Food risk – drug interactions

A number of medications are incompatible with certain foods. For example, if  antibiotics  are taken at the same time as dairy products, they become less effective. More than 300 medicines can become less effective or even toxic when taken with certain foods.

Drug interactions – facts and figures

Every German swallows an average of 1,250 pills and other medicines a year – and almost always without thinking about what they are swallowing with, sometimes with  milk , sometimes with  coffee , sometimes even with beer and often with a full meal. According to the German Association of Pharmacists, more than 315 drugs react to food.

These substances are found in over 5,000 common medicines. This means that 12.5 percent of medicines can have undesirable side effects in connection with food. Doctors do not always give their patients nutritional recommendations that need to be observed when taking the medication together with the prescription.

Which interactions are possible?

Most of the time, however, the interaction is not too dramatic, for example if you only occasionally swallow a headache medicine. Patients and the chronically ill who receive up to ten different medications daily are considered at risk. This increases the risk potential immensely, reports the independent British Committee on Toxicity.

Sometimes a drug just doesn’t work as well when it enters the body with certain foods. Occasionally, drugs in the intestines block the absorption of important substances such as calcium, fluorine or  iodine . In rare cases, the interactions between medication and food can even lead to  sleep disorders  and tachycardia.

Common drug interactions

The most common effects of the most common medications are listed here.

antibiotics and dairy products

Milk, quark, yoghurt and cheese and antibiotics do not go together. The important drug group of tetracyclic antibiotics such as doxycycline can form compounds with the calcium from dairy products that the body can no longer break down. This slows down the effect of the drug, so to speak. Foods containing calcium such as milk and  yoghurt etc.  should therefore be eaten no earlier than two hours after taking these antibiotics.

antibiotics and caffeine

Antibiotics containing gryase inhibitors are often prescribed for bladder or kidney infections. Caffeine, such as that found in coffee, cola or tea, can lead to agitation, tachycardia and sleep disorders because the drug inhibits the breakdown of caffeine. Therefore, it is better to completely avoid caffeine while taking it.

iron tablets and caffeine

Anemia medications are useless if taken with coffee or tea. The tannic acid in the drinks binds the iron ions in the stomach. In this way, the iron is excreted instead of ending up in the bloodstream via the intestinal wall. For example, pregnant women who take their iron supplement with breakfast should not drink tea or coffee for at least two hours before and after taking the pills.

grapefruit juice and painkillers, sleeping pills, antihistamines, antihypertensives

Grapefruit juice should be avoided completely when taking medication, even if some of the symptoms are rather rare. The  flavonoids contained in it , which are the pigments contained in the plants, increase the effect of numerous medicines by around 30 percent and can, for example   , trigger high blood pressure . This also applies to bitter oranges, which are found in some orange jams and marmalades.

  • Care should be taken with heart tablets containing the active ingredient nifedipine. Together with grapefruit, there is a risk of a drop in blood pressure, heart palpitations and headaches.
  • In combination with painkillers, the heart can get out of rhythm:  cardiac arrhythmias  are the result.
  • Together with  sleeping pills  , it can lead to intoxicated symptoms.
  • In the worst case, some  antihistamines  in combination with grapefruit can also lead to cardiac arrhythmia.

licorice and diuretics

Diuretics are drugs that dehydrate the body. At the same time, they flush out vitamins and minerals. If liquorice lovers take dehydrating medicines over a longer period of time, there is an increased loss of potassium. The symptoms: muscle weakness, drowsiness, weaker reflexes and increased blood pressure.

Asthma medication with theophylline and black pepper

The pharmaceutical manufacturer Madaus warns: Anyone who likes to use black pepper as a hot spice should be particularly careful, because the piperine it contains inhibits the breakdown of theophylline, which is mainly   prescribed for severe bronchial asthma . One study found that piperine can increase theophylline levels. These patients should also avoid foods or medicines containing tannins. Black tea, green tea, walnut, raspberry, oak and witch hazel contain tannins.

Antidepressants and wine or cheese

Antidepressants often contain so-called MAO inhibitors. These inhibit the enzyme monoamine oxidase (MAO), which breaks down certain messenger substances. To put it simply, MAO inhibitors increase the concentration of various messenger substances in the brain in this way: They ensure that more of the happy messenger substances  serotonin , noradrenaline and  dopamine  are available in the brain. The mood enhancers come into conflict with foods high in protein and tyramine that have been stored for long periods of time. This also includes sauerkraut, cheese, white beans and salted herring.

The protein product tyramine cannot be broken down in the body while it is being taken, since the enzyme that is essential for this process is not working. If cheese and wine – especially Chianti – are taken together with MAO inhibitors, this can   trigger life-threatening high blood pressure crises and cerebral hemorrhages . Bananas  and pineapples, nutmeg, figs, raisins, yoghurt, soy sauce and sauerkraut are also considered potentially dangerous  .

No problem: anticoagulants and green leafy vegetables

According to recent studies and contrary to a lot of information, blood thinners that are often prescribed, so-called anticoagulants such as Marcumar, are unproblematic, for example to prevent thrombosis. Vitamin K is found in green leafy vegetables (cabbage, spinach, kohlrabi, lettuce, sauerkraut), liver, meat and eggs.

There is no need to avoid such foods containing vitamin K, writes the German Society for Nutrition (DGE): “A number of clinical studies have shown that even by consuming large amounts of foods rich in vitamin K, the quick value is not or only insignificantly influenced For patients on anticoagulant therapy with vitamin K antagonists, there is therefore no reason to avoid vitamin K-rich foods such as liver, spinach, broccoli, white, red, green and cauliflower. to renounce.”

However, it makes sense to refrain from taking appropriate multivitamin preparations or to clarify their intake with the doctor treating you.

Advice on taking medicines

Instructions on when to take the medication can be found on the package insert. If it says “take before a meal”, then the drug should be taken 60 to 30 minutes before the meal. “Take with meals” means taken within five minutes of a meal. “Intake after a meal”: there should be an interval of 30 to 60 minutes between the meal and the intake.

Medications should always be taken with sufficient liquid, preferably pure water. Alcoholic beverages should generally be avoided if medication has been prescribed. The effect can be increased in the case of sedatives or blood pressure medication: alcohol also promotes the absorption of the medication and increases its effectiveness. It is therefore essential to heed the warnings on the drug leaflets, since, for example, the ability to react can be severely reduced even with low alcohol consumption.

It is best to wait half an hour after taking the medication to drink fruit juices and lemonades. With antibiotics, there should be at least two hours between taking and drinking milk. Even with iron preparations, neither milk, cream, nor  rhubarb  or protein-rich products should be consumed.

Ask the doctor or pharmacist

However, most people hardly need to change their diet when they take drugs, the Committee on Toxicity report concludes. Numerous interactions, such as the reduced effect of antibiotics when consuming dairy products at the same time, are described on most medication instructions.

However, the experts strongly advise you to read the instructions for use carefully under the heading “Interactions” before taking any medicines. If in doubt, the pharmacist should be consulted, especially in the case of non-prescription medicines. Physicians should research their patients’ dietary habits before prescribing drugs.


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