Geri0304_19-33_food

Pharmacology
Food-drug interactions
Careful drug selection and patient counseling can
reduce the risk in older patients
Eric R. Leibovitch, MD, FACP • Robert L. Deamer, PharmD, BCPSLeslie A. Sanderson, RD, CNSD Older patients are at high risk for food-drug interactions. These patients are commonly on multiple medications for chronic medical conditions. Age-related physiologic changes affecting drug absorption, distribution, metabolism and excretion, as well as drug action occur in these patients, and this variability in drug action may be further potentiated by interactions with foods. The most prominent interactions involve drug absorption from the GI tract; however tions. [Editor’s note: Foods in the cover
alterations in drug metabolism are also highly significant. Food-drug interactions have been reported amongst a wide range of therapeutic drug classes, including, but not limited to, cardiovascular, psychoactive, anti-infective, endocrinologic, gastrointestinal, and respiratory agents.
Health care providers can prevent significant drug therapy-related morbidity by carefully selecting drugs for geriatric patients and thoroughly counseling these patients about drug interactions with the Leibovitch ER, Deamer RL, Sanderson LA. Food-drug interactions: Care drug selection and ication effects are frequently altered by patient counseling can reduce the risk in older patients. Geriatrics 2004; 59(Mar):19-33.
Key words: Food • interaction • drug absorption • drug distribution ing drug absorption, distribution, me-tabolism and excretion, as well as drugaction. In addition, endocrine dys-function, restrictive diets, and alco- Nrecently in the medical litera- caused by drug interactions are of potentiate these interactions.Additional aged cheeses are just a few of the every- Dr. Leibovitch is senior attending physician and coordinator of internal medicineeducation, Ventura County Medical Center; and adjunct professor of medicine, Uni- versity of California Los Angeles School of Medicine.
Dr. Deamer is the former director of pharmacotherapy education and research, family practice residency program, department of medical education, Ventura County Medical Center, assistant clinical professor, University of California Los AngelesSchool of Medicine and University of Southern California School of Pharmacy; he is currently drug education program coordinator; Kaiser Permanente, Southern California.
Disclosure: The authors have no real or apparent conflicts of interest related to thesubjects under discussion.
March 2004 Volume 59, Number 3 Geriatrics
Food-drug interactions
Table Pharmaceutical agents implicated in significant food-drug interactions in older adults Medication
Effects of food
Potential clinical implications
Cardiovascular agents
For Client Review Only. All Rights Reserved. Advanstar Communications Inc. 2003 CNS medications
Triazolam Carbamazepine Nefazodone Trazodone HClQuetiapine fumarate Geriatrics March 2004 Volume 59, Number 3
Food-drug interactions
Pharmaceutical agents implicated in significant food-drug interactions in older adults (continued) Medication
Effects of food
Potential clinical implications
CNS medications, continued
High Na diet ↓ Li blood levelsLow Na diet ↑ Li blood levels Anti-infective agents
↓ (substantial) absorption with cations beans, pickled fish, yeast extracts, red wines, overripe avocados, or figs) ↓ (substantial) absorption with cations Ciprofloxacin Levofloxacin All other fluoroquinolones March 2004 Volume 59, Number 3 Geriatrics
Food-drug interactions
Pharmaceutical agents implicated in significant food-drug interactions in older adults (continued) Medication
Effects of food
Potential clinical implications
Endocrine medications
GI tract medications
Respiratory tract medications
Allergic conditions
DiphenhydramineClemastine fumarateFexofenadine HClCetirizine HCl Immunosuppressants
Prepared for Geriatrics by Eric R. Leibovitch, MD, FACP, Robert L. Deamer, PharmD, BCPS, and Leslie A. Sanderson, RD, CNSD, using informationfrom references 1-6 and 13-15.
Geriatrics March 2004 Volume 59, Number 3
Food-drug interactions
mechanism for food-drug interaction.
Drug absorption may be the most
tions.9,10 Aging itself is associated with
cal and dietary references are key.4-6 Be- face of the GI tract.9 In some instances, remains unknown.
with anticholinergic properties (eg, tra- ditional antihistamines; diphenoxylateHCl with atropine sulfate) slow gastric also alter gastric pH, which affects therate of dissolution of many drugs. Milk structed to take these agents on an empty only and to stay upright and consume
acidic fruit juices, vegetable juices, car- nothing else for at least 30 minutes.
(relating to the drug’s absorption, dis- tribution, metabolism, and excretion).
fluoroquinolones as mentioned above.
in vitamin K (eg, asparagus, red leaf let- tation as well as improve absorption.
farin, making it essential to counsel pa- tients to limit any variability in vitamin tion of penicillins. Thus, physicians are Geriatrics March 2004 Volume 59, Number 3
Food-drug interactions
with older adults whenever possible.
content of the diet, and the transit time ilar effects. A high-fat diet can compete ticular) or consuming high quantitiesof highly processed foods. Alternately, fect of either high carbohydrate diets or Elimination of drugs. Drugs are elim-
to take medications in regards to meals.
Drug distribution. Many factors in-
10.Thomas JA. Drug-nutrient interactions.
tions: Avoiding therapeutic paraly-sis. J Clin Psychiatry 1998; 13.Williams L, Davis JA, Lowenthal DT.
Drug metabolism. Nutrients can ei-
ample is the effect grapefruit juice (GFJ) used drugs.7,8 By inhibiting intestinal— 10th ed. Philadelphia, Pa: SaundersCompany; 2000:399-414.
exactly as instructed. G
March 2004 Volume 59, Number 3 Geriatrics

Source: http://www.ciape.org.br/matdidatico/adriana_keller/fooddrug_interactions_careful_drug_selection_patient_counseling.pdf