FOOD-DRUG INTERACTIONS

Ada sesetengah ubatan yang diambil boleh berinteraksi dengan makanan yang diambil..jadual dibawah menunjukkan jenis ubatan dan food interaction.

TABLE 1: FOOD-DRUG INTERACTIONS

Disease	Types of Drugs	Food Interactions	Examples of Drug (Brand Name)
Allergies	Antihistamines	Take without regard of food. Bioavailabilty decreases with apple, orange, grapefruit juice.	Diphenhydramine (BENADRYL) Loratadine (CLARITYNE) Cetrizine (ZYRTEC)
Arthritis/Pain	Analgesics	Take on empty stomach for rapid relief	Paracetamol (PANADOL)
Arthritis/Pain	Non-Steroidal Anti Inflammatory Drugs (NSAIDs)	Take with food or milk to decrease stomach upset	Aspirin Ibuprofen (Brufen)
Arthritis/Pain	Corticosteroids	Take with food or milk to decrease stomach upset	Prednisolone
Asthma	Bronchodilators	High fat meals may increase the amount of theophylline in the body, while high carbohydrate meals decrease it. Avoid eating / drinking large amounts of caffeine - containing food, drinks.	Theophylline Salbutamol
Cardio-Vascular Disorders	Diuretics	Take on empty stomach/with milk to decrease stomach upset.	Frusemide Bumetanide Hydrochlorothiazide
Cardio-Vascular Disorders	Beta Blockers	Take with food to increase bioavailability.	Atenolol Metoprolol Propranolol
Cardio-Vascular Disorders	Nitrates	Take on empty stomach.	IsosorbideDinitrate (ISORDIL) Nitroglycerin
Cardio-Vascular Disorders	Angiotensin Coverting Enzymes	Take on empty stomach. Ensure adequate fluid intake.	Captopril Perindopril Lisinopril
Cardio-Vascular Disorders	Inhibitors (ACEi)	Avoid salt substitutes.	Enalapril
Cardio-Vascular Disorders	MNG-CoA Reductase inhibitors (Statins)	Avoid grapefruit / related citrus. Avoid high fibre meals. Best taken before bedtime.	Atorvastatin (LIPITOR) Simvastatin (ZOCOR)
Cardio-Vascular Disorders	Anticoagulants	Limit food high in Vitamin K such as broccoli, leafygreens, cauliflower as it produces blood - clotting substances that may reduce effectiveness of the drug. Vitamin E (400IU or more) may prolong clotting time leading to bleeding.	Warfarin
Infections	Penicillin/Quinolones /Cephalosporins	Take on empty stomach 1 hour before or 2 hours after unless it upsets stomach, take with food but not with dairy or calcium - fortified food. Quinolone: Avoid caffeine as it increase excitability & nervousness	Penicillin:Penicillin V, Amoxicillin Quinolones:Ciprofloxacin, Ofloxacin Cephalo: Cephalexin, Cefuroxime
Infections	Macrolides	May take with food if GI distress. Avoid citrus food, carbonated drinks and citrus juices	Azithromycin Erythromycin Clathromycin
Infections	Sulfonamides	Take with food and at least with 8 ounces of water.	Sulfamethoxazole/ Trimethoprim (BACTRIM)
Infections	Tetracycline	Take with food and at least with 8 ounces of water. Avoid taking it with dairy products, antacids, vitamin supplements containing iron as it can interfere with drug’s effect.	Tetracycline Doxycycline
Infections	Nitromidazole	May take with food to decrease GI distress.	Metronidazole (FLAGYL)
Infections	Antifungals	Take with food to increase absorption. Do not take itraconazole with citrus.	Fluconazole Ketoconazole Itraconazole
Mood Disorders	Monoamine Oxidase (MAO) Inhibitors	Do not take foods or alcoholic beverages containing tyramine (eg.cheese, tapai, soy sauce, tofu, bananas, raisins, caffeine) while taking this drug and for 2 weeks after discontinuation.	Selegiline
Mood Disorders	Anti-Anxiety	May take with food to decrease GI distress. Caffeine may cause excitability and lessen the anti-anxiety effect of the drug.	Alprazolam Diazepam
Mood Disorders	Antidepressant	To be taken with or without food.	Sertraline (ZOLOFT) Fluoxetine (PROZAC)
Stomach Conditions	Histamine Blockers	To be taken with or without food. Caffeine may irritate stomach.	Cimetidine (TAGAMET) Ranitidine (ZANTAC)

TABLE 2: HERBS/SUPPLEMENTS-DRUG INTERACTION

Herbs Supplements	Interacting Drug	Possible Effects
Ginseng to stimulate adrenal gland which increases energy and reduce blood glucose	Warfarin	May decrease drug’s effectiveness
	Corticosteroids	May potentiate drug and increase side effects
	Antihypertensive	May increase blood pressure
	MAOIs	May increase insomnia, headache, tremulousness
*Gingko Biloba* for the treatment of dementia & to improve memory	Aspirin	Bleeding
	Warfarin	Haemorrhage
	Thiazide	Hypertension
Garlic to lower blood pressure & cholesterol	Warfarin	Increased effectiveness of warfarin, leads to bleeding
Ginger for nausea & bowel spasms	Warfarin	Increased effectiveness of warfarin, leads to bleeding
*Dong Quai* for menopausal symptom control	Warfarin	May increase the effect of this drug which can lead to bleeding
St. John’s wort a natural anti –depressant for mild to moderate depression.	Amitriptyline	Worsen depression as it reduces concentration of the drug in the blood
	Digoxin	Decrease digoxin concentration leading to reduce efficacy of digoxin
	Theophylline	Worsen signs & symptoms of asthma as it reduces concentration of the drug in the blood
	Oestrogen	Causes breakthrough bleeding
Green Tea as an antioxidant	Calcium	Decreases calcium absorption
Green Tea as an antioxidant	Warfarin	Warfarin activity might be lowered due to high level of vitamin K in herb
Turmeric as an anti inflammatory, to treat digestive and liver problems, skin diseases, wounds	NSAIDs	May increase bleeding and gastrointestinal irritation
	Warfarin, Aspirin	May increase the effect of this drug which can lead to bleeding
	Ranitidine,Omeprazole	May increase production of stomach acid
*AzadirachtaIndica (Neem*) antiseptic, antiviral, antipyretic, anti-inflammatory, anti-ulcer	Insulin	May decrease glucose level further
	Immunosuppressants (eg:Cyclosporine Azathioprine)	May increase immune’s system which leads to decrease of medications efficacy.
*Ocimumtenuiflorum* *(tulasi)* for common colds, headache	Anticoagulants,antiplatelets	May slow blood clot which leads to increase bleeding and bruising
*Eurycomalongifolia (Tongkat Ali)* to stimulate male hormones, increase libido	Immunosuppressants	May further weaken immune system

Mechanism Of Food – Drug Interaction

mekanisma terbahagi kepada dua jenis iaitu Pharmacokinetic dan pharmacodynamic

Sesetengah pharmacokinetic mechanisms akan ada/wujud apabila berkurang atau meningkatnya

Penyerapan drug oleh badan
Pengagihan drug dalam badan
Metabolisma drug
Penyingkiran drug dari badan

Medication Safety Measures

( tips untuk elakkan food-drug interaction:

Sentiasa baca label preskripsi dan juga pamplet yang disertakan bersama ubatan (directions, warnings, interaction precautions)
Ikut arahan cara pengambilan ubatan yang diarahkan oleh doktor.
Ambil ubatan dengan air putih.Elakkan mengambil dengan air panas kerana kepanasan kadangkala mengurangkan keberkesanan ubatan.
Jangan campurkan dengan makanan keculi jika diarahkan.
Jangan ambil ubatan herba atau supplement dalam masa yang sama anda mengambil ubatan.
Jangan minum alkohol semasa anda mengambil ubatan.
Beritahu doktor atau farmasi ubatan yang sedang diambil atau herba yang dimakan.
Beritahu Doktor tentang perubahan dalam gaya hidup kebelakangan ini (exercise, diet, alcohol intake).
Jika ada sebarang keraguan tentang ubatan,rujuk doktor atau farmasi.