"Oh, the medicine is too bitter, just take it with some juice!" Little do they know, some medicines cannot be taken with food indiscriminately. This is because some foods can interact with certain drugs, affecting their absorption and metabolism, and in some cases, causing toxic side effects, creating an "incompatibility." What are the "taboos" between food and medicine?
I. Juice
Dihydroergotamine mesylate, sertraline, antihypertensive drugs, itraconazole
Dihydroergotamine mesylate, sertraline, antihypertensive drugs (such as amlodipine besylate, felodipine, benidipine, nifedipine, etc.), itraconazole, etc., should not be taken with grapefruit juice.
Grapefruit juice inhibits the CYP3A4 enzyme of the cytochrome P450 enzyme system, which can suppress the drug metabolism process mediated by this enzyme. Taking it with grapefruit juice can increase the risk of toxicity from dihydroergotamine mesylate (nausea, vomiting, ischemic vasospasm, etc.); it can increase the blood concentration of sertraline, raising the risk of adverse reactions; it can reduce the oral bioavailability of itraconazole, weakening its antifungal effect; and it can increase the blood concentration of antihypertensive drugs, leading to serious adverse reactions such as hypotension.
II. Alcohol
Cephalosporins, metronidazole, ketoconazole, aspirin, sleeping pills
Cephalosporin drugs (such as cefoperazone, ceftriaxone, cefoxitin, cefuroxime, etc.), metronidazole, ketoconazole, aspirin, sedative-hypnotics, etc., should be avoided during use.
Taking cephalosporin drugs, metronidazole, ketoconazole, etc., with alcohol can cause a "disulfiram-like reaction" characterized by chest tightness, shortness of breath, throat swelling, limb weakness, facial flushing, headache, nausea, etc. This is because the drug inhibits acetaldehyde dehydrogenase in the human body, leading to a block in ethanol metabolism and the production of toxicity.
Aspirin, on the other hand, inhibits acetaldehyde oxidase, preventing ethanol from being smoothly converted to acetic acid after being metabolized to acetaldehyde, leading to accumulation and causing discomfort symptoms such as headache, nausea, and vomiting.
Drinking alcohol while taking sedative-hypnotic drugs can further enhance the central nervous system depression of the drug. Excessive suppression can cause a person to react slowly, lead to drowsiness, or even unconsciousness.
III. Tea
When taking iron supplements and berberine, it is not advisable to drink tea or use tea water to take the medicine.
Tea water contains about 10% tannin components, which are broken down into tannic acid in the body. Tannic acid can form an insoluble precipitate with iron ions, affecting the absorption of iron supplements. This not only affects the drug's efficacy but also irritates the gastrointestinal tract, causing abdominal pain or constipation. Tannic acid can also precipitate the alkaloids in berberine, thereby reducing its efficacy. Therefore, tea should not be consumed 2 hours before or after taking berberine.
IV. Spinach/Caffeine
Calcium supplements should not be taken with foods rich in fiber (such as spinach) or caffeine (such as coffee, cola).
Fiber can form compounds that are not easily absorbed with calcium, thereby hindering calcium absorption. Caffeine can inhibit calcium absorption and promote its excretion through urine.
V. Milk
Generally, it is advisable to wait 1-2 hours after taking medicine before drinking milk.
Milk contains various substances that make it difficult for drugs to be absorbed by the gastrointestinal tract. Milk can easily form a coating on the surface of the drug. The calcium, magnesium, and other minerals in the milk can react chemically with the drug to form water-insoluble substances, affecting drug release and absorption. Some drugs may even be destroyed by the ions in milk, reducing the drug's concentration in the blood and affecting its efficacy.
For example, alendronate, antidiarrheal drugs, bismuth subcitrate potassium, and tetracycline should not be taken with milk. The reasons are as follows:
Milk high in calcium can reduce the absorption of bisphosphonates;
Milk not only reduces the efficacy of antidiarrheal drugs, but the lactose it contains can also worsen diarrhea symptoms;
The protein in milk can easily form complexes with the bismuth ions in bismuth subcitrate potassium, thereby reducing its efficacy;
The calcium in milk can also bind with tetracycline, affecting its absorption.
VI. Bitter Melon
Nateglinide, pioglitazone
Bitter melon has a certain blood sugar-lowering effect. When used in combination with nateglinide or pioglitazone, it increases the risk of hypoglycemia.
VII. Betel Nut
Amantadine hydrochloride, haloperidol should not be taken with betel nut.
The cholinergic effect of betel nut can antagonize the anticholinergic effect of amantadine, thereby reducing its efficacy. The cholinergic activity of betel nut can also enhance the extrapyramidal adverse effects of haloperidol, so they should not be taken together.
The metabolic process of drugs in the body is complex, and many factors can affect drug metabolism. The food we eat in our daily lives can also impact drug metabolism, which in turn affects drug efficacy. When taking medicine, what you can and cannot eat is often not clearly explained by doctors when giving instructions, and pharmacists should play a greater role in this area. Remember, rational drug use is a responsibility, and safe drug use is the prerequisite.