Food : Drug Interactions
A food-drug interaction can:
- prevent a medicine from working the way it should
- cause a side effect from a medicine to get worse or better
- cause a new side effect
- a medicine can also change the way your body uses a food. Any of these changes can be harmful
What else can affect how my medicines work?
Age, weight, and sex; medical conditions; the dose of the medicine; other medicines; and vitamins, herbals, and other dietary supplements can affect how your medicines work. Every time you use a medicine, carefully follow the information on the label and directions from your doctor or pharmacist.
Here are some of the most common contra-indications and their consequences. This list is not conclusive, so always check with a healthcare professional that any medications are safe to take along with any supplement that might be recommended. Remember certain foods, such as grapefruit can interact with drugs such as statins, and alcohol is not recommended with many medications.
| Herb / Dietary Supplement | Drugs | Potential consequences / reactions |
|---|---|---|
| 5-Hydroxytryptophan | Fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine | ↑ Risk of serotonin syndrome |
| Acacia | Amoxicillin | ↓ Absorption of Amoxicillin |
| Alfalfa | Warfarin | ↓ The effect of Warfarin |
| Aloe vera | Digoxin | ↑ Digoxin toxicity |
| American ginseng | Warfarin | ↓ The effect of Warfarin |
| Arginine | Enalapril, Nitroglycerin | ↑ Hypotensive effects |
| Arginine | Spironolactone | ↑ Risk of hyperkalemia |
| Bitter orange | Phenelzine | ↑ Risk of hypertensive crisis |
| Dong quai | Aspirin, Heparin, Ticlopidine, Warfarin | ↑ Risk of bleeding |
| Evening primrose | Warfarin | ↑ Risk of bleeding |
| Garlic | Ritonavir | ↓ The effect of Ritonavir |
| Garlic | Saquinavir | ↓ The effect of Saquinavir |
| Garlic | Warfarin | ↑ Risk of bleeding |
| Ginkgo | Aspirin, cilostazol, clopidogrel, dipyridamole, heparin, ibuprofen, naproxen,ticlopidine, warfarin | ↑ Risk of bleeding |
| Ginkgo | Risperidone | ↑ Risk of adverse effects |
| Ginkgo | Trazodone | Excessive sedation |
| Glucosamine | Warfarin | ↑ Risk of bleeding |
| Hawthorn | Digoxin | ↑ Digoxin toxicity |
| Liquorice | Warfarin | ↑ Risk of bleeding |
| l-Tryptophan | Citalopram, duloxetine, fluoxetine, fluvoxamine, isocarboxazid, paroxetine, phenelzine, selegiline, sertraline, sibutramine, tranylcypromine, venlafaxin | ↑ Risk of serotonin syndrome |
| l-Tryptophan | Zolpidem | ↑ Zolpidem-induced side effect |
| Melatonin | Zolpidem | ↑ Sedative effects |
| N-acetylcysteine | Nitroglycerin | Severe hypotension/headaches |
| Niacin | Atorvastatin, cerivastatin, lovastatin, rosuvastatin, simvastatin | ↑ Risk of myopathy or rhabdomyolysis |
| PABA | Dapsone, sulfamethoxazole | ↓ Antibacterial effects |
| Potassium | Amiloride, benazepril, captopril, enalapril, fosinopril, indomethacin, lisinopril, moexipril, quinapril, ramipril, spironolactone, trandolapril, triamterene | ↑ Risk of hyperkalemia |
| Red yeast rice | Cyclosporin | ↑ Creatine phosphokinase values |
| S-adenosylmethionine | Clomipramine | ↑ Risk of serotonin syndrome |
| St John’s wort | See below | See below |
| Valerian | Alprazolam, phenobarbital | ↑ Central nervous system depression |
| Vitamin A | Acitretin, bexarotene, etretinate, isotretinoin, tretinoin | ↑ Risk of Vitamin A toxicity |
| Vitamin B6 | Altretamine | ↓ Response to altretamine |
St John’s wort alters the effects of the following drugs
| Drugs | Potential consequences / reactions |
|---|---|
|
Bupropion, buspirone, eletriptan, meperidine, trazodone MAOI: isocarboxazid, phenelzine, tranylcypromine SSRI: citalopram, duloxetine, fluoxetine, fluvoxamine, nefazodone, paroxetine, sertraline, venlafaxine TCA: amitriptyline, amoxapine, clomipramine, desipramine, doxepin, imipramine, nortriptyline, protriptyline, trimipramine |
↑ Risk of serotonin syndrome |
| Fentanyl, Morphine, Oxycodone | ↑ Sedation |
| Lidocaine , Propofol, sevoflurane | ↑ Risk of cardiovascular collapse |
| Piroxicam, rasagiline, risperidone, tetracycline, tolbutamide, tretinoin | ↑ Photosensitivity reactions |
St John’s wort reduces the effects of the following drugs
Amiodarone
Benzodiazepine: alprazolam, clonazepam, diazepam, midazolam,triazolam; Busulfan; Calcium channel blockers: diltiazem, felodipine, nicardipine, nifedipine, nitrendipine,verapamil; Carbamazepine; Cyclophosphamide; Cyclosporin; Dapsone; Dexamethasone; Digoxin; Docetaxel; Dolasetron; Doxorubicin; Erlotinib; Erythromycin; Estrogens ⁄ progestogens: estradiol, gestodene, levonorgestrel, norethindrone ; Etoposide; Exemestane; Fexofenadine; Finasteride; Flutamide; Gliclazide;
Haloperidol; Ifosfamide; Imatinib; Irinotecan; Ivabradine; Ixabepilone; Lapatinib; Loperamide; Maraviroc; Mephenytoin
Methadone; NNRTI: delavirdine, efavirenz, nevirapine; Omeprazole; Ondansetron; Paclitaxel; Phenprocoumon; Phenytoin;
Protease inhibitors: amprenavir, atazanavir, darunavir, fosamprenavir, indinavir, nelfinavir, ritonavir, saquinavir, tipranavir ;
Quetiapine ; Quinidine ; Sildenafil ; Sirolimus ; Sunitinib ; Tacrolimus ; Tamoxifen ; Temsirolimus ; Teniposide ; Tramadol
Vinblastin ; Vincristine; Voriconazole; Warfarin
Amended from-Tsai HH, Lin HW, Simon Pickard A, Tsai HY, Mahady GB. Evaluation of documented drug interactions and contraindications associated with herbs and dietary supplements: a systematic literature review. International journal of clinical practice. 2012 Nov;66(11):1056-78.
https://onlinelibrary.wiley.com/doi/full/10.1111/j.1742-1241.2012.03008.x
