Last week, we continued our education series on the importance of knowing your medications and the possibilities of food/medication interactions. Medications can be affected by many different things such as age, weight, medical conditions, other medications, as well as food and drinks. The best way to understand your medications is to ask your physician at the time they are prescribed or your local pharmacist for over-the-counter medications. We are only providing a general list of interactions, but there are many more and the effects can be different for different people. We have already touched on antihistamines, arthritis, pain, and fever analgesics/antipyretics, NSAIDS, narcotics, bronchodilators, anti-anxiety medicines, antidepressants, antipsychotics, sedatives and hypnotics, bipolar medicines, and cardiovascular medications such as ACE inhibitors, beta blockers, diuretics, glycosides, lipid-altering agents, vasodilators/ nitrates, and vitamin K agonists/ anticoagulants.

This week we want to cover a very important class of medications that we all have needed and will need at some point in our lives; antibiotics. Medicines known as antibiotics or antibacterials are the ones used to treat infections caused by bacteria. None of these medicines will work for infections that are caused by viruses (such as colds and flu). One important rule of thumb when it comes to antibiotics is that you always need to be sure and finish all of your medicine for an infection, even if you are feeling better. All of the medicine prescribed is needed to kill the cause of infection. The exact amount is always ordered for a specific reason. If you stop the medicine early, the infection may come back, and then the next time, the medicine may not work for the infection. Ask your doctor if you should drink more fluids than usual when you take medicine for an infection. Below, are several classifications of antibiotics.

• Examples of Quinolone antibacterials include ciprofloxacin (Cipro) and levofloxacin (Levaquin). Take Levaquin oral solution one hour before eating or two hours after eating. Don’t take Cipro with dairy products (like milk and yogurt) or calcium-fortified juices alone, but you can take Cipro with a meal that has these products in it. Tell your doctor if you take foods or drinks with caffeine when you take Cipro, because caffeine may build up in your body.

• Examples of Tetracycline antibacterials include doxycycline, minocycline, and tetracycline. Take these medicines one hour before a meal or two hours after a meal, with a full glass of water. You can take tetracycline with food if it upsets your stomach, but avoid dairy products (such as milk, cheese, yogurt, ice cream) one hour before or two hours after. You can take minocycline and some forms of doxycycline with milk if the medicine upsets your stomach.

• An example of Oxazolidinone antibacterials is linezolid. Avoid large amounts of foods and drinks high in tyramine while using linezolid. High levels of tyramine can cause a sudden, dangerous increase in your blood pressure. Follow your doctor’s directions very carefully. Foods with tyramine include those that are spoiled, or not refrigerated, handled, or stored properly. Aged, pickled, fermented, or smoked foods may also contain tyramine. Some of these are cheeses, especially strong, aged, or processed cheese, such as American processed, cheddar, colby, blue, brie, mozzarella, and parmesan cheese, yogurt, sour cream (you can eat cream and cottage cheese), beef or chicken liver, dry sausage (including salami, pepperoni, and bologna), caviar, dried or pickled herring, anchovies, meat extracts, meat tenderizers, avocados, bananas, canned figs, dried fruits (raisins, prunes), raspberries, overripe fruit, sauerkraut, soy beans and soy sauce, yeast extract, broad beans (fava), and excessive amounts of chocolate. Many foods and drinks with caffeine also contain tyramine. Ask your doctor if you should avoid or limit caffeine. Avoid alcohol while using linezolid. Many alcoholic drinks contain tyramine, including tap beer, red wine, sherry, and liqueurs. Tyramine can also be in alcohol-free and reduced alcohol beer.

• An example of a Metronidazole antibacterial is metronidazole (flagyl). Don’t drink alcohol while taking metronidazole and for at least one full day after finishing the medicine. Alcohol and metronidazole can cause nausea, stomach cramps, vomiting, flushing, and headaches.

• Antifungals are medicines that treat or prevent fungal infections. Antifungals work by slowing or stopping the growth of fungi that cause infection. Examples include fluconazole (Diflucan), itraconazole, posaconazole, voriconazole, griseofulvin, and terbinafine. Itraconazole capsules will work better if you take it during or right after a full meal. Itraconazole solution should be taken on an empty stomach. Posaconazole will work better if you take it with a meal, within 20 minutes of eating a full meal, or with a liquid nutritional supplement. Don’t mix voriconazole suspension with any other medicines, water, or any other liquid. Griseofulvin works better when taken with fatty food. You can take the rest of the antifungals listed here on a full or empty stomach. Avoid alcohol while you are taking griseofulvin because griseofulvin can make the side effects of alcohol worse. For example, together they can cause the heart to beat faster and can cause flushing.

• Antimycobacterials treat infections caused by mycobacteria, a type of bacteria that causes tuberculosis (TB), and other kinds of infections. Ethambutol can be taken with or without food. Take the rest of these medicines one hour before a meal or two hours after a meal, with a full glass of water. Avoid foods and drinks with tyramine and foods with histamine if you take isoniazid alone or combined with other antimycobacterials. High levels of tyramine can cause a sudden, dangerous increase in your blood pressure. Foods with histamine can cause headache, sweating, palpitations (rapid heart beats), flushing, and hypotension (low blood pressure). Follow your doctor’s directions very carefully. Foods with tyramine are listed above. Foods with histamine include skipjack, tuna, and other tropical fish. Many foods and drinks with caffeine also contain tyramine. Ask your doctor if you should avoid or limit caffeine. Avoid alcohol. If you drink alcohol every day while using isoniazid you may have an increased risk of isoniazid hepatitis.

• Antiprotozoals treat infections caused by certain protozoa (parasites that can live in your body and can cause diarrhea). Examples include metronidazole (Flagyl) and tinidazole. Together alcohol and these medicines can cause nausea, stomach cramps, vomiting, flushing, and headaches. Avoid drinking alcohol while taking metronidazole and for at least one full day after finishing the medicine. Avoid drinking alcohol while taking tinidazole and for three days after finishing the medicine.

Always read the label information carefully before you use medications. If you have any questions, don’t hesitate to ask a doctor or pharmacist. Check back for part 5 of food/medication interactions.

Source: https://www.fda.gov/downloads/Drugs/.../