Tuesday, December 11, 2012

Antirheumatic drugs and foods



Some food and beverages may interact with drugs being prescribend in rheumatology against rheumatic diseases as well as concomitant diseases like osteoporosis. Some foods and beverages block the drug's absorption, so one gets less benefit ore even none at all. On the other hand foods and beverages may increase absorption or free plasma levels and so render them more powerful. Apart from acting on the drug itself, foods and beverages might increase toxicity. Neutriceuticals / dietary supplements might also interact.

Fruit
Fruits with lots of fruit acid like citrus fruits and apples may intereact with your medication. Especially grapefruit acts with cyclosporine A, it increases plasma levels of the drug (cyclosporine A and other drugs carry a warning about grapefruit juice on their labels). These fruits might also interact with methotrexate, but we use more subcutaneous methotreaxate and clinically see no interaction. Alendronate and other oral biphosphonates might also interact, but the stomach should be empty taking the drug and you should only take it with non-sparkling water.

Coffee
Coffee might interact with alendronate and other oral biphosphonates, but the stomach should be empty taking the drug and you should only take it with non-sparkling water.

Milk and milk products
Milk and milk products like yogurt, icecream, cheeses might block quite a lot of drugs, but in rheumatology only penicillamine, and though the drug still is on the list of DMARDs, I haven't seen a patient on this drug during the past 17 years, and before I have only seen patients to come off this drug.

Alcohol
If you are taking drugs that go with the risk of liver toxicity, like methotrexate of leflunomide, it's highly recommended avoiding alcohol.

St. John's Wort
St. John's Wort might increase liver toxicity of other drugs. Some people have to take sildenafil because of vasculitis, St. John's Wort might reduce plasma levels.

Vitamin E and Ginseng
Vitamin E and Ginseng might enhance the bleeding effects of nonsteroidal anti-inflammatory drugs like low-dose aspirin, ibuprofen, and others.

This list is far from complete and if you read something on the topic, please notify me, that I add other interactions. I´ll look myself for addional information.

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