It is estimated that in more than half of patients there are interactions between taken medications and various food ingredients. Their consequences are often difficult to predict. Find out how antibiotics, psychotropic drugs, and heart medications interact with food. How does tyramine affect drug absorption?
Most commondrug-food interactionsrelate to malabsorption in the stomach and intestines. Their effect is the intensification or weakening of the drug's effect, resulting from its increased or decreased absorption. A stronger effect of the drug may result in, for example, poisoning. The effect of reducing its absorption, and thus its concentration in the blood, may be the lack of therapeutic effect - very dangerous in the case of chronic diseases.
Food ingredients, after being absorbed, can also influence the metabolism of drugs in the liver. This type of interaction is much more difficult to predict, and therefore more dangerous. Enzymes in the liver are responsible for the metabolism and removal of medicinal products from the body. This is possible thanks to cytochromes - a group of proteins that participate in enzymatic processes. Cytochrome P450 is most important for drug metabolism. Its different varieties (there are about 30 in the liver) are involved in the processes of transformation and removal from the body of 90 percent. drugs.
Some food ingredients may accelerate or inhibit the action of certain types of cytochrome P450, thus affecting the metabolism of drugs. The result of such interactions is either an accelerated or slower elimination of drugs from the body, which has a direct impact on their plasma concentration, and thus also on the strength and duration of action. One of the best known cytochrome P450 inhibitors is grapefruit juice.
ImportantThe list of drugs that interact with food ingredients is much longer than the one presented by us, so always read the package leaflet or ask your pharmacist for advice before taking the drug.
Antibiotics: interactions with food
Medicines used to treat all kinds of infections very often interact with food ingredients. Be sure to read the package leaflet or ask your pharmacist for advice before taking an antibiotic, chemotherapeutic, antifungal or antiviral drug.
Some of them should be taken before or aftera meal - not necessarily during the meal. In the case of antibiotics such as azithromycin (Sumamed, Azitrox) or erythromycin (Davercin), a meal increases their degradation, reducing their concentration in the blood. This, unfortunately, results in a lack of therapeutic effects. As a result, these medications should be taken one hour before or two hours after a meal.
Another group of antibiotics that should be given special attention are tetracyclines (Tetracycline, Doxycycline). Dairy products (milk, yogurt, cottage cheese, cottage cheese) reduce the absorption of these drugs from the gastrointestinal tract, reducing their concentration in the blood by up to 50%. A similar interaction occurs with chemotherapeutic agents such as ciprofloxacin (Cipronex, Ciprobay) and norfloxacin (Nolicin), and with the antifungal ketoconazole. This obviously results in no or less therapeutic effects. Therefore, it is best to avoid using these drugs at the same time as dairy products.
Psychotropic drugs: interactions with food
One of the groups of drugs most exposed to interactions with food ingredients are psychotropic preparations used in the treatment of insomnia, depression and epilepsy. The mechanisms of these interactions are often similar to those for antibiotics or drugs for high blood pressure. For example, sedatives and hypnotics such as midazolam (Dormicum) and diazepam (Relanium) should not be used in combination with grapefruit juice as it reduces their metabolism and raises blood levels. With these drugs, there is a risk of respiratory and circulatory depression.
The same interaction takes place when grapefruit juice is used concomitantly with the anticonvulsant drug carbamazepine (Amizepin, Neurotop, Tegretol). This combination will increase the side effects of the drug, including gastrointestinal disturbances, dizziness, drowsiness, ataxia, and even disturbed consciousness. High fat meals will in turn increase the absorption of antidepressants such as amitriptyline (Amitriptyline), clomipramine (Anafranil) and imipramine (Imipramine). As a result, the concentration of drugs in the blood will increase and their side effects will increase (sweating, accommodation disorders, drowsiness, restlessness).
Hypertension drugs: interactions with food
- People taking metoprolol (Betaloc, Metocard, Beto), propranolol or bisoprolol (Bisocard, Concor, Corectin) should not combine these drugs with meals rich in fat (scrambled eggs, bacon, butter, lard). This type of food can accelerate their absorption, which as a resultIt may result in a slow heart rate, arrhythmias, drop in blood pressure and heart failure. Caution should also be exercised by people using amlodipine (Amlopin, Amlozek, Cardilopin), felodipine (Plendil), nifedipine (Cordafen), nitredypine (Nitredypine) and verapamil (Isoptin, Staveran). These drugs interact with grapefruit juice to reduce their metabolism. This results in an increase in their action, which leads to a drop in pressure, facial flushing and headache.
- It is also dangerous to combine diuretics with certain food ingredients. For example, furosemide interacts with glycyrrhizin, an ingredient in licorice found in candies and expectorants. It increases the effect of the diuretic while increasing the excretion of potassium through the kidneys. This can cause weakness, muscle cramps and pain, paralysis, cardiac arrhythmias and even cardiac arrest.
- People using quinapril (Accupro, Acurenal), enalapril (Enarenal, Benalapryl, Mapryl) and captopril (Captopril) should also be careful. When taking these drugs, it is recommended to significantly reduce the amount of sodium (table s alt) in meals in people over 64 years of age. Their simultaneous use may disturb the blood supply to the kidneys and their function, which in turn may lead to their damage. The result is acute kidney failure. Potassium should also be limited (tomato juice, s alt substitutes). In large quantities, when combined with these drugs, it can cause heart rhythm disturbances, heart block and stops, sensory disturbances in the extremities, as well as headaches, muscle weakness, drowsiness and confusion.
- Cardiac glycosides - digoxin (Digoxin) and methyldigoxin (Bemecor) are also a very dangerous group of drugs. A characteristic feature of these drugs is a very small difference between the therapeutic dose and the toxic dose. Such drugs are said to have a narrow therapeutic index. Thus, special attention should be paid to the way they are taken. Among other things, their use is contraindicated with products rich in fiber (bran, oatmeal), because they reduce the absorption of the drug from the gastrointestinal tract. This lowers the blood levels of the drug and therefore reduces the therapeutic effect. You should also not take digoxin and methyldigoxin simultaneously with liquorice preparations (candies, expectorants). They cause the increased excretion of potassium from the body, and this increases the toxic effect of glycosides. This is manifested by a slow heart rate and serious disturbances in the rhythm of its work.
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Who needs to watch out for tyramine?
The negative character of many food-drug interactions is tyramine. It is a chemical compound found in many food products of plant and animal origin. Consuming it in small amounts does not affect the human body, but its accumulation may pose a threat to he alth and life.
Some drugs inhibit the body's natural metabolism of tyramine, thereby increasing its concentration in the blood. The effect of this is psychomotor agitation, acceleration of heart activity, a sharp increase in blood pressure, and sometimes also a hemorrhagic stroke. This effect is demonstrated by drugs such as: Furazolidone (antibacterial for intestinal infections), Isoniazid (anti-tuberculosis), moclobemide (Aurorix, Mobemid, Moklar) with antidepressant effect and selegiline (Segan, Selgin, Selerin) used in the treatment of Parkinson's disease.
To avoid this type of interaction, people taking these medications should avoid tyramine-containing products. These include: salami, pepperoni, Bolognese sausage, cheeses (cheddar, emmentaler, camembert, brie, blue, mozzarella, parmesan, provolone, Romano, roquefort, stilton, gruyère), fish (pickled, s alted, smoked), beef liver, chicken liver, soy sauce, caviar, avocado, chocolate, bananas, figs, broad beans, yeast extracts, caffeine, vermouth and chianti wines, and French Chartreuse and Scottish Prambuie.
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