Unknown to most people is the fact that everyday foods and Herbal supplements can and do interact with popular prescription medications. I became interested while talking to my Pharmacist that my son couldn take decongestant cold medications with his heart medication. Well, I knew about interactions between two drugs, but when the Pharmacist told me he couldn have grapefruit juice, I was stunned. Seems that grapefruit juice increases the blood concentrations of the drug. Basically that means that it greatly enhances the effects of the drug which could result in an overdose of the medication. This is everyday grapefruit juice! It got me wondering about other everyday foods and Herbs we take. Below are a few foods and Herbs that have an effect on your medications.

This list is a basic guide, and is by no means the meant to replace your Doctor or Pharmacist. Consult with them about any prescriptions you are taking and the foods and Herbs that will interact with them. Although I have taken this information from a handout from a local Hospital, Use this information at your own risk. Again, I am not a Doctor or Pharmacist, and I have had NO medical training, so please consult with yours for more information.

People usually ask if Herbal supplements change the way their prescription drugs work. The answer is YES! Some medications should never be taken with Herbal supplements. Some can cause unwanted side effects or cause the medication to stop working to their full effect.

Another misconception about supplements is that they are completely safe because they are natural. Yes, they may be from plants, but they are not natural to your body. Herbal supplements are not tested or inspected like prescription drugs are tested, so the supplements vary in quality and strength from pill to pill and bottle to bottle.

Just like supplements, foods can change the way your body responds to medications. One example is grapefruits and grapefruit juice. Many people aren aware that grapefruit juice can increase the drug levels of certain medications. An increase in the levels will also increase the side effects of the drug.

Things to Remember

1. Herbal supplements and foods can change the way your medications work. 2. Tell your caregiver what Herbal supplements you take and what foods you eat often.3. Ask your Doctor or Pharmacist what Herbal supplements or foods will interact with your medications.4. Always talk with your Doctor or Pharmacist FIRST before taking any Herbal supplements.

DISCLAIMER: The following charts are not all inclusive and do not contain every interaction of drugs with foods and herbs. It serves as a guide only. Consult with your Doctor, Pharmacist or a registered dietician if you have any questions.

Analgesics (Pain Relievers)

AspirinCelecoxib (Celebrex)Ibuprofen (Advil, Motrin)Naproxen

Food: Avoid alchohol. Avoid large amounts of orange juice and vitamin C.Herbs:Avoid Black Cohosh, Dong Quai, Evening Primrose, Feverfew, Flaxseed Oil, and Ginko as it increases the risk of bleeding.

NarcoticsCodeine (Tylenol #2, 3, 4)Morphine (MS Contin)Oxycodone (Oxycontin/Percocet)

Foods:Avoid alchohol.Herbs:Do not take with Kava or Valerian as it may make you feel drowsy.

Antibiotics

Ciproflaxacin (cipro)Levofloxacin (Levaquin)

Food: Take 2 Hrs before or 6 Hrs after antacids, dairy products amd multi-vitamins that contain calcium, iron, zinc, or magnesium. Avoid large amounts of caffeine.See Chart 3 below.Herbs:

Methronidazole

Foods:Avoid alchohol during and 3 days after taking this medication to avoid nausea and vomiting.Herbs:

Penicillin

Foods:Citrus fruits/juices and carbonated beverages will decrease desired effect.Herbs:

Tetracycline

Foods:Take 2 Hrs before or 6 Hrs after antacids, dairy products amd multi-vitamins that contain calcium, iron, zinc, or magnesium.Herbs:Dong Quai or St. John Wort increase the risk of sunburn.

Trimethoprim/Sulfamethoxazole (Bactrim, Septra)

Foods:May cause rash if taken with alchohol.Herbs:Dong Quai or St. John Wort increase the risk of sunburn.

Anticoagulants (Blood Thinners)

Warfarin (Coumadin)

Food: Avoid alchohol. Avoid foods high in Vitamin K: beef liver, oils and green leafy vegetables (broccoli, brussel sprouts, cabbage, collards, spinach). Herbs: Avoid Black Cohosh, Dong Quai, Evening Primrose, Feverfew, Flaxseed Oil and Ginko as they increase the risk of bleeding. Do not take St. John Wort as it may decrease the desired effect.

Cholesterol Lowering Agents

Atorvastatin (Lipitor)Pravastatin (Pravachol)Rosuvastatin (Crestor)Simvastatin (Zocor)

Food: Avoid alchohol. Do not take with grapefruit juice.Herbs: St. John Wort may decrease desired effect.

Diabetes Medications

Glipizide (Glucotrol, Glucotrol XL)Glyburide (Glynase, Micronase)Metformin (Glucophage)

Food: Avoid alchohol.Herbs: Do not take with Ephedra as it may increase blood sugar and decrease desired effect.

Erectile Dysfunction

Sildenafil (Viagra)Tadalafil (Cialis)Vardenafil (Levitra)

Food: Do not take with grapefruit juice.Herbs: Do not take with Yohimbe as it may increase side effects.

Gastrointestinal Agents (Stomach Meds)

Prochlorperazine (Compazine)

Food: Do not take with alchohol.Herbs: Do not take with Dong Quai, Kava, St. John Wort or Valerian as they may make you drowsey.

Cimetidine (Tagamet)

Foods: Avoid alchohol. Take 1 hour before or 2 hours after antacids. Limit caffeine intake; see Chart 3.Herbs: St John Wort may decrease desired effect.

Lansoprozole (Prevacid)Omeprazole (Prilosec)Pantoprazole (Protonix)Rabeprazole (Aciphex)

Foods: Avoid alchohol as it may cause upset stomach.Herbs: St. John Wort may decrease desired effect.

Heart and Blood Pressure Medications*Note: The following herbs may cause an INCREASE in blood pressure and decrease desired effect of any blood pressure medications: Black Cohosh, Dong Quai, Ephedra, Hawthorn, Quassia, Vervain and Yohimbe.

Angiotensin Converting Enzyme (ACE) Inhibitors-Captopril (Capoten)Linisopril (Prinivil, Zestril)

Food: Avoid salt substitutes that contain potassium and potassium rich foods; see Chart 1.Herbs: See *Note above

Beta Blockers-Atenolol (Tenormin)Metoprolol (Lopressor, Toprol ZL)Propranolol (Inderal)

Foods: Avoid alchohol.Herbs: See *Note above.

Calcium Channel Blockers-Diltiazem (Cardizem, Tiazac)Verapamil (Calan, Verelan)

Foods: Do not take with grapefruit juice. A low sodium diet may be recommended.Herbs: See *Note above.

Digoxin (Lanoxin)

Foods: Avoid antacids. Limit caffeine intake; see Chart 3 below.Herbs: Avoid Ma Huang and St. John Wort as they may decrease desired effect.

Nitrates-Isosorbide (isordil, Imdur)Nitroglycerin Patch (Nitrol)

Foods: Avoid alchohol.Herbs: See *Note above.

Diuretics (Water Pills)

Furosemide (Lasix)Hydrochlorothiazide

Food: INCLUDE potassium rich foods in diet; see Chart 1 below.Herbs: See *Note above under Heart and Blood Pressure Medications.

Hormone Replacement Therapy

Estrogen (Premarin, Premphase, Prempro)

Food: Avoid alchohol.Herbs: St John Wort may decrease desired effect. Do not take Black Cohosh Dong Quai, Red Clover or Saw Palmetto because of the possible side effects.

Mood Disorders

Aripiprazole (Abilify)Clozapine (Clozaril)Olanzapine (Zyprexa)Risperidone (Risperdal)

Food: Avoid alchohol. Do not take grapefruit juice. Limit caffeine intake; see Chart 3.Herbs: Do not take with Kava, St. John Wor or Valerian as they may make you feel drowsy.

Benzodiazepines-Alprazolam (Zanax)Clonazepam (Klonopin)Diazepam (Valium)Lorazepam (Ativan)

Foods: Avoid alchohol. Do not take grapefruit juice. Limit caffeine intake; see Chart 3 below.Herbs: Do not take with Kava, St. John Wor or Valerian as they may make you feel drowsy.

Lithium (Eskalith, Lithobid)

Food: Avoid alchohol. Limit caffeine intake; see Chart 3 below.Herbs: Avoid Green Tea.

Monoamine Oxidase Inhibitors (MAOI (Nardil)Tranylcypromine (Parnate)

Foods: Avoid alchohol. Avoid tyramine-rich foods see Chart 2 below.Herbs: Do not take with Ephedra, Kava, Ginko, St. John Wort or Yohimbe as they may increase effect and cause a serious increase in blood pressure.

Selective Seratonin Reuptake Inhibitors (SSRI (Celexa)Escitalopram (Lexapro)Fluoxetine (Prozac)Paroxetine (Paxil)

Food: Avoid alchohol.Herbs: Do not take with Ephedra, Kava, Melatonin, Valerian or Yohimbe as they may make you drowsy. Do not take with St. John Wort as it may increase effect of drug and risk of side effects.

Tricyclic Antidepressants (TCA (Elavil)Desipramine (Norpramin)Nortriptyline (Pamelor)

Foods: Avoid alchohol. Do not take with grapefruit juice.Herbs: Do not take with Kava, St. John Wort or Valerian as they may make you feel drowsy.

Oral Contraceptives (Birth Control)

Estradiol CypionateEthinyl EstradiolMestranol

Food: Avoid smoking.Herbs: Do not take with Chaste Tree Berry, Red Clover, Saw Palmetto or St. John Wort as they may decrease desired effect.

Osteoporosis

Alendronate (Fosomax)Risendronate (Actonel)

Food: Take only with plain water. Do not take anything else within 30 minutes of taking these drugs as they may decrease desired effect.Herbs:

Seizure Medications

Carbamazepine (Carbatrol, NOT Tegretol)Divalproex (Depakote)Oxcarbazepine (trileptal)phenytoin (Dilantin)

Food: Avoid alchohol. Do not take with grapefruit juice.Herbs: Evening Primrose increases risk for seizures. Do not take with Kava or Valerian as they may make you feel drowsy. St. John Wort may decrease desired effect.

Thyroid Medications

Levothyroxine (Levoxyl, Synthroid, Unithroid)Thyroid (Armour Thyroid)

Food: Limit intake of Brussel Sprouts, cabbage, kale, greens, rutabaga, soybeans and turnips.Herbs: Do not take with Lemon Balm.

Miscellaneous

Antihistamines-Chlorpheniramine (Chlor-Trimeton)Diphenhydramine (Benadryl)

Food: Do not take with alchohol.Herbs: Do not take with Kava or Valerian as it may make you feel drowsy.

Cyclosporine (Neoral, Sandimmune)

Foods: Do not take with grapefruit juice.Herbs: Do not take with Echinacea or St. John Wort as they may decrease desired effect.

PrednisoneMethylprednisolone

Food: Avoid alchohol. Calcium supplements may be recommended to prevent Osteoporosis.Limit caffeine intake; see Chart 3 below.Herbs: Avoid Echinacea or St. John Wort as they may decrease desired effect.

Theopylline (theo-Dur)

Foods: Avoid alchohol.Limit caffeine intake; see Chart 3 below.Herbs: Do not take with Ephedra or Green Tea as it may increase effect of drug.

Foods:Herbs:

Chart # 1

High potassium rich foods include the following:

Apricots, Artichokes, Asparagus, Avacado, Banana, Broccoli, Brussel Sprouts, Carrots, Celery,Chocolate, Dates, Dried Beans, Dried Fruit, Figs, Greens, Honeydew, Milk, Orange Juice, Potato,

Pumpkin, Prune Juice, Raisins, Rhubarb, Spinach, Squash, Tomato, V-8 Juice

Chart # 2

High tyramine-content foods include the following:Aged Cheese*, Aged Meat,Anchovies, Avacados, Bananas, Beer, Broad Beans, Caffeine

Chicken Liver, Chocolate, Cola Drinks, Canned Figs, Mushrooms, Raisins, Sausages, Sour Cream Soy Sauce, Wine (Chianti, Sherry), Yeast, Yogurt

*Camembert, Chedder, Gruyer, processed American and Stilton

Chart # 3

High caffeine-content foods include the following:Chocolate (milk and dark, Coffee (brewed, cappuccino, expresso)Caffeinated water (Java, Kank, Aqua Blast), Ice Cream (coffee, chocolate)Soft Drinks (Mountain Dew, Coca Cola, Pepsi, Root Beer, Sunkist Orange Soda)Teas (green Tea, Ginseng, Snapple Iced Tea, Lipton)