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FOOD and DRUG INTERACTION

DRUG INTERACTIONS

The medications you are taking may have some side effects. In order to minimize them:

1) Follow the instructions from your physician and take your medication as prescribed (e.g. once daily, twice daily, every 12 hours).

2) Follow your pharmacist's instructions and take the medication under the conditions specified (e.g. with meals or between meals, with water, juice, or milk).

The following table contains information on overcoming some of the possible side effects. This is a partial list of medications known to affect your nutritional status if you are on the medication for a long time.

DRUG CLASSES	INTERACTION	SUGGESTIONS
ANTI-INFECTIVES
Erythromycin stearate, Penicillin, Ampicillin, Amoxocillin, Augmentin, Dicloxacillin (Dynapen), Rifampin (Rifadin)	All food and especially acidic fruit or fruit reduce effectiveness	Take 1 hour before or 2 hours after meals. Take with water. Avoid carbonated drinks.
Isoniazid (INH, Nydrazid)	Effectiveness is decreased by alcohol; with certain foods, can cause increased blood pressure.	Avoid alcohol and avoid aged cheeses, beer, ripe avocados, vermouth, liver, sausages, mushrooms, smoked or pickled fish or meat, soy sauce, sour cream, yogurt and bananas.
Fluoroquinolones (Cipro, Floxin)	Exaggerate the effects of caffeine.	Avoid coffee and products containing caffeine.
Metronidazole (Flagyl)	Causes stomach upset; with alcohol, causes nausea and vomiting.	Take with food. Avoid alcohol.
Tetracyclines (Achromycin but not Minocin or Vibramycin)	Effectiveness is decreased by all food, especially dairy products or supplements containing iron.	Take with water, never with milk or iron supplement. Take 1 hour before or 2 hours after eating.

ANTICOAGULANTS
Warfarin (Coumadin)	Effectiveness is decreased by foods containing a lot of Vitamin K	Eat moderate portions of citrus, fish and fish oils, potato chips, leafy green vegetables, egg yolks and liver.

ANTIDEPRESSANTS
MAO Inhibitors (Marplan, Nardil, Parnate)	With certain foods, can cause high blood pressure and stroke.	Avoid alcohol. Take drug at least 30 minutes before meal. Follow prescribed diet

ANTIDIABETICS
(Diabinese, Glucotrol, Micronase, Orinase, Tolinase) and all Insulins	Effectiveness is reduced by alcohol and food.	Do not use salt substitutes. Eat moderate amounts of foods high in potassium; citrus, juices, apricots, bananas, leafy vegetables and tomatoes

CARDIOVASCULARS ACE Inhibitors and Potassium Sparing Diuretics (Capoten, Monopril, Prinivil, Vasotec, Zestril and Aldactone, Dyazide and Maxzide).	May cause elevated serum potassium	Take with food.
Beta Blockers and others (Betapace, Inderal, Lopressor, Normodyne, Tenormin and Apresoline, Catapres, Serpasil and Wytensin).	Food increases their effectiveness	Take with food.
Quinidine	May cause stomach irritation.	Take with food; avoid excessive intake of citrus juice.
Diuretics (Bumex, Diuril, Esidrix, Lasix).	May cause stomach irritation; may deplete serum potassium	Take with food. Eat foods high in potassium: citrus, citrus juices, apricots, bananas, leafy vegetables and tomatoes.
MISCELLANEOUS
Cholestyramine (Questran).	Reduces absorption of fats, vitamins and minerals	Take 2 hours before or after meals with juice, milk or pulpy fruit. Follow high fiber, low cholesterol diet
Lithium (Lithane, Lithobid)	May become toxic if salt and water intake are inadequate	Do not restrict salt and water intake; do not follow a low sodium diet
Cyclosporine (Sandimmune, Neoral)	Grapefruit juice increases effectiveness	Avoid taking Grapefruit juice
Tacrolimus (Prograf, FK-506)	Grapefruit juice increases effectiveness	Avoid taking Grapefruit juice
Erythromycin	increases effectiveness of Cyclosporine (Sandimmune, Neoral) and Tacrolimus (Prograf, FK-506)	Do not take Erythromycin, use another antibiotic.

REMINDER: Antacids such as Amphojel, Basalgel, Gelusil, Maalox, Mylanta, Riopan, MOM, Tums, etc. cause reduced effectiveness of most drugs. If you must take antacids, take them at least 1 hour before or 2 hours after taking medication or immediately after a meal.

The following is a list of some of the most common gastrointestinal side effects associated with medication and suggestions on how to overcome these side effects. Following these suggestions will help your medications work properly and maintain your nutritional status throughout the course of your medical treatment.

Most of your medications may cause some form of gastrointestinal discomfort. If you have these symptoms, we suggest the following actions to minimize them and be sure to tell your doctor and/or transplant coordinator:

SYMPTOMS

LOSS OF APPETITE

• serve favorite food/snacks

• try to eat your meal when you have the best appetite provide attractive meals

• provide attractive meals

• add variety in color, texture or temperature to diet to boost appetite

• serve small, frequent meals or snacks in a pleasant environment.

WEIGHT GAIN

• use low calorie foods, beverages and snacks

• control access to food, beverages and snacks

• avoid high calorie food whenever possible, especially concentrated sweets and high fat food/snacks.

ALTERED TASTE

• take medication with adequate liquid

• use sugarless gum to take away the taste or to freshen taste

• rinse mouth with lemon juice or water

• mask taste of drug with food such as juice or applesauce if possible.

DRY MOUTH

• moisten food with adequate liquid

• use less salt, less dry food in diet

• include moist, soft texture food

• add moisture to food by using sauces, gravies

• avoid spicy, high acidic food

• use gum or suck on ice chips

• maintain adequate fluid intake.

NAUSEA

• eat small frequent meals

• serve easily digestible food

• limit fluid with meals

• use dry food (toast, cracker or dry meal) to curb nausea

• serve cold, clear beverages or juice

• avoid fatty, spicy foods

• reschedule meal time if nausea occurs at the same time each day.

EPIGASTRIC DISTRESS (HEARTBURN, BELCHING)

• small, frequent meals, and avoid overeating

• avoid blenderized/pureed food (it stimulates acid secretion)

• control use of alcohol, caffeine, pepper, chocolate and chili

• reduce highly acidic foods and juices

• avoid spicy, greasy, fried foods

• avoid eating before bedtime

• control milk and cream usage.

IMMUNOSUPPRESSANTS SIDE EFFECTS AND NUTRIUTIONAL CONSIDERATIONS

Common Side Effects	Nutritional Considerations
Prednisone
Altered carbohydrate metabolism	Decrease intake of concentrated sweets or use diabetic diet
Altered lipid metabolism	Decrease intake of saturated fat or use diet appropriate for specific type of hyperlipiderma
Sodium retention (sometimes leading to edema and hypertension)	Moderate-to-low sodium diet
Pancreatitis	Moderate-to-low fat intake
Peptic ulcer	Avoid caffeine, alcohol. pepper, chili powder. and any other foods not tolerated; small frequent feedings
Increased appetite (causing excessive weight gain--fat deposition)	Calorie-modified diet and exercise
Ulcerative esophagitis	Modified food consistency
Abdominal distention	Small, frequent feedings
Negative nitrogen balance (secondary to protein catabolism)	High-protein diet, adequate calories
Enhanced potassium and/or phosphorus excretion	High-potassium or high-phosphorus diet with supplements if necessary
Imuran
Infection (fungal, protozoal, viral, and uncommon bacteria)	Monitor intake and increase protein and calories if indicated
Steatorrhea	Low-fat diet
Severe bone marrow depression	lsolatlon techniques when Leukocyte count is extremely low
Cyclosporine
Hypertension	Decrease sodium intake
Hyperkalemia	Decrease potassium intake
Gum hyperplasia	Good dental hygiene

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