DRUG FOOD INTERACTIONS

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1 ANTIHYPERTENSIVES Natural licorice in large amounts can aggravate high blood pressure and can lower potassium levels. Natural licorice should be avoided with all antihypertensive medications. (Read food ingredient labels for licorice root or licorice extract.) CALCIUM CHANNEL BLOCKERS: Supplemental calcium may reduce the Take any vitamin or mineral supplement containing Norvasc (amlodipine) effectiveness of calcium channel blockers. calcium, two hours before or two hours after taking Procardia (nifedipine) Norvasc or Procardia. ACE INHIBITORS: May raise potassium levels. Avoid salt and salty foods. Vasotec (enalapril) Avoid salt substitutes that contain potassium. Zestril/Prinivil (lisinopril) Caution with potassium supplements. Accupril (quinipril) Alcohol should be avoided Lotensin (benazepril) Capoten (captopril) ANTIOTENSIN II RECEPTOR ANTAGONISTS: Cozaar (losartan) May raise potassium levels. Potassium supplements or salt substitutes containing potassium should not be taken without consent from MD. OTHER CARDIOVASCULAR MEDICATIONS Digoxin Food high in fiber (such as bran) or pectin (such as applesauce) may decrease the absorption of digoxin. Digoxin should be taken a few hours before or after eating something high in fiber or pectin. Natural licorice should be avoided.

2 Coumadin (warfarin sodium) Foods high in Vitamin K may counteract the blood thinning properties of this drug. Advise patient to maintain consistent diet; patients on Coumadin should not significantly vary the amount of Vitamin K rich vegetables/foods in their diet from day to day. Foods high in Vitamin K should be limited dark green leafy vegetables, spinach, kale, broccoli, lettuce, turnips, cabbage, brussel sprouts, soybean and vegetable oil, beef liver, raw cauliflower. Green tea is also high in Vitamin K and may need to be discontinued. OTHER MEDICATIONS Aspirin Can be irritating to the stomach Take with food or milk. Avoid or limit the use of alcohol. Fosamax (alendronate) Food or beverages other than water may interfere with absorption of the drug. Tube feedings or enteral supplements may interfere with drug absorption. Fosamax must be taken on an empty stomach at least 30 minutes before eating or drinking anything other than water (including other medicines or vitamins). This medication should be taken with a full glass (6-8 oz or 180 ml-240 ml) of plain water once daily unless directed otherwise by MD. Advise patient to swallow the tablets whole and not to chew or suck on them. Tell patient not to not lie down for at least 30 minutes after taking this medication to prevent esophageal irritation. Dilantin (phenytoin) Dilantin increases the metabolism of vitamins D and K; may cause folate-deficiency anemia. Dilantin doses should be administered at least two hours before or two hours after an intermittent tube feeding or ingestion of an enteral supplement. (If a patient is receiving continuous enteral feedings, consult with healthcare provider.). Eating generous amounts of milk, liver, dark green, leafy vegetables may help replace the vitamins destroyed by Dilantin.

3 Sinemet (levodopa/carbidopa) High protein meals may lead to a decreased response to levodopa. Pyridoxine (Vitamin B6) in doses of more than 5 mg/day may reverse levodopa s drug effectiveness. It is best to be consistent on a daily basis as to when Sinemet is administered with relationship to meals. Avoid protein intake swings. Limit foods containing Vitamin B6: avocado, bacon, beans, beef, liver, dry skim milk, port, peas, sweet potato, and tuna. Iron (ferrous sulfate, ferrous gluconate) Eggs and milk decrease iron absorption. Coffee and tea that is drunk with a meal or 1 hour after a meal may also decrease iron absorption. Do not administer with dairy products or eggs space two hours apart. Foods/beverages high in Vitamin C may enhance absorption of iron: oranges and orange juice, broccoli, strawberries, green peppers, tomatoes, potatoes. Synthroid (levothyroxine) Certain foods may decrease absorption of this medication when taken at the same time. Some foods may interfere with thyroid function. Synthroid should be taken separately from: soybean flour, walnuts, dietary fiber. The following should be avoided: soybeans, cabbage, turnips, brussel sprouts, kale and rutabagas. CHOLESTEROL LOWERING MEDICATIONS Grapefruit or grapefruit juice may increase the serum concentration of these and other MG-COA reductase inhibitors. Eating grapefruit or drinking grapefruit juice should be avoided unless otherwise instructed by MD. Lipitor (atorvastatin) Avoid alcohol to reduce the risk of liver damage. ZOCAR (SIMVASTATIN) POTASSIUM DEPLETING: Increases potassium loss in the urine. Maintain consistent consumption of foods high in potassium such as organ meats, bananas, tomatoes, cantaloupe, potatoes, spinach. Have potassium levels checked regularly by healthcare provider. Lasix (furosemide) Hydrodiuril (hydrochlorothiazide)

4 DIURETICS POTASSIUM SPARING: May raise potassium levels. Foods high in potassium should be avoided as well as potassium supplements or salt substitutes containing potassium. Aldactone, Novo-Spiroton, Aldactazide, Spiractin, Spirotone, Verospiron, Berlactone (spironolactone) Dyrenium (triamterene) ANTIBIOTICS Cipro (ciprofloxacin) Levaquin (levofloxacin) Calcium and other minerals may decrease absorption of Cipro and other fluoroquinolones. Take medication on an empty stomach or at least one to two hours before or after a meal. Take antacids, magnesium, calcium, iron or zinc supplements two hours before or two hours after medication administration.

5 Drugs Associated with Weight Gain Antidepressants Amitriptyline (Elavil) Mitazapine (Remeron) Nortriptyline (Aventyl, Pamelor) OHAs Pioglitazone (Actos) Rosiglitazone (Avandia) Glucocorticoids Dexamethasone (Cecadron, Dexan) Methylprednisolone (Medrol, Meprolone) Prednisone Prednisolone Drugs Associated with Weight Loss SSRI Antidepressants Citalopram (Celexa) Fluoxetine (Prozac) Cardiac Agents Digoxin (Lanoxin) Furosemide (Lasix) Benzodiazepines Clonazepam (Klonopin) Lorazepam (Ativan) OHAs Metformin (Glucophage) Antipsychotics Haloperidol (Haldol) Olanzapine (Zyprexa) Risperidone (Risperdal) Miscellaneous Cyproheptadine (Periactin) Lithium (Eskalith, Lithobid) Omeprazole (Prilosec)

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