SHOULD FOOD BE TAKEN WITH DRUGS? It certainly makes a difference with micronised phenytoin, as 'Fenantoin' Absorption of phenytoin (diphenylhydantoin) from a preparation containing the acid in micronised form ('Fenantoin'; AeO, Sweden) was accelerated by food taken at the same time in a single dose (300mg) study in 8 healthy volunteers. They took the drug with a standardised breakfast or on an empty stomach. • AVe values indicated that during 0-2hours and 2-4 hours, respectively, the mean extent of absorption was 65 and 50 % greater with than without food. • The peak concentration was greater with than without food, with a mean individual increase of 40 % and a mean overall increase of 27 %. The peak concentration of the metabolite, 4-hydroxyphenytoin, was also significantly higher with than without food. • Times to peak concentration and elimination half-lives did not differ significantly between the 2 states. It seems that the risk of plasma phenytoin fluctuation in an individual would be reduced by always taking the drug in the same relationship to meals. In particular, patients with toxic effects during the first 4-6 hours after taking phenytoin with a meal should benefit from taking it several hours before a meal, as this would lead to slower absorption and a lower peak concentration. Melander. A. et a!.: European Journal of Clinical Pharmacology IS: 269 (No 4. 1979) The effect on erythromycin depends on the formulation taken The effect of a standard breakfast on absorption of erythromycin estolate capsules, enteric coated tablets of erythromycin base and erythromycin ethylsuccinate oral suspension were determined in single dose studies. 20 subjects took the capsules and tablets (2S0mg) and 12 the oral suspension (400mg in Sm!) with or without food. • Taking erythromycin estolate after the meal increased the AVe by an average of 64 % and mean peak blood levels by 82 %. The mean peak time increased from 3.2 to 4.3 hours. All differences were significant (p < 0.05). • A meal did not significantly alter peak blood levels or AVe of enteric coated erythromycin base, but the average peak time increased significantly from 4.9 to 7.9 hours, with an increase in lag time. • All subjects had detectable levels after taking the estolate with or without food, but 3 had no detectable levels for 12 hours after taking the base in the fasting state and 5 had no detectable levels after taking it with food . .. Food did not significantly affect mean peak levels, time of peak and A ues after the ethylsuccinate suspension. Bechtol , LD. et a!.: Current Therapeutic Research 25: 618 (May 1979) 14 INPHARMA 23 June 1979 0156-2703/79/0623-0014 $00.50/0 © ADIS Press

SHOULD FOOD BE TAKEN WITH DRUGS?

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SHOULD FOOD BE TAKEN WITH DRUGS?

It certainly makes a difference with micronised phenytoin, as 'Fenantoin' Absorption of phenytoin (diphenylhydantoin) from a preparation containing the acid in micronised form ('Fenantoin'; AeO, Sweden) was accelerated by food taken at the same time in a single dose (300mg) study in 8 healthy volunteers. They took the drug with a standardised breakfast or on an empty stomach.

• AVe values indicated that during 0-2hours and 2-4 hours, respectively, the mean extent of absorption was 65 and 50 % greater with than without food.

• The peak concentration was greater with than without food, with a mean individual increase of 40 % and a mean overall increase of 27 %. The peak concentration of the metabolite, 4-hydroxyphenytoin, was also significantly higher with than without food.

• Times to peak concentration and elimination half-lives did not differ significantly between the 2 states. It seems that the risk of plasma phenytoin fluctuation in an individual would be reduced by always taking the drug in the same relationship to meals. In particular, patients with toxic effects during the first 4-6 hours after taking phenytoin with a meal should benefit from taking it several hours before a meal, as this would lead to slower absorption and a lower peak concentration. Melander. A. et a!.: European Journal of Clinical Pharmacology IS: 269 (No 4. 1979)

The effect on erythromycin depends on the formulation taken The effect of a standard breakfast on absorption of erythromycin estolate capsules, enteric coated tablets of erythromycin base and erythromycin ethylsuccinate oral suspension were determined in single dose studies. 20 subjects took the capsules and tablets (2S0mg) and 12 the oral suspension (400mg in Sm!) with or without food.

• Taking erythromycin estolate after the meal increased the AVe by an average of 64 % and mean peak blood levels by 82 %. The mean peak time increased from 3.2 to 4.3 hours. All differences were significant (p < 0.05).

• A meal did not significantly alter peak blood levels or AVe of enteric coated erythromycin base, but the average peak time increased significantly from 4.9 to 7.9 hours, with an increase in lag time.

• All subjects had detectable levels after taking the estolate with or without food, but 3 had no detectable levels for 12 hours after taking the base in the fasting state and 5 had no detectable levels after taking it with food .

.. Food did not significantly affect mean peak levels, time of peak and A ues after the ethylsuccinate suspension. Bechtol , LD. et a!.: Current Therapeutic Research 25: 618 (May 1979)

14 INPHARMA 23 June 1979 0156-2703/79/0623-0014 $00.50/0 © ADIS Press