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Brochure: 1989
Developed jointly by: American Pharmaceutical Association,
Food and Drug Administration, Food Marketing Institute,
National Consumers League
 
                     Food and Drug Interactions
 
INTRODUCTION
 
Physicians and pharmacists recognize that some foods and drugs,
when taken during the same period of time, can alter the body's
ability to utilize a particular food or drug, or cause serious
side effects.  This brochure is designed to help you decide if
your diet should be changed in any way to adjust to the effects
of medicine you are using. It covers the interactions - that is,
what can occur between foods and drugs - of the more commonly
used medications, both prescription and nonprescription (or
over-the-counter).
 
This brochure should not be used in place of advice from a family
physician or family pharmacist.  Make sure your doctor knows
about every drug you are taking, including drugs you obtain
without a prescription order.  If you have any problems related
to medication, call your physician or pharmacist immediately.
One drug may interact with another, in some cases creating
serious medical problems.  This brochure does not cover the
interaction of one medicine with another.
 
Interactions will vary according to the dosage, your age, sex and
your overall health.
 
Although alcohol is actually a drug rather than a food, its
interaction with drugs is covered in this brochure because
alcohol, when consumed while taking certain medications, can be
extremely dangerous.  It is a good rule of thumb to avoid
consuming alcohol while taking any drug unless a physician or
pharmacist indicates that the combination is acceptable.
 
Cigarettes can also diminish the effectiveness of medication or
create added hazards with certain medications.
 
Caffeine, which is found in coffee, tea, soft drinks and
chocolate and some medications, can also affect the action of
some drugs.
 
Medication should never be taken during pregnancy without the
advice of your physician.
 
In this brochure, the generic (nonproprietary) name for each drug
is stated first.  Brand names are capitalized and represent only
some examples.
 
ALLERGIES, ASTHMA, COLDS* AND COUGHS
 
Antihistamines-Antihistamines are used to relieve or prevent the
symptoms of colds and hay fever and other types of allergy.  They
act to limit or block histamine which is released by the body
when we are exposed to substances that cause allergic reactions.
     Some commonly used antihistamines:
     brompheniramine/Dimetane, Bromphen
     chlorpheniramine/Chlor-Trimeton, Teldrin
     diphenhydramine/Benadryl, Benaphen
INTERACTION-Avoid taking with alcoholic beverages because
antihistamines combined with alcohol may cause drowsiness and
slowed reactions.
 
Bronchodilators-Bronchodilators are used to treat the symptoms of
bronchial asthma, chronic bronchitis and emphysema.  These
medicines relieve wheezing, shortness of breath and troubled
breathing.  They work by opening the air passages of the lungs.
     Some commonly used bronchodilators:
     aminophylline/Phyllocontin, Somophyllin
     theophylline/Slo-Phyllin, Theo-Dur
INTERACTION-Avoid eating or drinking large amounts of foods or
beverages which contain caffeine because both bronchodilators and
caffeine stimulate the central nervous system.
 
*Many over the counter cold remedies contain aspirin in
combination with other active ingredients.  See Aspirin under
Arthritis and Gout.
 
ARTHRITIS AND GOUT
 
Aspirin-Aspirin reduces pain, fever and inflammation.
     Aspirin is available in many brands.
INTERACTION-Because aspirin can cause stomach irritation, avoid
alcohol.  To avoid stomach upset, take with food.  Do not take
with fruit juice.
 
Corticosteroids-Cortisone-like drugs are used to provide relief
to inflamed areas of the body.  They lessen swelling, redness,
itching and allergic reactions.
     Some commonly used steroids:
     betamethasone, dexamethasone, hydrocortisone,
     methylprednisolone, prednisone, triamcinolone
INTERACTION-Avoid alcohol because both alcohol and
corticosteroids can cause stomach irritation.  Also avoid foods
high in sodium (salt).  Check labels on food packages for sodium.
Take with food to prevent stomach upset.
 
Ibuprofen and Other Anti-Inflammatory Agents-Ibuprofen relieves
pain and reduces inflammation and fever.
     Some commonly used anti-inflammatory agents:
     ibuprofen/Advil, Haltran, Medipren, Motrin, Nuprin
     naxproxen/Naprosyn
INTERACTION-These drugs should be taken with food or milk because
they can irritate the stomach.  Avoid taking the medication with
those foods or alcoholic beverages which tend to bother your
stomach.
 
Indomethacin-This medication is used to treat the painful
symptoms of certain types of arthritis and gout by reducing
inflammation, swelling, stiffness, joint pain and fever.
    A commonly used brand name:
    Indocin
INTERACTION-This drug should be taken with food because it can
irritate the stomach.  Avoid taking the medication with the kinds
of foods or alcoholic beverages which tend to irritate your
stomach.
 
Piroxicam-This medication is used to treat pain, inflammation,
redness, swelling and stiffness caused by certain types of
arthritis.
    A commonly used brand name:
    Feldene
INTERACTION-This medication should be taken with a light snack
because it can cause stomach irritation.  Avoid alcohol because
it can add to the possibility of stomach upset.
 
HEART AND CIRCULATORY DISEASES
 
Diuretics-Diuretics increase the elimination of water, sodium and
chloride from the body.
     Some commonly used diuretics:
     furosemide/Lasix
     triamterene/Dyrenium
     hydrochlorothiazide (HCTZ)/Esidrix, Hydrodiuril
INTERACTION-Diuretics vary in their interactions with nutrients.
Loss of potassium, calcium, and magnesium occurs with some
diuretics.  Your doctor may prescribe a potassium supplement.
With some diuretics, potassium loss is less significant.  Consult
with your doctor or pharmacist.
 
Vasodilators-Vasodilators are used to relax veins and/or arteries
to reduce work of the heart.
     Some commonly used vasodilators:
     nitroglycerine/Nitrogard, Nitrostat
INTERACTION-Use of sodium (salt) should be restricted for
medication to be effective. Check labels on food packages for
sodium.
 
Anti-Hypertensives-Anti-hypertensives relax blood vessels,
increase the supply of blood and oxygen to the heart and lessen
its work load.  They also regulate heart beat.
     Some commonly used anti-hypertensives:
     atenolol/Tenormin
     captopril/Capoten
     hydralazine/Apresoline
     methyldopa/Aldomet
     metoprolol/Lopressor
INTERACTION-Use of sodium (salt) should be restricted for
medication to be effective.  Check labels on food packages for
sodium.

Anticoagulants-Anticoagulants are used to reduce clotting of the
blood.
     A commonly used anticoagulant:
     warfarin/Coumadin, Panwarfin
INTERACTION-Moderation in consumption of foods high in vitamin K
is recommended because vitamin K produces blood-clotting
substances.  Such foods include spinach, cauliflower, brussel
sprouts, potatoes, vegetable oil and egg yolk.
 
INFECTIONS
 
Erythromycin-Erythromycin is an antibiotic used to treat a wide
variety of infections, including those of the throat, ears and
skin.
     Some commonly used erythromycin products:
     erythromycin/E-Mycin
     erythromycin estolate/Ilosone
     erythromycin ethylsuccinate?E.E. S., E-Mycin E
INTERACTION-Erythromycins vary in their reactions with food;
consult your doctor or pharmacist for instructions.
 
Methenamine-Methenamine is used to treat urinary tract
infections.
     Some commonly used brand names;
     Mandelamine, Urex
INTERACTION-Cranberries, plums, prunes and their juices help the
action of this drug. Avoid citrus fruits and citrus juices.  Eat
foods with protein, but avoid dairy products.
 
Metronidazole-This agent is an anti-infective which is used to
treat intestinal and genital infections due to bacteria and
parasites.
     Commonly used brand name: Flagyl
INTERACTION-Do not take alcohol while using this drug, because it
may cause stomach pain, nausea, vomiting, headache, flushing or
redness of the face.
 
Penicillins-Penicillins are antibiotics used for treatment of a
wide variety of infections.
     Some commonly used penicillins:
     amoxicillin, ampicillin, bacampicillin,
     penicillin G and penicillin V
INTERACTION-Amoxicillin and bacampicillin may be taken with food;
however, absorption of other types of penicillins is reduced when
taken with food.
 
Sulfa Drugs-Sulfa drugs are anti-infectives which are used to
treat stomach and urinary infections.
     Some commonly used sulfa drugs:
     co-trimoxazole/Bactrim, Septa
     sulfisoxazole/Gantrisin
INTERACTION-Avoid alcohol, as the combination may cause nausea.
 
 
Tetracyclines-Tetracyclines are antibiotics that are used to
treat a wide variety of infections.
     Some commonly used brand names:
     tetracycline hydrochloride/Achromycin,
     Sumycin, Panmycin
INTERACTION-These drugs should not be taken within two hours of
eating dairy products such as milk, yogurt or cheese, or taking
calcium or iron supplements.
 
PAIN
 
Aspirin-(See aspirin under Arthritis and Gout)
 
Codeine-Codeine is a narcotic that is contained in many cough and
pain relief medicines.  Codeine suppresses coughs and relieves
pain, and is often combined with aspirin or acetaminophen in
medications.
     Some commonly used brand names:
     Aspirin with Codeine, Tylenol with Codeine.
INTERACTION-Do not drink alcohol with this medication because it
could increase sedative effect of medication.  Take with meals,
small snacks or milk because this medication may cause stomach
upset.
 
Other Narcotic Analgesics-Narcotics are used for the relief of
pain.
     Some commonly used narcotic analgesics;
     meperidine, morphine, oxycodone, pentazocine,
     propoxyphene
INTERACTION-Do not drink alcohol because it increases sedative
effect of the medications.  Take these medications with food,
because they can upset the stomach.
 
Ibuprofen and Other Anti-Inflammatory Agents-(See Ibuprofen under
Arthritis and Gout)
 
PSYCHIATRIC OR EMOTIONAL PROBLEMS
 
Most medications for psychiatric or emotional disturbances
interact with alcohol in a dangerous manner.
 
Lithium Carbonate-Lithium regulates changes in hormone levels in
the brain, balancing excitement and depression.
INTERACTION-Follow the dietary and fluid intake instructions of
your physician to avoid very serious toxic reactions.
 
MAO Inhibitors-MAO Inhibitors are used primarily to treat
depression.
     Some commonly used MAO Inhibitors:
     isocarboxazid/Marplan
     phenelzine/Nardil
     tranylcypromine/Parnate
INTERACTION-A very dangerous, potentially fatal interaction can
occur with foods containing tyramine, a chemical in alcoholic
beverages, particularly wine, and in many foods such as hard
cheeses, chocolate, beef or chicken livers.  Be sure to follow
physician's instructions.
 
SLEEP DISTURBANCES
 
Do not use alcohol with any sleep medications.
 
STOMACH AND INTESTINAL PROBLEMS
 
Cimetidine, Famotidine, Ranitidine-These medications are
prescribe to treat ulcers.  They work by reducing the amount of
acid in the stomach.
     Some commonly used brand names:
     cimetidine/Tagamet
     famotidine/Pepcid
     ranitidine/Zantac
INTERACTION-Follow the diet your doctor orders.
 
Laxatives-Some laxatives stimulate the action of muscles lining
the large intestine.  Other types of laxatives soften the stool,
or add bulk or fluid to help food pass through the system.
INTERACTION-Most laxatives are available without prescriptions.
Excessive use of laxatives can cause loss of essential vitamins
and minerals and may require replenishment of potassium,
sodium and other nutrients through diet.  Mineral oil can cause
poor absorption of some vitamins.  Discuss the use of laxatives
with your doctor or pharmacist.
 
Other National Consumers League (NCL) publications on drug safety
include:
 
     When Medications Don't Mix:
     Preventing Drug Interactions
 
     Guide to Warning Labels on
     Nonprescription Medications
 
Single copies are free from NCL members, $1 for non-members.
Spanish editions and bulk rates are available.
 
NCL is a nonprofit membership organizations working to promote
fairness at the marketplace and workplace.  $20 annual membership
includes a subscription to our consumer bulletin and
discounts on publications.  Write:
 
     NCL
     National Consumers League
     815 15th Street, N.W. Suite 928-N
     Washington, D.C.  20005
 
NCL would like to thank the following:
 
     APhA
     American Pharmaceutical Association
     2215 Constitution Avenue, N.W.
     Washington, D.C.  20037
 
     FDA
     Food and Drug Administration
     5600 Fishers Lane
     Rockville, MD  20857
 
     FMI
     Food Marketing Institute
     1750 K Street, N.W., Suite 700
     Washington, D.C.  20006