rupatadine, Cimetidine a substance called histamine,  The bioavailability reduces when taken within
Cetirizine which is produced by the body. 15 min before eating a high-fat meal vs fasting
Histamine can cause itching,  Bioavailability decreases if taken with apple,
sneezing, runny nose, and watery orange, or grapefruit juice
eyes  Avoid taking sedatives or anti-depressants
Antitubercular Drugs To treat several types of  High fat meals decrease the serum concentration
Mycobacterial Infections of cycloserine, a bacteriostatic anti-tubercular
Generic Names: including Mycobacterium Avium drug and results in incomplete eradication of
Rifampicin, Ethambutol, Complex, Leprosy and in bacteria
Ethionamide, Amikacin, combination with other  Food greatly decreases isoniazid bioavailability
Streptomycin, Capreomycin, antibacterials to treat Latent or  Increase fluid intake
Active Tuberculosis
Para-Aminosalicylic Acid  Avoid alcohol
(PAS), Linezolid  Supplement Vitamin B6
 Take 2 hours before or after aluminum
magnesium or calcium containing antacids, iron,
vitamins, sucralfate, milk containing products
and food supplements
Antidiabetics To control and manage blood  Antidiabetic drugs are usually taken immediately
glucose levels amongst people after a meal (except Gliclazide)
Generic Names: with Diabetes  Gliclazide and Glipizide should be given 30
Acarbose, Glimepiride, minutes before a meal
Glipizide, Glyburide, Insulin,  Metformin should be taken with a meal to limit
Metformin, Miglitol, gastrointestinal side effects. Metformin may
Nateglinide, Pioglitazone, cause malabsorption of vitamin B12, which may
Repaglinide, Rosiglitazone result in B12 deficiency and subsequent anemia
ACE Inhibitors Calcium Calcium channel blockers are  Calcium channel blockers should always be
Channel Blockers prescribed for High Blood taken with a meal or a glass of milk to protect
Pressure and Heart Problems the stomach
Generic Names:  Don’t take calcium channel blockers with
Amlodipine, Diltiazem, grapefruit juice or grapefruit
Felodipine, Isradipine, Some of the drugs that are likely to interact with
Nicardipine, Nifedipine, calcium channel blockers include:
Nisoldipine, Verapamil  Other high blood pressure medications,
including ACE (angiotensin-converting enzyme)
inhibitors or beta blockers
 Diuretics (water pills)
 Some eye medications
 Large amounts of vitamin D or calcium
supplements
 Drugs used to treat arrhythmia
 Digitalis, also called digitoxin (Digoxin)
 Drugs that contain cortisone, or any
corticosteroids
ACE Inhibitors with ACE inhibitors cause a decrease Avoid
Thiazides in angiotensin II causing  Salt substitutes: They have potassium, and ACE
vasodilation and therefore a inhibitors make your body retain potassium
Generic Names: reduction in Blood Pressure.  Too much potassium can interfere with this
Fosinopril, Captopril, Thiazide diuretics causes an electrical signaling in the myocardium, causing
Moexipril increase in urine production arrhythmia and heart palpitations
 (Diuresis) and results in a  Avoid eating large amounts of foods high in
decrease in blood volume and a potassium, such as bananas. Other foods high in
reduction in blood pressure potassium include avocados, beets, oranges and
orange juice, potatoes, spinach, tomatoes and
tomato sauce, as well as salt substitutes
 The absorption of ACEs inhibitors is increased
when taken on an empty stomach
 Over-the-counter nonsteroidal anti-inflammatory
drugs or NSAIDs (like aspirin, ibuprofen, and
naproxen): These may cause your body to retain
sodium and water and make ACE inhibitors not
work as well
Corticosteroids To control problems with Body’s When taking corticosteroids for more than a month,
Immune System and Swelling. you may retain water. You may also gain weight and
Generic Names: They are also involved in have an increased appetite. Long-term use may
Bethamethasone (Celestone), Balancing Body’s Water, Salt weaken your bones and also raises blood sugar
Prednisone (Prednisone and Potassium levels
Intensol), Prednisolone  Avoid salt and salty foods
(Orapred, Prelone),  Limit the amount of processed foods like frozen
Triamcinolone, dinners, packaged entrees, and canned soups
Methylprednisolon  Eat enough protein i.e. Milk, meats, eggs, peanut
butter, nuts, tofu, dried beans or peas are high in
protein.
 Increase your calcium and Vitamin D, K, A, C,
or protein intake
 Limit caffeine intake
 Take with food or milk to decrease stomach
upset
 Limit grapefruit and other citrus fruits
Monoamine To treat Depression, Emotional  A rapid, potentially fatal increase in blood
Oxidase (MAO) and Anxiety Disorders pressure can occur if foods or alcoholic
Inhibitors beverages containing tyramine are consumed
while taking MAO inhibitors
Generic Names:  Avoid foods high in tyramine and other pressor
Phenelzine/Nardil, amines during drug use and for 2 weeks after
Tranycypromine/Parnate discontinuation
 These include aged cheeses, aged meats, soy
sauce, tofu, miso, fava beans, snowpeas,
sauerkraut, avocadoes, bananas, yeast extracts,
raisins, ginseng, licorice, chocolate, and caffeine
 Avoid alcohol
Cholesterol Lowering Drugs For treatment of high levels of  Take with food
Fats (Lipids), such as  Do not take with grapefruit or other citrus fruits
Generic Names: cholesterol, in the blood  Follow a diet low in cholesterol and dietary fat
Rosuvastatin, Simvastatin, (Hyperlipidemia)  Do not take with the drug Cordarone (intended
Ezetimibe, Pravastatin, for abnormal heart rhythms)
Fluvastatin, Lovastatin  Avoid alcohol
  The absorption of Rosuvastatin, another anti-
hyper lipidemic agent, should be administered on
an empty stomach
 Simvastatin, Ezetimibe, Pravastatin and
Fluvastatin may be taken without regards to
food. However, high fiber diets may lower the
efficacy of these drugs
 Consumption of pectin or oat bran together with
Lovastatin reduces absorption of the drug
 Decrease dietary fat and cholesterol while taking
these medications.
Anti-Coagulants Commonly known as Blood  Avoid foods high in Vitamin K
Thinners, are chemical  Leafy vegetables (e.g. kale, collards, turnip
Generic Names: substances that prevent or reduce greens, swiss chard, salad greens, parsley,
Dabigatran, Heparin, Warfarin coagulation of blood, prolonging spinach) are the highest sources of vitamin K
the clotting time  Limit caffeine-rich products i.e. tea and coffee
 Green tea contains vitamin K; it can make
warfarin ineffective
 Limit alcohol
 Avoid vitamins that contain high doses of
vitamin K, A and E
 Fish oil may increase the INR level (The test
measures how much time it takes for a patient's
blood to clot)
 Avoid cranberry juice
 Avoid grape fruit juice
 Avoid garlic, ginger, ginko saw palmetto, and
horse chestnut
 Do not take with Cordarone (intended for
abnormal heart rhythms)
Beta Blockers To decrease Nerve Impulses to  Take with food to increase bioavailability
blood vessels  Take separately from orange juice, and avoid
Generic Names: natural licorice. It may be necessary to decrease
Metoprolol, Propranolol, dietary calcium and sodium, which may decrease
Nadolol absorption
 Take 2 hours before or 6 hours after calcium
supplement or antacids
 Avoid alcohol
Nitrates To relax Blood Vessels and  Take on an empty stomach with water to
lower demand for oxygen by the increase absorption, 1 hour before meals or 2-
Generic Names: heart hour after
Isosorbide Dinitrate, Sorbitate  Avoid alcohol
Nitroglycerin
Anti-Anxiety Drugs To treat Depression, Emotional  May take with food if upset stomach occurs
and Anxiety Disorders  Limit grapefruit and citrus consumption
Generic Names:  Caffeine may cause excitability, nervousness,
Lorazepan, Diazepam, and hyperactivity and lessen the anti-anxiety
Alprazolam effects of the drugs
 Use caution with sedative herbal products such
as chamomile, kava or stimulants such as
caffeine, guarana or mate
 Avoid alcohol
Stimulants To speed up the messages  Take with or without meals
between the Brain and Body.  Limit caffeine
Generic Name: They can make a person feel  Ensure adequate calcium intake
Methylphenidate more awake, alert
Depressant/ Anxiolytic Sedative-Hypnotic Drugs, they  Do not take with food or immediately after a
(Antianxiety) Drugs slow down activity of brain meal
Generic Name:
Zolpidem
Histamine Blockers To Relieve Pain, Promote  These medications can be taken with or without
Healing and Prevent Irritation food, with 8 ounces of water
Generic Names: from returning  A bland diet is recommended
Cimetidine, Famotidine,
 Take drug 2 hours before an iron or antacid
Ranitidine, Nizatadine
supplement is consumed. May decrease iron and
vitamin B12 absorption
 Caffeine products may irritate the stomach
 Avoid alcohol
Anticonvulsant/Antiepileptic To suppress the excessive rapid  Take with food or milk to decrease stomach
Therapy firing of neurons during Seizures upset
and also prevent the spread of  Avoid grapefruit or related citrus fruits, star
Generic Names: the seizure within the brain fruits, or pomegranate juice
Clonazepam,
Carbamazepine, Clobazam,  Supplement with calcium and vitamin D
Acetazolamide,  Avoid alcohol
Gabapentin
Anti-Cancer Drugs Effective in the treatment of  Take before meal
Malignant or Cancerous Tumors  Don’t take with food
Generic Names:  Avoid unpasteurized (raw) milk and milk
Cisplatin, Etoposide,
products, including raw milk yogurt, soft cheeses
Cyclophosphamide
made from unpasteurized milk
 Avoid unwashed fresh fruits and vegetables,
especially leafy vegetables that can hide dirt and
other contaminants
 Avoid some types of fish, both raw and
cooked, as they may contain high levels of
mercury
 Avoid unpasteurized fruit juice or cider
 Taking oral chemotherapy drugs with soft drinks
or fruit juices, particularly acidic grapefruit or
orange juice can alter stomach and intestinal pH