How to use the Guide to Food & Drug Interactions It is important to read the first page of this guide because the information is very useful. This guide contains most of thesignificant food-drug interactions, but other food-drug interactions may exist. If you have any questions, please contact oneof the telephone numbers listed on the back of this guide or ask your physician.
A food-drug interaction happens when the food you eat affects the medicine you are taking, so the medication cannot workthe way it should. Food-drug interactions can happen with both prescription and nonprescription (over-the-counter)medicines, including antacids, vitamin pills and herbal products.
Are all medications effected by food? Not all medicines are affected by food, but many medicines can be affected by what you eat and when you eat it. If you havefood in your stomach at the same time you take medication, it may delay or decrease the way a medication should act. Onthe other hand, some medicines are much easier to tolerate when taken with a meal or snack. You should always ask yournurse, pharmacist or physician for the best way to take your medications.
Facts to remember about food-drug interactions Read all directions and warnings printed on the “Patient Medication Information Sheet”. This information is printedfrom the manufacturer of the medication, and is located within the box that the prescription came in. Evennonprescription medicines can cause problems. Ask questions if you do not understand the directions.
Do not stir medicine into your food or take capsules apart unless instructed to do so. This may change the way amedicine works.
Do not take vitamin pills at the same time you take other medicines.
Do not mix medicines into hot drinks. Heat from the drink may destroy medication effectiveness.
Analgesic AgentsASPIRIN AND NONSTEROIDAL ANTI-INFLAMMATORY AGENTS (NSAIDS) (Advil, Motrin, Nuprin & other various brands) — 1, 5 3. Increase foods high in Vitamin C & folate.
z Naproxen (Aleve, Anaprox, Naprosyn) — 1, 5 4. Avoid and/or limit supplements — ginger, garlic or ginkgo.
5. Avoid alcohol.
3. Increase foods high in Vitamin C & folate.
4. Avoid and/or limit supplements — ginger, garlic or ginkgo.
z Lortab, Percocet, Vicodin ES. Lorcet — 1, 5z Percodan — 1, 2, 4, 5 z Cephalosporins (Ceclor, Ceftin, Cefzil, Keflex, Vantin) — 1 z Erthromycins (E-mycin, Erytab, EES, EryC, Biaxin, 2. Take on an empty stomach, 1 hour before or 2 hours after z Penicillins (PenG, Pentids, PenVK, Ampicillin, Dycill, z Quinolones (Avelox, Cipro, Floxin, Levaquin, Noroxin) 5. Take antacids, magnesium, calcium, iron, zinc, supplements or multivitamins/minerals separately z Tetracyclines (Doxycycline, Sumycin, Vibramycin) — 1, 3, 5 z Nitrofurantoin (Macrobid, Macrodantin) — 1, 5 z Trimethoprim with sulfamethoxazole (Bactrim/Barctrim DS, 8. Caution with grapefruit/grapefruit juice.
9. Avoid coumadin, contact physician for advice.
9. Avoid foods high in tyramine (See Dietary Guidelines).
1. Consistent Vitamin K (See Dietary Guidelines) z Warfarin (Coumadin) — 1, 2, 3, 4, 5, 8, 9 2. Caution with Vitamin C supplements — may decrease drug 3. Avoid/limit supplements such as garlic, ginger, ginseng, ginkgo, horse chestnut or coenzyme Q 10.
4. Avoid avocados.
5. Caution with alcohol.
6. Take with food.
7. Take magnesium supplements or antacids separately by 8. Do not take with septra/bactrim.
9. Check with physician before using over-the-counter (OTC) medications that might contain aspirin or nonsteroidalagents.
Cardiovascular AgentsACE INHIBITORS z Altace, Benzapril (Lotensin) — 1, 4, 5, 6, 7, 8 z Enalapril (Vasotec) — 1, 4, 5, 6, 7, 8 2. Take on an empty stomach, 1 hour before meals.
z Lisinopril (Prinivil) — 1, 4, 5, 6, 7, 8 3. Caution with/avoid grapefruit or grapefruit juice 2 z Fosinopril (Monopril) — 1, 4, 5, 6, 7, 8, 9, 10 5. Avoid salt substitutes. Caution with potassium z Nefedipine (Adalat, Procardia), Cardene — 2, 3, 7 z Verapamil (Calan, Isoptin) — 1, 3, 4, 7, 13 z Ditiazem (Cardizem, Dilacor, Tiazac) — 2, 3, 4, 7 9. Take magnesium supplements separately by 2 hours.
10. Take calcium supplements separately by 2 hours.
11. Caution with calcium and/or vitamin D supplements.
12. Watch fat intake.
14. Take separately from high fiber/pectin foods.
z Digoxin (Lanoxin, Digitek) — 9, 14, 15, 16, 17 15. Maintain high potassium, low sodium diet along with z Metroprolol (Lopressor, Toprol) — 1, 7 16. Caution with the following herbal products: aloe, z Nitrates (Imdur, ISMO, Isordil, Nitrocap, Sorbitrate) — 7 z Quinidine (Cardioquin, Duraquin, Quinaglute, Quinidex, z Furosemide (Lasix), Torsemide (Demadex) — 1, 2, 3, 4, 5 3. Watch sodium intake.
4. May need to increase potassium and magnesium z Spironolactone (Aldactone) — 1, 2, 3, 5, 6 5. Avoid natural licorice.
6. Avoid excessive potassium intake, potassium 7. Caution with calcium and/or Vitamin D supplements.
2. Take 30 minutes before meals or at bedtime as directed.
4. Take iron supplements at least one hour before drug.
5. Take magnesium supplements or antacids separately by 7. Consume a high fiber diet with 6-8 cups of water a day.
z Glipizide (Glucotrol, Glucotrol XL) — 1, 2, 8 3. Take with meals or just before meals as ordered by your z Glyburide (DiaBeta, Micronase) — 1, 3, 8 z Micronized, Glyburide (Glynase) — 1, 3, 8 4. Take 15-30 minutes before meals (do not take z Metformin (Glucophage, Glucophage XR) — 1, 3, 6, 8 5. Take with the first bite of food at each main meal.
6. May decrease absorption of Vitamin B12.
z Acarbose (Precose) — 5, 8z Miglitol (Glyset) — 5, 8 z Glyburide + metformin (Glucovance) — 1, 3, 6, 8z Glipizide + metformin (Metaglip) — 1, 2, 6, 8 z Avandia + metformin (Avandamet) — 1, 3, 6, 8z Avandia + Amaryl (Avandaryl) — 1, 3, 7, 8z Actos + Metformin (Actoplus Met) — 1, 3, 6, 7, 8 1. Avoid foods high in tyramine and other pressor amines z Tranylcypromine sulfate (Parnate) — 1, 2, 3, 4, 5 2. Avoid tryptophan supplements.
3. Avoid St. John’s wort and ginseng.
4. Limit caffeine.
5. Avoid alcohol.
1. Avoid foods high in tyramine and other pressor amines z Iron (Ferrous sulfate, Fergon, Feosol, Niferex, other brands) 1. Take with 8 ounces water or juice on empty stomach.
2. May take with food but will decrease absorption by 50%.
z Potassium Chloride (K-Dur, Micro-K, Kaon, K-lyte) — 8, 9 3. Take 1 hour before or 2 hours after eating bran, high phytate foods (See Dietary Guidelines), fiber, supplements,tea, coffee, red grape juice/wine, soy, dairy products or egg.
4. Vitamin C will increase absorption.
5. Meat increases absorption.
6. Take carbonate antacids, calcium, phosphorus, zinc or copper supplements separately by 2 hours.
7. Avoid alcohol.
8. Avoid salt substitutes.
9. Take with food.
z Albuterol (Proventil, Ventolin) — 1, 2 z Theophylline (TheoDur, Slo-Bid, other brands) — 1, 2, 3, 4 2. Limit caffeine.
3. Avoid alcohol.
4. Consistent intake of protein/carbohydrate for consistent drug levels. Avoid drastic changes in caffeine intake.
3. Caution with herbal products.
4. Avoid alcohol.
5. Caution with grapefruit juice.
z Amitriptyline (Elavil) — 1, 2, 3, 4, 6 z Fluoxetine (Prozac) — 1 (in a.m.), 4, 5, 6 2. Increase fiber foods may decrease drug affect.
4. Avoid St. John’s wort.
5. Avoid tryptophan supplement.
6. Avoid alcohol.
7. Take consistently with or without food.
1. Follow low fat, low cholesterol diet.
2. Avoid grapefruit/grapefruit juice.
3. Avoid St. John’s wort supplements.
6. Take 1/2 hour before breakfast and supper or as z Alendronate D (Fosamax D) — 1, 2, 4, 16 1. Take 1/2 hour before meals/food with 6 to 8 ounces of water (best if taken two hours before food).
2. Do not lie down for 30 minutes after medication is z Ibandronate Sodium (Boniva) — 1, 2, 3, 4 3. Consume adequate calcium and Vitamin D.
4. Limit alcohol.
5. May take with food.
z Barbiturates (Phenobarbital) — 3, 6, 7 8. May take with low protein foods or juice, not with high z Dexamethasone (Decadron) — 9, 10, 11, 12 11. May need foods high in potassium, vitamin A, C, D, 12. Take with food.
13. Consume a consistent amount of sodium.
14. Avoid iodine supplements.
15. Consume adequate fluid (2-3 liters/day).
16. Consume adequate calcium.
FOODS CONTAINING HIGH AMOUNTS OF VITAMIN K FOODS CONTAINING HIGH AMOUNTS OF TYRAMINEFoods that should be avoided z Aged cheesez Any outdated or nonpasteurized dairy product z Aged, Smoked or Pickled meats, fish, poultry, sausages (including lunch meats and hot dogs)z Leftover foods containing meat, fish or poultry z Any overripe, spoiled or fermented fruit or vegetablesz Fava or Broad beansz Avocadosz Sauerkraut z Yeast supplements, meat extracts, soy saucez Tap Beer (alcohol and wines may provoke an adverse reaction)z Herbal Teas (may interfere with medications or contain tyramine) FOODS CONTAINING HIGH AMOUNTS OF POTASSIUM For assistance or additional information on medications: 1. Mercy Hospital Inpatient Pharmacy . 810/985-14802. Mercy Hospital Outpatient Pharmacy . 810/966-31403. Mercy Hospital Outpatient Pharmacy (Mercy Health Center) . 810/966-7484 To find out more about Mercy Hospital, visit us online at


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