VERIFIED CONTENTAuthor: Karolina Karabin, MD, PhD, molecular biologist, laboratory diagnostician, nutrition and lifestyle consultant

A lot of people do not realize that what we drink drugs is of great importance, because it can significantly affect how a given drug behaves in our body. That is why we cannot take drugs with what we want and it is worth knowing the list of forbidden drinks that may affect the effects of drugs.

The influence of drinks on the effects of drugs

An interaction between drugs and beverages (or more food in general) means that a certain nutrient or compound in the drink changes the way that the drug affects our body. This may occur at the level of drug absorption or metabolism by individual enzymes.

As a consequence, the active substance of the drug may be strengthened or weakened. In the worst case, serious side effects can even threaten our lives.

What not to drink medication: coffee and tea

Coffee and tea are one of the most consumed beverages in the world and unfortunately not a good product for sipping medication. Both drinks contain caffeine and therefore should not be washed down with bronchodilators such as theophylline, aminophylline and adrenaline.

This combination may increase the risk of side effects such as hyperactivity, nervousness and increased heart rate. Similar symptoms can be aggravated by other caffeinated drinks such as cola or energy drinks.

In addition, drinking iron preparations with tea disrupts their absorption, because tea contains a large amount of tannins. Tannins form insoluble complexes with iron and prevent its proper absorption in the digestive tract.

What not to drink medication: citrus fruit juices

Citrus juices contain a lot of organic acids, which make them acidic. The consequence of this is the decomposition, binding or difficult absorption of certain drugs in the gastrointestinal tract, e.g. erythromycin.

In addition, drinking antacids containing aluminum with citrus juices increases the absorption of aluminum, which may result in its toxic concentration in the body.

The most widelyGrapefruit juice has been tested for drug interactions, and it may interact with more than 85 medications. There are many commonly used medications in this list, such as:

  • anti-cancer drugs, e.g. dasatinib, crizotinib,
  • anxiolytics, e.g. benzodiazepines,
  • antiviral and antibacterial drugs, e.g. erythromycin, maraviroc,
  • antilipemic drugs, e.g. lovasatin, atorvastatin,
  • drugs used in cardiovascular diseases, e.g. amiodarone, apixaban,
  • painkillers e.g. ketamine, alfentanil,
  • antiemetics e.g. domperidone,
  • immunosuppressants, e.g. cyclosporine, sirolimus,
  • drugs used in diseases of the urinary system, e.g. darifenacin.

Studies have shown that grapefruit juice may increase the systemic concentration of various drugs by impairing metabolism due to the activity of an enzyme called cytochrome P450 3A4 (CYP3A4). This enzyme is involved in the metabolism of about 50 percent. drugs and is found in intestinal epithelial cells and in the liver.

The chemicals in grapefruits that affect the activity of the enzyme CYP3A4 are flavonoids such as:

  • furanocoumarin,
  • kampferol,
  • naringenina,
  • quercetin.

For example, furanocoumarin is metabolized by the enzyme CYP3A4 to intermediates which inhibit the enzyme's action and consequently increase the concentration of the drug in the blood.

It's good to know that both freshly squeezed juice and fresh fruit can reduce the enzyme activity. One whole grapefruit or 200 ml of grapefruit juice is enough to increase the concentration of the drug and cause side effects. Therefore, to avoid drug interactions with grapefruit juice, do not take any medications with it, but also do not drink the juice for at least 4 hours before and after taking the drug.

It has also been found that grapefruit juice and other citrus juices act through an additional mechanism of drug transporters inhibition and reduce the systemic concentration of some drugs, e.g. fexofenadine.

Research shows that other citrus fruit juices, e.g. orange, lime, pomelo, may also have a similar or different effect. For example, hesperidin in orange juice can reduce the absorption of the antihypertensive drug celiprolol, as well as some antibiotics such as erythromycin, benzylpenicillin.

What not to drink drugs: alcohol (ethanol)

Many over-the-counter and prescription drugs interact very dangerous withalcohol, especially when it is consumed in large amounts. Drinking drugs with alcohol may alter their pharmacokinetics, including absorption and metabolism. Drug interactions with alcohol occur through various biochemical mechanisms, one of which is competition for metabolism with the same enzyme.

Alcohol can both reduce the desired effects and increase the side effects of medications. To understand exactly how alcohol interacts with certain medications, it's important to know how alcohol is metabolized. About 10 percent alcohol is metabolized in the first step in the stomach, intestines and liver.

One of the main enzymes involved in the metabolism of alcohol is alcohol dehydrogenase, which converts alcohol into acetaldehyde, which in turn is metabolized by aldehyde dehydrogenase to acetate. Additionally, alcohol is metabolized by enzymes from the CYP450 family, mainly CYP2E1.

Depending on the frequency of alcohol consumption, alcohol may either increase or inhibit the activity of the enzyme CYP2E1. Chronic, heavy consumption of alcohol increases the activity of the enzyme (up to 10 times), while short-term intensive consumption inhibits its activity. Therefore, drugs that are broken down by the enzyme CYP2E1 are metabolized faster in chronic heavy drinkers, which requires higher doses of drugs.

On the other hand, in single drinkers, the opposite is true and adverse reactions may intensify. Absolutely no drugs should be washed down with alcohol. However, we should be especially careful when taking the following medications:

  • drugs for hypertension, e.g. propranolol,
  • anxiolytics, e.g. benzodiazepines,
  • painkillers, e.g. ibuprofen, naproxen, paracetamol,
  • antidiabetic drugs, e.g. metformin,
  • antidepressants, e.g. MAO inhibitors,
  • antipsychotics, e.g. phenothiazine,
  • antihistamines, e.g. cetirizine, promethazine,
  • antibacterial drugs, e.g. erythromycin, chloramphenicol,
  • anticoagulants e.g. warfarin,
  • anticonvulsants, e.g. phenytoin,
  • antiemetics, e.g. metoclopramide.

The common problem is the interaction of alcohol with painkillers from the group of non-steroidal anti-inflammatory drugs, eg paracetamol, which can be especially dangerous to the liver. In addition, this combination may increase the risk of gastrointestinal bleeding.

What not to drink medication: milk and milk-based drinks

Milk is a product rich in calcium, which may limit or completely prevent the absorption of somedrugs, e.g. fluoroquinolones, tetracyclines. This is due to the formation of calcium ions to form water-insoluble s alts.

In addition, milk can cause a change in the pH of gastric juice, which causes premature dissolution of the drug shell, e.g. bisacodyl, which should only dissolve in the small intestine. As a result, it causes the drug to be released in the stomach and its irritation.

With what to drink medication?

It is best to take each drug with still water, because it is neutral for all active substances contained in the drugs. It will not affect the absorption of the drug or its pharmacological properties.

About the authorKarolina Karabin, MD, PhD, molecular biologist, laboratory diagnostician, Cambridge Diagnostics Polska A biologist by profession, specializing in microbiology, and a laboratory diagnostician with over 10 years of experience in laboratory work. A graduate of the College of Molecular Medicine and a member of the Polish Society of Human Genetics. Head of research grants at the Laboratory of Molecular Diagnostics at the Department of Hematology, Oncology and Internal Diseases of the Medical University of Warsaw. She defended the title of doctor of medical sciences in the field of medical biology at the 1st Faculty of Medicine of the Medical University of Warsaw. Author of many scientific and popular science works in the field of laboratory diagnostics, molecular biology and nutrition. On a daily basis, as a specialist in the field of laboratory diagnostics, he runs the content department at Cambridge Diagnostics Polska and cooperates with a team of nutritionists at the CD Dietary Clinic. He shares his practical knowledge on diagnostics and diet therapy of diseases with specialists at conferences, training sessions, and in magazines and websites. She is particularly interested in the influence of modern lifestyle on molecular processes in the body.

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