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Drug Interaction

MAOIs can cause hypertensive crisis when consumed with foods containing tyramine due to drug-food interactions. Enzyme-inducing drugs like rifampicin may cause vitamin deficiencies by inducing metabolism of vitamins. Orlistat and bile acid sequestrants can decrease absorption of fat-soluble vitamins. Some foods contain substances that can act on the same receptors as drugs, producing agonistic or antagonistic effects. A high protein diet can decrease absorption of l-dopa into the central nervous system through competition at the blood-brain barrier. Grapefruit juice interacts with many drugs by inhibiting cytochrome P450 enzymes in the gut wall.

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103 views1 page

Drug Interaction

MAOIs can cause hypertensive crisis when consumed with foods containing tyramine due to drug-food interactions. Enzyme-inducing drugs like rifampicin may cause vitamin deficiencies by inducing metabolism of vitamins. Orlistat and bile acid sequestrants can decrease absorption of fat-soluble vitamins. Some foods contain substances that can act on the same receptors as drugs, producing agonistic or antagonistic effects. A high protein diet can decrease absorption of l-dopa into the central nervous system through competition at the blood-brain barrier. Grapefruit juice interacts with many drugs by inhibiting cytochrome P450 enzymes in the gut wall.

Uploaded by

Chrissie
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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drug interactions drug-food

Effects of drugs on food


MAOIs cause the cheese reaction withtyramine-containing foods causing a hypertensivecrisis
Enzyme inducers (rifampicin, anticonvulsants) may induce the metabolism of vitamin D and folate
causing respective deficiencies.
Orlistat and bile-acid sequestrants maydecrease the absorption of fat-soluble vitamins(A, D, E, K).
Stimulant laxatives (senna, biscodyl) anddiuretics may cause electrolyte losses
altered drug effects
liquorice vitamin K ethanol
Some foods contain substances that act on the same receptors or sites of action as drugs. Agonistic or
antagonistic effects may be observed.
clearance
high protein diet decreases the uptake of l-dopa into the CNS by competition between amino acids
and l-dopa at the bloodbrain barrier.
distribution
high protein diet decreases the uptake of l-dopa into the CNS by competition between amino acids
and l-dopa at the bloodbrain barrier.
grapefruit juice
amlodipine lovastatin atorvastatin midazolam buspirone nifedipine carbamazepine
nimodipine cisapride saquinavir cyclosporin simvastatin diltiazem tacrolimus
ethinyloestradiol triazolam felodipine verapamil
first-pass metabolism
In general, food increases liver blood flow from the gut causing increased extent of availability of drugs
subject to high first-pass metabolism (see
absorption
Iron, calcium and other divalent or trivalent ions (e.g. dairy products or in supplements) may chelate
some drugs decreasing extent of absorption, e.g. quinolones and tetracyclines are chelated by
antacids, and by calcium in milk.
Stimulation ofgastric enzymes and acid may degrade somedrugs, e.g. flucloxacillin.
Food may decrease the extent of absorption, particularly of polar, hydrophilic, lipid insoluble drugs,
e.g. atenolol
drug-drug
drugs with important interactions
antiarrhythmics cause enzyme inhibition cyclosporin anticonvulsants cause enzyme induction
digoxin anticoagulants multiple mechanisms hypoglycaemic agents antidepressants cause
enzyme inhibition lithium protease inhibitors cause enzyme inhibition theophylline
Pharmacodynamic
examples
MOA inhibitors enhances ephedrine effects
b-blockers and b2-agonists
Drug effect is altered through receptor, cellular or other physiological mechanisms. Enhancement or
antagonism may occur. e.g. !-agonist/!-blocker-mutual competition at receptor site.
Pharmaceutic
Physicochemical interactions may occur prior to systematic availability e.g. inactivation of phenytoin
within IV giving sets if pH is <7.0.
Pharmacokinetic
Altered elimination
Renal excretion
reduced prostaglandin synthesis in kidney through NSAIDs, decreasing renal blood flow and less
antihypertensive effect of diuretics
Competition for ionic cotransporte.g. Li+/Na+ " Li+ accumulation withdiuretics.
Competition for active secretion in proximaltubulee.g. probenecid/penicillin "$[penicillin]
Altered pH of urinee.g. HCO!aspirin excretion
Enzyme inhibition
in the presence of amiodarone, the plasma concentration of metoprolol is higher than would normally
be expected
Enzyme induction
Interactions may occur at metabolic or renal sites of elimination. Metabolic interactions include enzyme
induction or inhibition. These happen especially with drugs metabolized by
cytochrome-P450-mediated metabolism
Altered availability
carbidopa is a drug used in conjunction with levodopa (L-dopa) in the treatment of Parkinsons
disease. L-Dopa, which is converted to dopamine in the body, can cross the bloodbrain barrier.
Carbidopa prevents the conversion of L-dopa to dopamine; however, it cannot cross the bloodbrain
barrier and so acts to reduce the peripheral side-effects while still allowing the desired effects of the
drug.
Altered bacterial florae.g. antibiotics/sulphasalazine " # cleavageof sulphasalazine in large intestine.
Altered first-pass metabolisme.g. oestrogens/ascorbic acid " $[oestrogen
Altered motilitye.g. metoclopramide/digoxin " #[digoxin]
Chelation within the gute.g. tetracyclines/Ca2+"#[tetracycline

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