"Should I take this with or

without food?"
"Which foods should I avoid
taking with my medications?"
The importance of studying drug interaction
• Medicine have interaction with food/ herbs
• Benefit and negative impact
• difficulty to get the data food consumption during medication used
• Food - drug can alter pharmacokinetic & pharmacodynamic
Food mechanism to alter absorption

• Altered gastric pH
• Bind to drug
• Dilution of drug particle
• Alter rate absorption
• Compete for absorption site
Metabolism

• Food influence enzyme metabolism

CYP 450
• Ex: Grapefruit
Excretion
• Effect in Urinary pH
• Acidic food: increased excretion of basic drug (amfetamin, quinidine)
• Basic food: increased excretion of acidic drug (salisilat, fenobarbital)
Antihypertensive
• Antihypertensive drug + food with high sodium?
• Propranolol+rich protein food?
• ACE inhibitor (Kaptopril) + food =?
• Felodipine+ Grapefruit juice?
Grapefruit Juice (Jeruk bali)
• Inhibite enzyme cytochrome
CYP3A
• CYP 3A4 substrates like
Felodipine, midazolam,
cyclosporine and raise their
concentrations above toxic
levels.
Warfarin (Anticoagulant)

• Interferes with hepatic synthesis of vitamin

• Warfarin vs High Protein Diet (telur, daging ayam dan
sapi, jeroan, udang, ikan tuna)?
• Warfarin + Vegetables (broccoli, bayam, sayuran2 hijau Brussels) are
high in vitamin K.
• Problems: Eating large quantities or making sudden changes in the
amounts eaten of these vegetables, interferes (menurunkan) with the
effectiveness and safety of warfarin therapy.
• Solution: Reduce consume these vegetables
Warfarin + Cranberry (Bluebery)?
• Flavonoid
• inhibit the activity of CYP2C9
• Elevated INR without bleeding in elderly patient.
Antibiotic
• Siprofloksasin, Fluoroquinolon,
Tetrasiklin + milk
• Ciprofloxaxin + Grapefruit
Juice?
Azithromycin + Food?
Bioavailability?
HOW ABOUT ENTERETIC COATED TABLET??
• Disintegrate drug in intestinal
• Reduce interaction
• Separation main absorption site of drug
Analgesics and Antipyretics
Analgesics and antipyretics are used to treat mild to moderate pain and fever.

• Acetaminophen + Food?
• NSAIDs like ibuprofen, naproxen, ketoprofen
+ food?
• NSAIDs+alcohol?
• Ibuprofen + Coca Cola?
• Problems: The Cmax and AUC0-alpha of ibuprofen were significantly increased
after single and multiple doses of Coca-Cola
• Solution: The daily dosage and frequency of ibuprofen must be reduced when
administered with Coca-Cola.
Bronchiodilators

• Bronchodilator+High fat meals?

• Bronchodilator+ carbohydrate meals?
• Teophyllin+ alcohol?
• Bronchodilators and caffeine?
• Bronchodilators + Grapefruit?
Antihistamines

• Fexofenadine, loratadine, rupatadine, cimetidine cetirizine, are all

antihistamines
• on an empty stomach to increase their effectiveness
Antidiabetic
• Glimepiride
• Immediate release glipizide
• Extended release glipizide tablets
• Acarbose, an alpha-glucosidase inhibitor
 PREVENTION
• Take pills/ capsule with a large glass of
water
• Do not mix a drug directly into a food or
drink
• Take no medicines with alcohol
• Every drug should be known taken on full
or empty stomach
REFERENCES