Drug Interaction Guide

8/22/2019 Drug Interaction Guide

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ood-



What you eat and drink can affect theway your medicines work. Use thisguide to alert you to possible “food-drug

interactions” and to help you learn whatyou can do to prevent them.

In this guide, a food-drug interaction is achange in how a medicine works causedby food, caffeine, or alcohol.

A food-drug interaction can:

▪ prevent a medicine from working theway it should

▪cause a side effect from a medicine toget worse or better

▪ cause a new side effect

A medicine can also change the way your body uses a food. Any of these changes

can be harmful.This guide covers interactions betweensome common prescription and over-the-counter medicines and food, caffeine, andalcohol. These interactions come from

medicine labels that FDA has approved.This guide uses the generic names of medicines, never brand names.

What else can affect how

my medicines work?Your age, weight, and sex; medicalconditions; the dose of the medicine; other medicines; and vitamins, herbals, andother dietary supplements can affect how

your medicines work. Every time you usea medicine, carefully follow the informationon the label and directions from your doctor or pharmacist.

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Does it matter if I take amedicine on a full or empty

stomach?Yes, with some medicines. Somemedicines can work faster, slower, better,or worse when you take them on a full or empty stomach. On the other hand, some

medicines will upset your stomach, andif there is food in your stomach, that canhelp reduce the upset. If you don’t seedirections on your medicine labels, askyour doctor or pharmacist if it is best to

take your medicines on an empty stomach(one hour before eating, or two hoursafter eating),with food, or after a meal (fullstomach).

Does it matter if I take mymedicine with alcohol?

Yes, the way your medicine works canchange when:

▪ you swallow your medicine withalcohol

▪ you drink alcohol after you’ve takenyour medicine

▪ you take your medicine after you’ve

had alcohol to drink Alcohol can also add to the side effectscaused by medicines. You should talk toyour doctor about any alcohol you use or plan to use.

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How do I know if caffeine isin my food or drinks?

Check the labels on your foods and drinksto see if they have caffeine. Some foodsand drinks with caffeine are coffee, coladrinks, teas, chocolate, some high-energydrinks, and other soft drinks. For more

about caffeine go to:www.fda.gov/downloads/UCM200805.pdf

Remember!

This guide should never take theplace of the advice from your doctor,pharmacist, or other health careprofessionals. Always ask them if thereare any problems you could have when

you use your medicines with other medicines; with vitamins, herbals andother dietary supplements; or with food,caffeine, or alcohol.

What isn’t in this guide?

This guide won’t include every medicineand every type of medicine that’s used totreat a medical condition. And just because

a medicine is listed here, doesn’t mean youshould or shouldn’t use it.

This guide only covers food-druginteractions with medicines you shouldswallow. It doesn’t cover, for example,

medicines that you put on the skin, injectthrough the skin, drop in your eyes andears, or spray into your mouth.

This guide also doesn’t cover drug-druginteractions, which are changes in theway your medicines work caused by other medicines. Prescription medicines caninteract with each other or with over-the-counter medicines, and over-the-counter medicines can interact with each other.

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This guide usually doesn’t cover interactions between medicines and

vitamins, herbals, and other dietarysupplements.

Find out what other interactions and sideeffects you could have with the medicinesyou use so you can try to avoid or prevent

them. If you have any questions, talk toyour doctor or pharmacist. To nd out moreabout how to use your medicines safely,visit the Web sites listed on the back panelof this guide.

How do I use this guide?

This guide arranges information by:

Types of medicines used totreat the medical condition

Examples of active ingredients in

medicines of this typeInteractions are listed by

Food, Caffeine, and Alcohol.

Medical conditions

If you see…▪ A medical condition

you have

▪ One of the types of

medicines you use, or

▪ One of your medicines used asan example here,

nd out if food, caffeine, or alcohol might

change the way your medicine works.

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Allergies

Antihistamines

Antihistamines treat or relievesymptoms of colds and allergies,

such as sneezing, runny nose, stuffynose, and itchy eyes. They block thehistamine your body releases whena substance (allergen) causes thesymptoms of an allergic reaction. Someantihistamines you can buy over-the-counter and some you can buy onlywith a prescription from your doctor or other health care professionalwho can write a prescription. Someantihistamines can cause drowsiness.

Examplesbromphen i ramine ce t i r i z inech lo rphen i raminec lemast inedes lo ra tad ined iphenhydraminefexo fenad inel evoce t i r i z inet r ip ro l id ine

Interactions

Alcohol: Avoid alcohol because itcan add to any drowsiness caused

by these medicines.

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Arthritis, Pain, and Fever Analgesics/Antipyretics (Pain

relievers/Fever reducers)

Analgesics/antipyretics relieve mild to

moderate pain and lower fever.

Exampleace taminophen

Acetaminophen relieves mild tomoderate pain from headaches,muscle aches, toothaches, backaches,menstrual cramps, the common cold,pain of arthritis, and lowers fever.

Interactions

Alcohol: If you drink three or more alcoholic drinks every day,ask your doctor if you should use

medicines with acetaminophen or other pain reliever/fever reducers. Acetaminophen can cause liver damage. The chance for severe liver damage is higher if you drink three or

more alcoholic drinks every day.Non-Steroidal Anti-Inammatory

Drugs (NSAIDs)

NSAIDs relieve pain, fever, and

inammation. Some NSAIDs you canbuy over-the-counter and some youcan buy only with a prescription. Theover-the-counter NSAIDs give shortterm relief from minor aches and

pains from headaches, muscle aches,toothaches, backaches, menstrualcramps, and minor aches and pain of

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arthritis. NSAIDs may be prescribedfor conditions such as osteoarthritis

(arthritis caused by the breakdown of the lining of the joints). NSAIDS cancause stomach bleeding.

Examplesasp i r ince lecox ibd ic lo fenaci bupro fenke topro fen naproxen

Interactions

Food: Take these medicines withfood or milk if they upset your

stomach.Alcohol: If you drink three or morealcoholic drinks every day, ask your doctor if you should use medicineswith NSAIDs or other pain relievers/

fever reducers. NSAIDs can causestomach bleeding and the chanceis higher if you drink three or morealcoholic drinks every day.

Narcotic AnalgesicsNarcotic analgesics treat moderateto severe pain. Codeine can alsohelp you cough less. Some of thesemedicines are mixed with other

medicines that aren’t narcotics, suchas acetaminophen, aspirin, or coughsyrups. You can only buy narcoticanalgesics with a prescription. Followyour doctor’s or pharmacist’s advice

carefully because these medicines canbe habit forming and can cause seriousside effects if not used correctly.

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I

Examplescodeine + acetaminophen

hydrocodone + acetaminophenmeper id inemorph ineoxycodone + acetaminophen

nteractions

Alcohol: Don’t drink alcohol whileusing narcotics. Alcohol can increasethe chance of dangerous sideeffects, coma, or death.

Asthma

Bronchodilators

Bronchodilators treat and preventbreathing problems from bronchialasthma, chronic bronchitis,emphysema, and chronic obstructivepulmonary disease (COPD). Thesemedicines relax and open the air passages to the lungs to relievewheezing, shortness of breath, troubledbreathing, and chest tightness.

Take these medicines only as directed.If your symptoms get worse or youneed to take the medicine more oftenthan usual, you should talk to your doctor right away.

Examplesa lbu te ro ltheophy l l ine

Interactions

Food: Food can have differenteffects on different forms of

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theophylline (some forms areregular release, sustained release,

and sprinkles). Check with your pharmacist to be sure you knowwhich form of the medicine you useand if food can affect your medicine.

Follow directions for sprinkle forms

of the medicine. You can swallowsprinkle capsules whole or openthem and sprinkle them on softfoods, such as applesauce or pudding. Swallow the mixture without

chewing, as soon as it is mixed.Follow with a full glass of cool water or juice.

Caffeine: Using bronchodilatorswith foods and drinks that have

caffeine can increase the chanceof side effects, such as excitability,nervousness, and rapid heart beat.

Alcohol: Avoid alcohol if you’reusing theophylline medicinesbecause alcohol can increase thechance of side effects, such asnausea, vomiting, headache, andirritability.

Cardiovascular Disorders

These medicines prevent or treatdisorders of the cardiovascular system,

such as high blood pressure, angina(chest pain), irregular heart beat,heart failure, blood clots, and highcholesterol. Some types of medicinescan treat many conditions. For

example, beta blockers can treat highblood pressure, angina (chest pain),and irregular heart beats.

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ACE Inhibitors (Angiotensin

Converting Enzyme Inhibitors)

ACE inhibitors alone or with other medicines lower blood pressure or treatheart failure. They relax blood vesselsso blood ows more smoothly and the

heart can pump blood better.

Examplescap topr i lena lapr i ll i s inopr i lmoex ip r i lqu inapr i lramipr i l

InteractionsFood: Take captopril and moexiprilone hour before meals.

ACE inhibitors can increase theamount of potassium in your body.

Too much potassium can be harmfuland can cause an irregular heartbeatand heart palpitations (rapid heartbeats). Avoid eating large amountsof foods high in potassium, such

as bananas, oranges, green leafyvegetables, and salt substitutes thatcontain potassium. They can raisethe level of potassium even higher.Tell your doctor if you are taking salt

substitutes with potassium, potassiumsupplements, or diuretics (water pills)because these can add to the amountof potassium in your body.

Beta Blockers

Beta blockers can be used alone or with other medicines to treat high blood

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pressure. They are also used to preventangina (chest pain) and treat heart

attacks. They work by slowing the heartrate and relaxing the blood vessels sothe heart doesn’t have to work as hard topump blood.

Don’t suddenly stop taking a beta blocker

without talking to your doctor. If you stopa beta blocker suddenly, you can getchest pain, an irregular heartbeat, or aheart attack. Your doctor might tell you todecrease your dose gradually.

Examplescarved i lo lmetopro lo l

InteractionsFood: Take carvedilol with food todecrease the chance it will lower your blood pressure too much. Takecarvedilol extended release capsules

in the morning with food; don’t crush,chew, or divide the capsule. Takemetoprolol with a meal or right after ameal.

DiureticsSometimes called “water pills,” diureticshelp remove water, sodium, and chloridefrom the body. Diuretics reduce sodiumand the swelling and excess uid caused

by some medical problems such as heartor liver disease. Diuretics can also treathigh blood pressure.

Examplesbumetan idefu rosemidehydroch lo ro th iaz ide

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meto lazonet r iamterene

tr iamterene + hydrochloroth iaz ide

Interactions

Food: Take your diuretic with food if it upsets your stomach.

Some diuretics cause loss of theminerals potassium, calcium, andmagnesium from the body.

Other diuretics, like triamterene

(not with hydrochlorothiazide),lower the kidneys’ ability to removepotassium, which can cause highlevels of potassium in the bloodstream (hyperkalemia). Too much

potassium can be harmful and cancause an irregular or rapid beatingof the heart. When you use diureticsthat can increase potassium in your body, avoid eating large amounts

of foods high in potassium, such asbananas, oranges, and green leafyvegetables, and salt substitutes thatcontain potassium. They can raisethe level of potassium even higher.Tell your doctor if you are takingsalt substitutes with potassium or potassium supplements becausethey can add to the amount of potassium in your body.

Glycosides

Glycosides treat heart failure andabnormal heart rhythms. They helpcontrol the heart rate and help the heart

work better.Example

d igox in

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InteractionsFood: Take digoxin one hour beforeor two hours after eating food. Tryto take it at the same time(s) everyday and carefully follow the labeland directions from your doctor.Foods high in ber may decrease thedigoxin in your body, so take digoxinat least two hours before or twohours after eating foods high in ber (such as bran).

Avoid taking digoxin with sennaand St. John’s wort since they maydecrease the amount and action of digoxin in your body.

Avoid taking digoxin with black

licorice (which contains theglycyrrhizin used in some candies,cakes and other sweets). Digoxinwith glycyrrhizin can cause irregular heart beat and heart attack.

Lipid-Altering Agents (also

called Statins)

Statins lower cholesterol by loweringthe rate of production of LDL (low-density lipoproteins, or sometimescalled “bad cholesterol”). Some of thesemedicines also lower triglycerides.Some statins can raise HDL-C (high-density lipoproteins, or sometimes

called “good cholesterol”), and lower the chance of heart attack, stroke, or small strokes.

Examples

ato rvas ta t inf l uvas ta t inl ovas ta t in

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I

pravas ta t ins imvas ta t inrosuvas ta t in

nteractions

Food: You can take most statinson a full or empty stomach. Some

statins will work better if youtake them with an evening meal.Don’t drink more than one quartof grapefruit juice a day if you aretaking atorvastatin, lovastatin, or

simvastatin. Large amounts of grapefruit juice can raise the levelsof those statins in your body andincrease the chance of side effects.Some statins don’t interact with

grapefruit juice. Ask your doctor or pharmacist if you have anyquestions.

Alcohol: Avoid alcohol becauseit can increase the chance of liver

damage.

Vasodilators-Nitrates

Nitrates prevent or treat chest pain(angina). They work by relaxing theblood vessels to the heart, whichimproves the blood and oxygen ow tothe heart.

Examples

i sosorb ide d in i t ra te or mononi t ra ten i t rog lycer in

Interactions

Food: You can take all forms of nitrates on a full or empty stomach.

Alcohol: Avoid alcohol. Alcohol may

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add to the blood vessel-relaxing effectof nitrates and lead to a dangerously

low blood pressure.

Vitamin K Agonists/

Anticoagulants

Anticoagulants are also called “blood

thinners.” They lower the chanceof blood clots forming or growinglarger in your blood or blood vessels. Anticoagulants are used to treat peoplewith certain types of irregular heartbeat,

people with prosthetic (replacementor mechanical) heart valves, andpeople who have had a heart attack. Anticoagulants also treat blood clots thathave formed in the veins of the legs or

lungs.

Examplewar fa r in

InteractionsFood: You can take warfarin on a fullor empty stomach. Vitamin Kin food can make the medicine lesseffective. Eat a normal balanced diet

with a steady amount of leafy greenvegetables, and talk to your doctor before making changes in your diet.Foods high in vitamin Kinclude broccoli, cabbage, collard

greens, spinach, kale, turnipgreens, and brussel sprouts. Avoid cranberry juice or cranberryproducts while using anticoagulantsbecause they can change the

effects of warfarin. Many dietarysupplements and vitamins caninteract with anticoagulants and can

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reduce the benet or increase therisk of warfarin. Avoid garlic, ginger,

glucosamine, ginseng, and ginkgobecause they can increase thechance of bleeding.

Alcohol: Tell your doctor andpharmacist if you drink alcohol or

have problems with alcohol abuse. Avoid alcohol because it can affectyour dose of warfarin.

Gastroesophageal ReuxDisease (GERD) andUlcers

Proton Pump Inhibitors

Proton Pump Inhibitors (PPIs) work bydecreasing the amount of acid madein the stomach. They treat conditionswhen the stomach produces too much

acid. Some of these medicines you canbuy over-the-counter to treat frequentheartburn, such as omeprazole andlansoprazole. Some of these medicinesyou can only buy with a prescriptionto treat conditions such as ulcers,gastroesophageal reux disease, andto reduce the risk of stomach ulcersin people taking nonsteroidal anti-inammatory drugs (NSAIDs). (See Arthritis, Pain and Fever-Nonsteroidal

Anti-inammatory Drugs above.) Protonpump inhibitors are also used alongwith antibiotics to stop infections in thestomach that cause ulcers.

Proton pump inhibitors come in differentforms (such as delayed-release tablets,delayed-release disintegrating tablets,

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immediate release). Don’t change your dose or stop using these without talking

to your doctor rst.

Examplesdex lansoprazo leesomeprazo lelansoprazo leomeprazo lepan toprazo lerabeprazo le

Interactions

Food: You can take dexlansoprazoleand pantoprazole on a full or emptystomach. Esomeprazole should betaken at least one hour before a

meal. Lansoprazole and omeprazoleshould be taken before eating. Askyour doctor or pharmacist how youshould take rabeprazole.

Tell your doctor if you cannot

swallow delayed-release medicineswhole because you shouldn’t split,crush, or chew them. Some of thesemedicines can be mixed with foodbut you must carefully follow the

label and directions from your doctor or pharmacist.

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Hypothyroidism

Hypothyroidism is a condition where thethyroid gland doesn’t produce enoughthyroid hormone. Without this hormone,the body cannot function properly, so

there is poor growth, slow speech, lackof energy, weight gain, hair loss, drythick skin, and increased sensitivity tocold.

Thyroid Medicines

Thyroid medicines controlhypothyroidism but they don’t cureit. They reverse the symptoms of hypothyroidism. Thyroid medicine

is also used to treat congenitalhypothyroidism (cretinism),autoimmune hypothyroidism, other causes of hypothyroidism (such as after thyroid surgery), and goiter (enlarged

thyroid gland). It may take severalweeks before you notice a change inyour symptoms. Don’t stop taking themedicine without talking to your doctor.

Examplel evo thyrox ine

Interactions

Foods: Tell your doctor if you

are allergic to any foods. Takelevothyroxine once a day in themorning on an empty stomach,at least one-half hour to one hour before eating any food. Tell your

doctor if you eat soybean our (also found in soybean infantformula), cotton seed meal, walnuts,

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and dietary ber; the dose of themedicine may need to be changed.

Infections

Be sure to nish all of your medicine

for an infection, even if you are feelingbetter. All of the medicine is needed tokill the cause of infection. If you stopthe medicine early, the infection maycome back; the next time, the medicinemay not work for the infection. Ask your doctor if you should drink more uidsthan usual when you take medicine for an infection.

Antibacterials

Medicines known as antibioticsor antibacterials are used to treatinfections caused by bacteria. None of these medicines will work for infectionsthat are caused by viruses (such ascolds and u).

Quinolone Antibacterials

Examples

c ip ro f loxac inl evo f loxac inmoxi f loxac in

Interactions

Food: You can take ciprooxacinand moxioxacin on a full or emptystomach. Take levooxacin tablets

on a full or empty stomach. Takelevooxacin oral solution one hour

before eating or two hours after eating.

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Don’t take ciprooxacin with dairyproducts (like milk and yogurt) or

calcium-fortied juices alone, but youcan take ciprooxacin with a meal thathas these products in it.

Caffeine: Tell your doctor if you takefoods or drinks with caffeine when you

take ciprooxacin, because caffeinemay build up in your body.

Tetracycline Antibacterials

Examples

doxycyc l ineminocyc l inete t racyc l ine

Interactions

Food: Take these medicines one hour before a meal or two hours after ameal, with a full glass of water.

You can take tetracycline with food

if it upsets your stomach, but avoiddairy products (such as milk, cheese,yogurt, ice cream) one hour beforeor two hours after. You can takeminocycline and some forms of

doxycycline with milk if the medicineupsets your stomach.

Oxazolidinone Antibacterials

Example

l i nezo l id

Interactions

Food: Avoid large amounts of foodsand drinks high in tyramine while using

linezolid. High levels of tyramine cancause a sudden, dangerous increasein your blood pressure. Follow your doctor’s directions very carefully.

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Foods with Tyramine

Foods that are spoiled or not

refrigerated, handled, or storedproperly, and aged, pickled,fermented, or smoked foods maycontain tyramine. Some of these are:

• cheeses, especially strong, aged,or processed cheese, such as American processed, cheddar,colby, blue, brie, mozzarella, andparmesan cheese; yogurt; sour cream (you can eat cream and

cottage cheese)

• beef or chicken liver, dry sausage(including Genoa salami, hardsalami, pepperoni, and Lebanonbologna), caviar, dried or pickledherring, anchovies, meat extracts,meat tenderizers and meatsprepared with tenderizers

• avocados, bananas, canned

gs, dried fruits (raisins, prunes),raspberries, overripe fruit,sauerkraut, soy beans and soysauce, yeast extract (includingbrewer’s yeast in large quantities)

• broad beans (fava)• excessive amounts of chocolate

Caffeine: Many foods and drinkswith caffeine also contain tyramine.

Ask your doctor if you should avoidor limit caffeine.

Alcohol: Avoid alcohol while usinglinezolid. Many alcoholic drinkscontain tyramine, including tap

beer, red wine, sherry, and liqueurs.Tyramine can also be in alcohol-freeand reduced alcohol beer.

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I

Metronidazole Antibacterials

Examplemet ron idazo le

nteractions

Alcohol: Don’t drink alcohol while

taking metronidazole and for atleast one full day after nishingthe medicine; together alcohol andmetronidazole can cause nausea,stomach cramps, vomiting, ushing,

and headaches.

Antifungals

Antifungals are medicines that treat or prevent fungal infections. Antifungals

work by slowing or stopping the growthof fungi that cause infection.

Examplesf l uconazo lei t raconazo le

posaconazo levor iconazo legr iseo fu lv inte rb ina f ine

Interactions

Food: Itraconazole capsules willwork better if you take it during or right after a full meal. Itraconazolesolution should be taken on anempty stomach. Posaconazolewill work better if you take it with ameal, within 20 minutes of eating afull meal, or with a liquid nutritional

supplement. Don’t mix voriconazolesuspension with any other medicines, water, or any other liquid.

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Griseofulvin works better when takenwith fatty food.

You can take the rest of theantifungals listed here on a full or empty stomach.

Alcohol: Avoid alcohol while youare taking griseofulvin becausegriseofulvin can make the sideeffects of alcohol worse. For example, together they can causethe heart to beat faster and cancause ushing.

Antimycobacterials

Antimycobacterials treat infectionscaused by mycobacteria, a type of

bacteria that causes tuberculosis (TB),and other kinds of infections.

Examplesethambuto li son iaz id

r i famp inr i fampin + isoniaz idr i fampin + isoniazid + pyrazinamide

Interactions

Food: Ethambutol can be takenwith or without food. Take the rest of these medicines one hour before ameal or two hours after a meal, witha full glass of water.

Avoid foods and drinks with tyramineand foods with histamine if you takeisoniazid alone or combined withother antimycobacterials. High levels

of tyramine can cause a sudden,dangerous increase in your bloodpressure. Foods with histamine

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can cause headache, sweating,palpitations (rapid heart beats),

ushing, and hypotension (low bloodpressure). Follow your doctor’sdirections very carefully.

Foods that contain tyramine arelisted on page 21, under “Foods

with Tyramine.”

Foods with histamine includeskipjack, tuna, and other tropical sh.

Caffeine: Many foods and drinks

with caffeine also contain tyramine. Ask your doctor if you should avoidor limit caffeine.

Alcohol: Avoid alcohol. Manyalcoholic drinks contain tyramine,

including tap beer, red wine, sherry,and liqueurs. Tyramine can also bein alcohol-free and reduced alcoholbeer. If you drink alcohol everyday while using isoniazid you may

have an increased risk of isoniazidhepatitis.

Antiprotozoals

Antiprotozoals treat infections caused

by certain protozoa (parasites thatcan live in your body and can causediarrhea).

Examples

met ron idazo let i n idazo le

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Interactions

Alcohol: Together alcohol andthese medicines can cause nausea,stomach cramps, vomiting, ushing,and headaches. Avoid drinkingalcohol while taking metronidazole

and for at least one full day after nishing the medicine. Avoid drinkingalcohol while taking tinidazole andfor three days after nishing themedicine.

Psychiatric Disorders

Depression, bipolar disorder, general

anxiety disorder, social phobia, panicdisorder, and schizophrenia are afew examples of common psychiatric(mental) disorders. Use the amount of medicine that your doctor tells you to

use, even if you are feeling better. Insome cases it can take several weeksbefore you see your symptoms getbetter. Don’t stop these medicines untilyou talk to your doctor. You may need

to stop your medicine gradually to avoidgetting side effects. Some of thesemedicines can affect your thinking, judgment, or physical skills. Some maycause drowsiness and can affect howalert you are and how you respond.Don’t do activities like operatingmachinery or driving a car, until youknow how your medicine affects you.

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I

Anti-Anxiety and

Panic Disorder Medicines

Examplesa lp razo lamc lonazepam d iazepaml o razepam

nteractions

Alcohol: Avoid alcohol. Alcoholcan add to the side effects caused

by these medicines, such asdrowsiness.

Antidepressants

Antidepressants treat depression,general anxiety disorder, social phobia,obsessive-compulsive disorder,some eating disorders, and panicattacks. The medicines below work byincreasing the amount of serotonin,

a natural substance in the brain thathelps maintain mental balance.

Never stop an antidepressant medicinewithout rst talking to a doctor. You may

need to stop your medicine gradually toavoid getting side effects.

Examplesc i ta lopramesc i ta lopram f l uoxe t ineparoxe t ineser t ra l ine

Interactions

Food: You can take these medicineson a full or empty stomach. Swallow

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paroxetine whole; don’t chew or crush it.

Alcohol: Avoid alcohol. Alcoholcan add to the side effects causedby these medicines, such asdrowsiness.

Antidepressants-MonoamineOxidase Inhibitors (MAOIs)

MAOIs treat depression in peoplewho haven’t been helped by other

medicines. They work by increasing theamounts of certain natural substancesthat are needed for mental balance.

Examplesphene lz ine

t rany lcypromine

Interactions

Food: Avoid foods and drinks that

contain tyramine when you useMAOIs. High levels of tyramine cancause a sudden, dangerous increasein your blood pressure. Follow your doctor’s directions very carefully.

Foods that contain tyramine are listedon page 21, under “Foods withTyramine.”

Caffeine: Many foods and drinks withcaffeine also contain tyramine. Ask

your doctor if you should avoid or limitcaffeine.

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Alcohol: Don’t drink alcohol whileusing these medicines. Many alcoholic

drinks contain tyramine, including tapbeer, red wine, sherry, and liqueurs.Tyramine also can be in alcohol-freeand reduced alcohol beer. Alcohol alsocan add to the side effects caused by

these medicines.

Antipsychotics

Antipsychotics treat the symptomsof schizophrenia and acute manic or

mixed episodes from bipolar disorder.People with schizophrenia may believethings that are not real (delusions) or see, hear, feel, or smell things that arenot real (hallucinations). They can also

have disturbed or unusual thinking andstrong or inappropriate emotions. Thesemedicines work by changing the activityof certain natural substances in thebrain.

Examplesar ip ip razo lec lozap ineo lanzap ine quet iap iner i sper idonez ip ras idone

Interactions

Food: Take ziprasidone capsuleswith food.You can take the rest of these medicines on a full or emptystomach.

Caffeine: Avoid caffeine when using

clozapine because caffeine canincrease the amount of medicine inyour blood and cause side effects.

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I

Alcohol: Avoid alcohol. Alcoholcan add to the side effects caused

by these medicines, such asdrowsiness.

Sedatives and Hypnotics (Sleep

Medicines)

Sedative and hypnotic medicines treatpeople who have problems fallingasleep or staying asleep. They workby slowing activity in the brain to allowsleep. Some of these medicines you

can buy over-the-counter and some youcan only buy with a prescription.

Tell your doctor if you have ever abusedor have been dependent on alcohol,

prescription medicines, or street drugsbefore starting any sleep medicine.You could have a greater chance of becoming addicted to sleep medicines.

Examples

eszop ic lonezo lp idem

nteractions

Food: To get to sleep faster, don’ttake these medicines with a meal or right after a meal.

Alcohol: Don’t drink alcohol whileusing these medicines. Alcohol can

add to the side effects caused bythese medicines.

Bipolar Disorder Medicines

People with bipolar disorder experience

mania (abnormally excited mood,racing thoughts, more talkative thanusual, and decreased need for sleep)

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and depression at different times duringtheir lives. Bipolar disorder medicines

help people who have mood swings byhelping to balance their moods.

Examplescarbamazep ine diva lproex sodiuml amot r ig inel i t h ium

InteractionsFood: Take divalproex with foodif it upsets your stomach. Takelithium immediately after meal or with food or milk to avoid stomachupset. Lithium can cause you to lose

sodium, so maintain a normal diet,including salt; drink plenty of uids(eight to 12 glasses a day) while onthe medicine.

Alcohol: Avoid alcohol. Alcohol

can add to the side effects causedby these medicines, such asdrowsiness.

OsteoporosisBisphosphonates (bone calcium

phosphorus metabolism)

Bisphosphonates prevent and treatosteoporosis, a condition in which thebones become thin and weak andbreak easily. They work by preventingbone breakdown and increasing bonethickness.

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Examplesa lendronate sod ium

alendronate sodium +cho leca lc i fe ro libandronate sod iumr isedronate sod iumrisedronate sodium + calc ium

carbonateFood: These medicines work onlywhen you take them on an emptystomach. Take the medicine rstthing in the morning with a full glass

(six to eight ounces) of plain water while you are sitting or standing up.Don’t take with mineral water. Don’ttake antacids or any other medicine,food, drink, calcium, or any vitamins

or other dietary supplements for at least 30 minutes after takingalendronate or risedronate, andfor at least 60 minutes after takingibandronate. Don’t lie down for

at least 30 minutes after takingalendronate or risedronate andfor at least 60 minutes after takingibandronate. Don’t lie down until youeat your rst food of the day.

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More About UsingMedicines Safely

Read the label before you use anymedicine.

Over-the-counter Medicines

Over-the-counter medicine has a labelcalled Drug Facts on the medicinecontainer or packaging. The label isthere to help you choose the rightmedicine for you and your problem and

use the medicine safely. Some over-the-counter medicines also come witha consumer information leaet whichgives more information.

Prescription Medicines

Medication Guide(also called Med Guide):

This is one kind of information written

for consumers about prescriptionmedicines. The pharmacist must giveyou a Medication Guide each timeyou ll your prescription when thereis one written for your medicine.Medication Guides are made for certain medicines that have seriousrisks. The information tells aboutthe risks and how to avoid them.Read the information carefullybefore you use the medicine. If youhave any questions, ask a doctor or pharmacist.

For more information on MedicationGuides, visit: www.fda.gov/drugs

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Patient Package Insert(also called “PPI” or patientinformation):

This is another kind of informationwritten for consumers aboutprescription medicines. Your pharmacist might give this to you

with your medicine. It gives youinformation about the medicine andhow to use it. The pharmacist mustgive you a PPI with birth control pillsor any medicine with estrogen.

Resources

http://www.fda.gov/usemedicinesafely

Consumer education on how to chooseand use medicine, from the FDA.

http://www.medlineplus.gov

Health information for consumers, from

the government’s National Library of Medicine (NLM).

http://dailymed.nlm.nih.gov

FDA-approved drug labeling writtenfor healthcare professionals, from the

government’s National Institutes of Health (NIH); sometimes this labelingwill also have a “Patient Package Insert”or PPI or a “Medication Guide,” writtenfor patients.

http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm

Drugs@FDA website with FDA-approved labeling written for healthcareprofessionals; sometimes this labeling

will also have a “Patient Package Insert”or PPI, or a “Medication Guide,” writtenfor patients. The site may have a “Drug

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Safety Communication,” or “Other Important Information from FDA,” if

there has been new information aboutthe medicine that has not made it to thelabel yet.

http://www.fda.gov/drugs/ucm079489.htm

A personal medicine record can helpyou keep track of your prescriptionand over-the-counter medicines andvitamins, herbals, and other dietarysupplements you use. If you keep a

written record, it can make it easy toshare this information with all your healthcare professionals—at ofce,clinic and hospital visits, and inemergencies.

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National Consumers League

A 501(c)(3) nonprot membership

organization

Phone: 202-835-3323

Fax: 202-835-0747

Email: [email protected]

Web: www.nclnet.org

U.S. Department of Health andHuman Services

Food and Drug Administration

Phone: 1-888-INFO-FDA

Email questions: [email protected]: www.fda.gov/drugs

For an online version of this guide visit:

Documents

Drug Interaction Guide