Generics Blog|Medical-Care News

Drug Safety Alert!

Do you know what common foods interact with the drugs that you take? You should–a mistake can be fatal

There are times when scarfing down a whole bowl of broccoli may be too much of a good thing. Or when your fresh idea to eat salads for lunch every day can leave behind more than just some spinach in your teeth. Or when an extra glass of wine with dinner could kill you.

Those foods interact with drugs for high blood pressure, thyroid conditions, and diabetes. In some cases, the food can interfere with your treatment, either by making the drug less effective or more powerful.

In other cases, the food/drug mix can trigger unwanted side effects. For example, high-potassium foods such as broccoli can interact with so-called potassium-sparing diuretics used to treat hypertension, causing excess potassium in the body, which, in turn, can cause an irregular heartbeat and palpitations.

In some cases, the mix can be fatal. People with diabetes who drink regularly and are also taking a blood glucose- lowering drug may be putting themselves at increased risk for developing high levels of lactic acid, which, in some cases, can be deadly.

Get Drug-Smart

The chart can help you avoid mixing the most common prescription drugs with foods that can cause problems.

The Trouble with Grapefruit Juice

Drinking grapefruit juice with some drugs can inhibit intestinal enzymes that help your body absorb the drugs. The result? The amount of medication that ultimately enters your system may be more or less than you really need, which could negatively affect your treatment. The best advice: When taking these drugs (see the chart at right), avoid grapefruit juice for at least 2 hours before and after ingesting them, and stick with plain water.

Foods and Drugs That Don’t Mix

Legend for Chart:

A - IF YOU HAVE…
B - ARE YOU TAKING*…
C - THEN STEER CLEAR OF…
D - WHAT COULD HAPPEN

A

B

C

D

Allergies, seasonal

Claritin, Zyrtec, or Allegra (antihistamines)

alcoholic beverages

May increase the drowsiness effect of the drug.

Congestive heart failure or atrial fibrillatien

Lanexin (digoxin)

meals high in bran fiber

Can reduce the amount of the drug that is absorbed.

Tip: Take this drug separately.

Depression

Prozac, Zoloft, or Paxil (selective serotonin reuptake
inhibitor [SSRI] antidepressants)

alcoholic beverages

May increase drowsiness and dizziness, and worsen symptoms.
In general, people who are depressed should avoid alcohol.

Diabetes

Glucophage or Glucotrol XL (to lower blood sugar)
alcoholic beverages

May prolong the risk of abnormally low blood sugar. For
Glucophage, it may also increase the risk of lactic
acidosis (high levels of lactic acid, which, in some
cases, can be fatal).

Erectile dysfunction

Viagra

high-fat meals

May slow the rate at which the drug is absorbed.
Tip: Take this drug separately.

Heart attack, atrial fibrillation, venous thrombosis,
pulmonary embolism, or stroke

Coumadin (an anticoagulant)

varying amounts of foods high in vitamin K such as
turnip greens, broccoli, and green, leafy vegetables,
alcoholic beverages

High amounts of vitamin K decrease the drug’s effect,
whereas low amounts increase the drug’s effect. To keep
this drug working effectively, aim for consistent amounts
of vitamin K. Alcohol can increase the drug’s effect and
put you at risk of excessive bleeding.

Heartburn/gastroesophageal reflux disease (GERD)

Propulsid (a gastrointestinal stimulant)

grapefruit juice, alcoholic beverages

High blood pressure (hypertension) or congestive heart failure

Norvasc, Cardizem, Procardia, or Adalat (calcium channel
blockers) Zestril, Vasotec Accupril, Lotensin, or Prinivil
(ACE inhibitors)

grapefruit juice, salt substitutes containing potassium,
and large amounts of potassium-rich foods such as bananas,
green, leafy vegetables, and oranges

High cholesterol

Lipitor, Zocor, or Pravachol (HMG-CoA reductase
inhibitors or”statins”)

grapefruit juice, alcoholic beverages

Hypothyroidism

Synthroid (levothyroxine)

high-fiber diet; soy products, foods containing large
amounts of iodine, such as spinach, shellfish, saltwater
fish, and iodized salt

Fiber and soy products may decrease the amount of the
drug that is absorbed. Soy products may negatively affect
thyroid function. Iodine can affect thyroid hormone levels.
Tip: Aim for consistent amounts of iodine in your diet.

Insomnia

Ambien

alcoholic beverages

May increase the drowsiness effect of the drug or of
other drugs that help you fall asleep.

Osteoporosis

Fosamax

mineral water, orange juice, coffee, and tea;
high-fiber diet; soy products

These beverages can decrease the drug’s availability.
Tip: Take Fosamax with plain water.

* Prescription drugs are from among the top 60 brand-name prescription drugs sold in 1998. Source: Scott-Levin’s Source Prescription Audit, Newtown, PA. This listing of drugs is not comprehensive. If you are taking a different drug or a generic brand medication for any of these conditions, please see your doctor about possible interactions with foods.

Timing is what’s important. For best results, take Fosamax first thing in the morning, on an empty stomach, with plain water only-not with any other beverage or food. Wait for 30 minutes before consuming anything. For more information about Fosamax, consult your doctor or pharmacist or visit Fosamax’s Web site at www.fosamax.com.

The same food and drug interaction chart also incorrectly lists the seasonal allergy drug Allegra among the medications that increase drowsiness when alcoholic beverages are consumed. There are no drowsiness side effects associated with taking Allegra. If you drink alcohol while taking Allegra, any feelings of drowsiness can be attributed to the alcohol. For more information about Allegra, consult your doctor or pharmacist or visit Allegra’s Web site at www.allegra.com.

Timing is what’s important. For best results, take Fosamax first thing in the morning, on an empty stomach, with plain water only-not with any other beverage or food. Wait for 30 minutes before consuming anything. For more information about Fosamax, consult your doctor or pharmacist or visit Fosamax’s Web site at www.fosamax.com.

The same food and drug interaction chart also incorrectly lists the seasonal allergy drug Allegra among the medications that increase drowsiness when alcoholic beverages are consumed. There are no drowsiness side effects associated with taking Allegra. If you drink alcohol while taking Allegra, any feelings of drowsiness can be attributed to the alcohol. For more information about Allegra, consult your doctor or pharmacist or visit Allegra’s Web site at www.allegra.com.

Since it came on the market in 1998, Viagra (sildenafil) has changed the manner in which erectile dysfunction (ED) is managed. Over 23 million men throughout the world have tried it, with a modicum of success. Even though it is the best known solution to ED, there are other options as well.

Erectile dysfunction can range from occasional to complete inability to achieve and maintain penile tumescence, or erection. An erection occurs when the nervous system activates increased blood flow to the male reproductive organ: Blood vessels relax and the influx of blood causes the tumescence. Once the sexual excitement comes to fruition, excess blood drains returning the organ to its non-erect state.

Most causes of ED are physical, including diabetes, high blood pressure, cardiovascular disease, and other conditions. It is also due to lifestyle choices such as smoking and lack of exercise. Taken together, any or all of these factors affect the blood flow to the pelvis. Other causes may include low libido and relationship or partner issues. Surgeries to treat cancers–for example, prostate cancer–and injuries to the pelvic area may result in ED. A wide array of pharmaceuticals can also lead to ED.

The three major medications to manage ED–sildenafil, verdanfil (Levitra) and tadalafil (Cialis)–are all inhibitors of an enzyme called phosphodiesterase 5 (PDES). They work by relaxing the smooth muscle cells, which increases the blood flow to the pelvic area and allows tumescence in response to sexual stimulation.

These agents are not free of side effects, however, especially for those with severe heart disease. As such, they are contraindicated for those who have recently suffered a stroke, or who take alpha-blockers for high blood pressure or voiding dysfunction. Importantly, PDE5 inhibitors should not be taken with nitrates (the heart drug nitroglycerine), because the combination can cause a potentially fatal drop in blood pressure. In addition, PDE5 inhibitors have also been linked to a rare form of blindness. All three of these inhibitors share certain side effects, including headache, nasal congestion, facial flushing, gastrointestinal distress, and, less commonly, vision changes.

Among alternatives to these PDE5 inhibitors are injectibles like Alprostadil (caverjet, Edex, MUSE). In addition, vacuum devices are used to trigger the blood flow to the penile tissue. These approaches, however, are marred by their awkwardness of use. It is for this reason that ED sufferers are increasingly turning to safer and natural alternatives. While a number of remedies are touted to be helpful, more often than not the claims fall far short of the promises.

Among the natural choices, the amino acid citrulline is one of the most effective agents to enhance blood flow without any metabolic inhibition, as is the case with PDE5 inhibitors. While PDE5 inhibitors inactivate the enzyme that breaks down nitric oxide (NO), the small molecule that induces vasodilation and increased blood flow, citrulline functions systemically to induce NO and, as a result, flush the pelvic flow with blood. Thus, by boosting the body’s ability to offset any loss in NO, citrulline is an entirely safe and effective long-term alternative for a healthy libido.

AKA: Panax ginseng, Asiatic ginseng, Korean ginseng, Korean red ginseng. Chinese ginseng

PART USED: Root

WHAT IT DOES BEST: Asian ginseng is used for a wide variety of conditions. However, the most scientifically supported uses are for male infertility and erectile dysfunction (ED).

THE BACKGROUND: The Chinese have used Asian ginseng for over 2,000 years as a tonic to improve mental acuity and vitality, enhance physical performance and memory, reduce fatigue and strengthen the immune system.

WHAT’S THE ACTIVE INGREDIENT?

The primary active ingredients are known collectively as ginsenosides. Other actives include panaxans, which may help stabilize blood sugar.

RECENT FINDINGS: According to a report in the November 2002 issue of Urology, Asian ginseng was found to be effective for ED in a double-blind human study. In a related commentary in the January 2003 issue of The Journal of Family Practice, doctors from the University of Virginia Health Sciences Center in Charlouesville noted that Asian ginseng is a safe, suitable alternative to sildenafil (Viagra).

In addition to increasing sex drive, ginseng may help improve male fertility. In a preliminary human study published in the December 1996 issue of Panminerva Medica, 66 men who took Asian ginseng experienced increased sperm count, sperm motility and testosterone levels.

Besides the above, animal studies suggest Asian ginseng may help reduce the effects of stress and fatigue and enhance immune function. Recently, a mice study published in me March 2005 issue of Archives of Pharmacal Research found that ginsenosides derived from Asian ginseng could enhance memory and reduce amnesia.

POSSIBLE SIDE EFFECTS AND PRECAUTIONS: When taken in the recommended dosages, Asian ginseng is considered safe; however, in rare cases it may cause insomnia and headaches and enhance the effects of caffeine. Allergic reactions are possible. Long-term use may contribute to menstrual irregularities and breast pain in some women.

People scheduled for surgery, on blood-thinning medications or with uncontrolled high blood pressure should not take Asian ginseng without first consulting a physician.

Ginseng may affect blood glucose levels; therefore people with diabetes should consult a health care practitioner before use.

IS IT SAFE TO TAKE WHILE PREGNANT OR NURSING?

Asian ginseng is not recommended for pregnant or nursing women.

ARE THERE ANY DRUG INTERACTIONS?

People taking warfarin (Coumadin) or other blood-thinning medications should consult with a physician before taking Asian ginseng.

WHICH TYPE AND HOW MUCH?

The root is dried, powdered and made into capsules, liquid alcohol (tinctures) and dried extracts. Asian ginseng root extract standardized to approximately 4-7 percent ginsenosides is the most researched form.

* For whole powdered root, studies have used 0.5-2g daily.
* For tinctures, 2-3ml three times daily is usually recommended.