COMMON DRUG-DRUG and DRUG-FOOD INTERACTIONS

Drug Food/Drugs Effect

Antipsychotic + Antiparkinsons Antidepressant there is additive anticholinergic
effect, Anticholinergic effects:
Xerostomia. Constipation
Urinary Retention
Diphenhydramine Chlorphenamine Greater sedative side effect
MAO inhibitor Tyramine containing food Accumulation of Tyramine may
examples: pickled fish, cheddar lead to hypertension
cheese
Probenecid Penicillin Increase serum concentration of
Penicillin derivatives
Calcium Fluoroquinolones Floroquinolones are absorbed
poorly
Ketoconazole Antacid Decrease in absorption and
effectiveness of the antifungal
because Ketoconazole is best
absorbed in an acidic
environment
Bisacodyl Antacid Increase in pH may cause
disintegration of the enteric
coating and may cause gastric
irritation and vomiting
Tetracycline Metals There is low absorption of
Tetracycline due to
complexation
Tetracycline Mg, Al, Fe, Bi, Zn Antibacterial is absorbed poorly

Aluminum Hydroxide Doxycycline Decrease in absorption of

Doxycycline
Tetracycline Milk or Antacid Decrease amount of antibiotics

Doxycycline Iron It should be taken at least an

interval of 3 hours because there
is decrease in absorption of
Doxycycline

Fluoroquinolones Al and Mg Administer 4 hours before or 8

hours after meal

Captopril Food Decrease in the concentration of

captopril,
1 hour before meals
Alendronate and Resodronate Food Reduce bioavailability (use with
plain water only)

Acarbose and Miglitol Food First bite = maximum

effectiveness

Calcium Channel blockers and Grapefruit juice Reduce CYP450 particularly

Statins CYP3A4 therefore increase in
amount of unmetabolized and
increase serum concentration of
statins and calcium channel
blockers
Anticoagulant Antibiotics Increase anticoagulant effect
because of the interference of
Vitamin K production
Acetaminophen Alcohol At a high dose may lead to
COMMON DRUG-DRUG and DRUG-FOOD INTERACTIONS

hepatotoxicity

Disulfiram Warfarin and Phenytoin Enhance the activity of Warfarin

and Phenytoin because of
inhibition of enzyme

Digoxin Antibiotics (Erythromycin or Increase digoxin due to decrease

Tetracycline) bacterial flora therefore
decrease metabolism of Digoxin
therefore increase in serum
concentration of cardiac
glycoside (bacterial flora of the
intestine contributes to
metabolic process)
ASA Methotrexate Displacement of methotrexate
will increase MTX concentration
or may cause toxicity
Phenytoin Valproic Acid Displacement of Phenytoin will
result to increase in Phenytoin
concentration that may lead to
toxicity

Warfarin Phenobarbital Phenobarbital is an enzyme

inducer thereby increases the
metabolism and result in
decreased pharmacological
effect of Warfarin that may lead
to increase risk of thrombus
Oral contraceptives Phenobarbital, Rifampin Phenobarbital is an enzyme
inducer thereby increases the
metabolism and result in
decreased pharmacological
effect of Oral contraceptives that
may lead to unplanned
pregnancy
Alcohol Disulfiram Inhibits metabolism of alcohol

Cilostazol (anti-thrombotic) Diltiazem Diltiazem will increase the level

of Cilostazol by affecting enzyme
CYP3A4 metabolism
Digoxin Amiodarone increases the blood levels
of digoxin
Aspirin Clopidogrel can cause excessive bleeding

Aspirin Phenytoin, Valproic acid Increase anti- seizure level due

to protein binding displacement
COMMON DRUG-DRUG and DRUG-FOOD INTERACTIONS

Drug Food/Drugs Effect

Ascorbic acid Antacid Ascorbic acid increases levels of
aluminum hydroxide by
enhancing GI absorption.

NSAIDs, including: Diuretics: Furosemide NSAIDS decrease effectiveness

Ibuprofen of diuretics
Naproxen
Acetaminophen Phenytoin May increase risk of
Acetaminophen toxicity
Loperamide Diphenhydramine May increase risk of severe
constipation
Dextromethorphan MAOIs Serotonin syndrome
(sweating, dilated pupils,
hyperthermia etc)
Dextromethorphan Sedatives or tranquilizers Increase sedation

Acetaminophen Aspirin Avoid prolonged concurrent use

of aspirin and acetaminophen, it
may increase risk of analgesis
nephropathy. (additive effects)
OVER THE COUNTER DRUGS

ORAL HYPOGLYCEMIC AGENTS

Drug A Drug B Effect

Metformin Cimetidine May increase Metformin levels
therefore there is a risk of
hypoglycemia
Metformin Glipizide Risk of hypoglycemia, synergistic
effect
Pioglitazone Metformin Decrease levels of both drugs
Metformin Food Reduce absorption of Metformin

Glipizide Metformin May increase risk of

hypoglycemia
Metformin Metoprolol May alter glucose metabolism.
Prolong hypoglycemia and mask
hypoglycemic symptoms.
Glipizide Metoprolol May alter glucose metabolism.
Prolong hypoglycemia and mask
hypoglycemic symptoms.