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What should I avoid while taking medication? Drugs are almost always washed down with something – water, juice, coffee or tea. We know which of them should be taken before and which after a meal. We just don’t know that pharmaceuticals can interact dangerously with both beverages and many foods. The list of these connections grows alarmingly. Remember that you should always read the package leaflet before taking any medicine in terms of at least interactions and side effects.
It even happens that there is a tragedy. A 40-year-old man has been treated with tranylcypromine (a monoamine oxidase inhibitor) for depression for a month. During the night, he suddenly woke up and was dazed, nauseated and had extreme headaches. How did this come about? In the morning, as usual, he took another batch of medicine and again ate three thick slices of his favorite cheddar for breakfast. He also enjoyed it frequently at dinner. Until he suffered a nosebleed in the late evening, and his body temperature rose to over XNUMX ° C. His condition was dramatic, doctors tried to save him, but to no avail. An autopsy revealed that he died of a stroke caused by a sharp rise in blood pressure. Doctors concluded that this was caused by the extremely unfavorable combination of tyramine in cheese with an antidepressant (MAO inhibitor).
This is an extreme situation, we do not know how often similar ones happen, because such tragedies elude medical statistics. The cause of the patient’s death is not always thoroughly investigated. Unless it is a young man, without serious illnesses and it is difficult to find the cause of sudden death. It is therefore worth remembering that tyramine is found in other foods – hard cheese, chocolate, herring, red meat, salami, soy sauce and chicken liver. If consumed frequently by someone taking these types of antidepressants, they can cause dangerous interactions.
Dr. Katarzyna Wolnicka from the Food and Nutrition Institute in Warsaw warns that food products containing large amounts of fiber weaken the effects of digitalis and tricyclic antidepressants (such as amitriptyline), as they worsen their absorption in the gastrointestinal tract. People taking bisphosphonates, drugs for osteoporosis, should not eat foods, especially calcium-rich foods such as milk and dairy products, for two hours after taking them. You should also refrain from consuming vitamins with microelements and antacids during this time.
An electrifying mixture
Juices and drinks can be equally dangerous. Coffee in combination with antibiotics and anti-ulcer drugs (such as Tagamet and Zantac) can cause nervous tension and stomach irritation in some people. The caffeine and theophylline they contain change the gastric motility (other caffeinated stimulants, such as cola, also work). In combination with some drugs, it creates a lightning mixture. Women taking oral contraceptives with just one cup of coffee become shaky and shaky.
It is dangerous to wash down pharmaceuticals with grapefruit and orange juices. These drinks are not suitable for taking medications at all, as they alter their absorption. Dr. Wolnicka gives an example of grapefruit juice, which slows down the metabolism of antihistamines, i.e. antiallergic drugs (reducing the secretion of substances that contribute to hypersensitivity). The result is an increase in their concentration by as much as 300-700 percent. and heart rhythm disturbances.
American pharmacologists Joe and Teresa Graedon write extensively on this subject in their book “Dangerous drug interactions”, which was published in Poland a few years ago. They warn that there have been deaths in the US due to the combination of grapefruit juice with antiallergic drugs. It also causes multiple increases in the blood levels of statins, drugs that lower blood cholesterol such as lovastatin, simvastatin and atorvastatin. It also increases the concentration of some preparations used in hypertension (their blood level will then be, for example, three times higher than if they were washed down with water). The absolute ban on drinking grapefruit and orange juices applies to osteoporosis drugs, which in this combination stop working. It is much safer to wash down pharmaceuticals with still water.
Watch out for grapefruit juice
Lawson Health Research Institute researchers say that from 2008 to 2012, the number of medications with which grapefruit juice causes dangerous interactions increased from 17 to as many as 43. These are cardiological preparations such as verapamil and amiodarone, oncology preparations, statins and immunosuppressive drugs (protecting against rejection of the transplant by the recipient’s organism). And new information is constantly coming in.
Prof. David Bailey, one of the authors of the report on the subject, claims that grapefruit juice slows down the metabolism of these drugs to such an extent that if you take just one tablet, the effect can be as much as 5 to 10 lozenges. He admits that it rarely happens, but when it does, the consequences can be very serious: stomach bleeding, cardiac arrhythmias, respiratory disturbances, kidney damage, and even sudden death can occur.
The scientist cites tests in which the absorption of drugs after drinking a glass of water or grapefruit juice was compared. Felodipine was used for this, an agent that widens blood vessels and lowers blood pressure. It turned out that grapefruit juice caused three times higher concentration of this drug. Why? It contains furanocoumarin, a coumarin derivative that inhibits the breakdown of some drugs in the gastrointestinal tract, even before it enters the bloodstream. This process is taken into account when developing appropriate doses of the preparations. When disturbed with some juice or drink, the drug may penetrate in too high a concentration, which in turn increases the risk of side effects. Many patients are unaware of this, and doctors usually do not ask patients what their medications are drinking from.
Alcohol and cigarettes
People who abuse alcohol are at risk of adverse effects of drugs. In principle, no pharmaceuticals should be mixed with it, especially when they are drugs acting on the central nervous system, i.e. sleeping pills, sedatives, psychotropic drugs and antidepressants. Even moderate amounts of alcoholic beverages, consumed in the form of wine or beer with a meal, in combination with pharmaceuticals such as painkillers (panadol), anxiolytics (xanax, valium), antidepressants or painkillers (fiorinal, fioricet) can be dangerous.
More than a hundred years ago, this type of interaction, called additive synergism, was perfectly used by ship captains who wanted to complete the crew, but there was no one willing to embark. In agreement with the bartenders of the port tavern, they added chloral hydrate to the rum, a sedative (a precursor to the commonly used barbiturates). Such a mixture, called Mickey Finn, intensified the effects of alcohol so much that it knocked even the strongest sailors off their feet. Today, commonly used preparations knock down healthy people who only carelessly handle drugs.
Even cigarette smokers react differently to certain medications, which can affect the effectiveness of their treatment. This has been demonstrated by studies carried out by specialists from the clinic of gastrointestinal diseases and metabolism of the Medical University of Lodz. Theophylline, a component of tea leaves, which is also used as a bronchodilator, especially useful in people suffering from paroxysmal and chronic bronchospasm, bronchitis and emphysema, has been studied. It has been shown that in heavy smokers it passes from the liver into the blood in lower concentrations, which reduces the effectiveness of the treatment. It is dangerous for this drug due to the small spread between the therapeutic dose and the dose that already causes toxic symptoms.
Ginseng and St. John’s wort
It is also important what medications prescribed by a doctor are used together with over-the-counter preparations. And we do that often. Patients taking warfarin, an anti-clotting drug, or digoxin, a drug used in heart failure and atrial fibrillation, can get a heart attack if they drink the sedative St. John’s wort extract at the same time. These commonly used and safe herbs inhibit the absorption of these drugs in the body.
So far, over 20 have been described in the medical literature. these unfavorable relationships and more serious interactions are reported almost weekly. It is suspected that every year in Poland alone, at least several hundred people suffering from heart disease die who, in addition to the prescribed anticoagulant drug, have taken ginseng root extract. This popular preparation also inhibits the action of warfarin (a drug that reduces blood clotting). And when a patient’s blood clots too much, it can lead to a stroke.
Women using oral contraceptives can become pregnant if they are taking antibiotics (e.g. penicillin), anti-epileptic drugs or headache pills (fiorinal, femcet) at the same time. Even seemingly innocent cough preparations can trigger coma when taken with INHIBITOR inhibitors? MAOIs, antidepressants. A 4-year-old woman taking this antidepressant died after taking just XNUMX tablespoons of one of the most popular cough syrups containing dextromethorphan.