Herb-drug interactions: a re- systematic review and meta-analysis. Clin Pharmacol Ther view and study based on assessment of clinical case reports in , — Indian J Pharmacol 39, Eur J Clin Pharm 60, — AIDS J Clin Pharmacol Ther 50, — Parameters affecting the yield of DNA from human blood.
Molecular Anal Biochem , — Aberrant 3A5 gene in Africa. BMC Genet 14, 1— Warfarin dose creased expression and activity of CYP2B6 in liver. OMICS 23, 36— Chiba K. Pharmacogenet Genomics African specific warfarin pharmacogenetics-dosing algo- 15, — J Thromb Haemost 19, — The genetics of warfarin warfarin therapy in resource limited settings.
OMICS 23,— Post-mortem C. Venous thromboembolism requiring extended an- ABCB1 genotyping reveals an elevated toxicity for female ticoagulation among HIV-infected patients in a rural, digoxin users. Int J Legal Med , — Review of macother 51, — Sequence diversity in veloping countries.
Int J Cardiol , — Comparative utilization of polymorphic CYP3A5 expression. Nat Genet 27, — SLCO1B1 variants and statin-induced strand transfer inhibitor-based regimens. J Acquir Immune myopathy—a genome wide study. Lancet Glob Health 6, e—e Sci Rep 11, Prof on the population pharmacokinetics of efavirenz in HI- Case Manag 10, 39— Impact of — Curr Drug Metab R. Pharmacogenomics and hypertension: current in- 17, 30— Pharmacogenomics Person Med 12, Clinical comes of a pharmacist-managed anticoagulation clinic in the pharmacogenomics of carvedilol: the stereo-selective me- rural, resource-constrained setting of Eldoret, Kenya.
Pharmacogenomics 19, — J Thromb Haemost 9, — Pichette V, and du Souich P. Clin gelman-Sundberg MA. A novel mutant variant of the J Am Soc Nephrol 7, — Case report: population: association with diminished debrisoquine hy- severe central nervous system manifestations associated with droxylase activity.
Br J Clin Pharmacol 42, — BMC Infect Dis 16, 1—7. Pharmacogenet Genomics 8, 83— Clin Pharmacol Ther 96, — Novel variants of major drug-metabolising Risk factors for severe bleeding events during war- enzyme genes in diverse African populations and their pre- farin treatment: the influence of sex, age, comorbidity and co- dicted functional effects. Hum Genomics 3, 1— Eur J Clin Pharmacol 76, — Clinical Phar- October 27, Hypertension in Zimbabwe: a meta-analysis therapy.
Clin Pharmacol Ther 90, — Cytochrome Anal 3, 54— Circulation , — Pharmacogenomics J 19, — Profile and anticoagulation outcomes of patients on warfarin Drug Metab Dispos 40, — Atrial fibrillation in Sub- trough concentrations and neuropsychiatric adverse events Saharan Africa: epidemiology, unmet needs, and treatment in Japanese individuals infected with HIV BMC Infect options. Because people with several risk factors need special consideration, it is normal for healthcare professionals to perform a complete evaluation when a patient experiences their first blood clot.
This is particularly important for children. Additionally, warfarin should not be used during pregnancy because it may harm the growing fetus. Talk to your doctor about your treatment plan if you are pregnant or planning to become pregnant.
The body needs vitamin K to produce some essential blood clotting factors. Without enough vitamin K, these clotting factors may still be produced but are ineffective in clotting. Therefore, people with too little vitamin K have a bleeding tendency. Warfarin interferes with the action of vitamin K and therefore prolongs the time it takes to form a clot.
This is the intended effect of this therapy. Increasing vitamin K intake while you are on warfarin will work against the action of this medication.
Thank you for subscribing Our Housecall e-newsletter will keep you up-to-date on the latest health information. Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry. Show references Mahtani KR, et al. Vitamin K for improved anticoagulation control in patients receiving warfarin review. Cochrane Database of Systemic Reviews.
Accessed June 3, Ge B, et al. Updates on the clinical evidenced herb-warfarin interactions. Evidence-Based Complementary and Alternative Medicine. Chang C-H, et al. A practical approach to minimize the interaction of dietary vitamin K with warfarin. Journal of Clinical Pharmacy and Therapeutics. Hull RD, et al. Outpatient management of anticoagulation with warfarin. Accessed June 4, Holbrook A, et al. Evidence-based management of anticoagulant therapy: Antithrombotic therapy and prevention of thrombosis, 9th ed.
The interactions between natural products and drugs are based on the same pharmacokinetic and pharmacodynamic principles as drug-drug interactions. Several fruits and berries have recently been shown to contain agents that affect drug-metabolizing enzymes. The study of drug-drug, food-drug, and herb-drug interactions and of genetic factors affecting pharmacokinetics and pharmacodynamics is expected to improve drug safety and will enable individualized drug therapy.
Drugs can show their efficacy only if administered in appropriate quantity with appropriate combination of drugs and foods and at appropriate time.
In contrast to the easy access to information on drug-drug interactions, the information about food-drug interaction is not always available conveniently. It is a difficult and complex problem to accurately determine the effects of food and nutrients on a particular drug.
This article aims to help the healthcare professionals specially physicians and pharmacists and patients to become more knowledgeable about drug and food interactions.
Electronic search of literatures was conducted over a period of two months and all original research and review articles were included in this study. No literature was older than 20 years. The drugs were selected and reviewed on the basis of their general utilization pattern and realizing the need for reporting their interaction with different dietary supplements for better therapeutic use of these drugs within the recommended dose regimen.
Among all fruit juices, grape fruit juice GFJ possesses high interaction with almost all types of drugs. Taniguchi in reported a case of purpura associated with concomitant ingestion of cilostazol, aspirin and grapefruit juice in 79 years old man. His purpura disappeared upon cessation of grapefruit juice, although his medication was not altered. The most probable cause of his purpura is an increase in the blood level of cilostazol because of the inhibition of cilostazol metabolism by components of grapefruit juice; Taniguch.
GFJ is generally contraindicated to patients taking psychotropics and it is advised to inform patients about described interaction. With new anticonvulsants, serum iron and sodium need to be monitored. Additionally, users are advised to avoid drinking grape fruit juice within hr s of taking these anticonvulsants. Cholesterol-lowering agent lovastatin should be taken with food to enhance gastrointestinal absorption and bioavailability.
The absorption of rosuvastatin, another anti-hyper lipidemic agent, was significantly decreased in the fed state compared with the fasting state, which suggests that rosuvastatin should be administered on an empty stomach. Simvastatin, Ezetimibe, pravastatin and fluvastatin may be taken without regards to food. However, high fiber diets may lower the efficacy of these drugs. Consumption of pectin or oat bran together with Lovastatin reduces absorption of the drug, while alcohol intake does not appear to affect the efficacy and safety of Fluvastatin treatment.
Warfarin is commonly used to treat or prevent thromboembolic events. Some vegetables broccoli, Brussels sprouts, kale, parsley, spinach, and others are high in vitamin K. Eating large quantities or making sudden changes in the amounts eaten of these vegetables, interferes with the effectiveness and safety of warfarin therapy. Eating charbroiled food may decrease warfarin activity, while eating cooked onions may increase warfarin activity.
The combination of warfarin administration and cranberry juice ingestion appeared to be associated with an elevated INR without bleeding in elderly patient. A number of studies have been documented on the interaction of warfarin and cranberry juice. Specifically, cranberry juice may inhibit the activity of CYP2C9, the primary isoenzyme involved in the metabolism of S-warfarin.
It was suggested that cranberry juice increased the International Normalized Ratio INR of patients taking warfarin, but neither clearly identified cranberry juice as the sole cause of INR elevation. Antidepressant activity of monoamine oxidase inhibitors MAOIs was initially noted in the s. Although older monoamine oxidase inhibitors MAOIs are effective in the treatment of depressive disorders, they are under-utilized in clinical practice due to main concerns about interaction with tyramine-containing food matured cheese, red vine, ripped bananas, yogurt, shrimp paste and salami or so called cheese reaction, since they are capable of producing hypertensive crisis in patients taking MAOIs.
These medications carried with them dietary restrictions. Patients placed on anti hypertensive drugs will benefit from concomitant moderate sodium restricted diets. Smoking may decrease its plasma levels of by increasing its metabolism. Hesperidin, present in orange juice, is responsible for the decreased absorption of celiprolol.
Licorice extract, a common ingredient of dietary supplement contains glycyrrhizin and glycyrrhetinic acid. It is a potent inhibitor of bet- hydroxyl steroid dehydrogenase, it increases excess of cortisol to mineralocorticoid receptors causing sodium retention and potassium depletion, so it may interfere with various medicines including antihypertensive and antiarrhythmic agents. A practical guideline for an acceptable daily intake of glycyrrhizic acid seems to be 9.
This means no more than g liquorice and no more than half a cup of liquorice tea a day. Antibiotics are widely prescribed in medical practice. Many of them induce or are subject to interactions that may diminish their anti-infectious efficiency or elicit toxic effects.
Food intake can influence the effectiveness of an antibiotic. The intake of dairy products, however, needs to be monitored and encouraged with appropriate consideration of specific antibiotics involved. A number of studies give evidence that fluoroquinolones forming slightly soluble complex with metal ions of food show reduced bioavailability.
It was found that the absorption of ciprofloxacin mg tablets can be reduced by concomitant ingestion of the GFJ. Results showed that even a little quantity of milk containing extremely small amounts of calcium severely impair the absorption of the drug, so that the presence of this metal ion should be carefully controlled in order to avoid decreasing the available tetracycline. Food-drug interactions may reduce the bioavailability of drugs taken after meals negative food effects.
However, enteric-coated tablets that start to disintegrate when they reach the middle-to-lower region of the small intestine could reduce negative food effects. Results indicated that food-drug interactions were avoided by separating the main absorption site of drugs from that of food components. Analgesics and antipyretics are used to treat mild to moderate pain and fever.
For rapid relief, acetaminophen should be taken in an empty stomach because food may slow the body absorption of acetaminophen. Co-administration of acetaminophen with pectin delays its absorption and onset. Avoid or limit the use of alcohol because chronic alcohol use can increase the risk of liver damage or stomach bleeding.
The C max and AUC 0-alpha of ibuprofen were significantly increased after single and multiple doses of Coca-Cola, thereby indicating increased extent of absorption of ibuprofen. The daily dosage and frequency of ibuprofen must be reduced when administered with Coca-Cola.
Bronchodilators like theophylline, albuterol, and epinephrine possess different effects with food. The effect of food on theophylline medications can vary widely. High-fat meals may increase the amount of theophylline in the body, while high-carbohydrate meals may decrease it. Avoid alcohol if taking theophylline medications because it can increase the risk of side effects such as nausea, vomiting, headache and irritability.
Avoid eating or drinking large amounts of foods and beverages that contain caffeine e. Hence consuming large amounts of these substances while taking theophylline, increases the risk of drug toxicity. Fexofenadine, loratadine, rupatadine, cimetidine cetirizine, are all antihistamines. Rupatadine is commonly used for the management of diseases with allergic inflammatory conditions.
A study indicates that concomitant intake of food with a single 20 mg oral dose of rupatadine exhibits a significant increase in rupatadine bioavailability. A fraction of cimetidine is absorbed in the presence of food, allowing the remaining drug to be dissolved once the gut is cleared.
Thus, therapeutic levels are maintained throughout the dosing interval. Anti-tubercular drugs like isoniazid have been associated with tyramine and histamine interactions. Food greatly decreases isoniazid bioavailability. High fat meals decrease the serum concentration of cycloserine, a bacteriostatic anti-tubercular drug and results in incomplete eradication of bacteria.
Glimepiride is an antidiabetic and a new generation sulfonylurea derivative should be administered with breakfast or the first main meal of the day. It has absolute bioavailability and the absence of food interaction guarantee highly reproducible pharmacokinetics. However, extended release tablets should be taken with breakfast. Recent evidence pointed out the role of gastric acid secretion on the subsequent intestinal absorption of thyroxine in relation with the timing of food ingestion as well as with pH impairment associated to frequent gastric disorders like Helicobacter pylori infection and gastric atrophy.
Grapefruit juice may slightly delay the absorption of levothyroxine, but it seems to have only a minor effect on its bioavailability. Accordingly, the clinical relevance of the grapefruit juice-levothyroxine interaction is likely to be small.
Drug interactions may be theoretical or clinically relevant. A summary table is given to highlight some significant food-drug interactions. Table 1. Some may be taken advantage of, to the benefit of patients, but more commonly drug interactions result in unnecessary adverse events. Fortunately, undesirable drug interactions can be prevented. The prediction of whether a drug or drug product will show human food effect is challenging.
Mercaptopurine is a purine analog used for acute lymphoblastic leukemia and chronic myelogenous leukemias. Since it is inactivated by xanthine oxidase XO , concurrent intake of substances containing XO may potentially reduce bioavailability of mercaptopurine. This interaction may be clinically significant. Therefore most patients should try to separate the timing of taking mercaptopurine and drinking milk.
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