Earlier this week, we began educating about 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, and bronchodilators, but let’s take a look at a few more.

Cardiovascular disorders require use of very important medications. These medicines prevent or treat disorders of the cardiovascular system, such as high blood pressure, angina (chest pain), irregular heart beat, heart failure, blood clots, and high cholesterol. Some types of medicines can treat many conditions. For example, beta blockers can treat high blood pressure, angina (chest pain), and irregular heart beats.

• ACE Inhibitors (Angiotensin Converting Enzyme Inhibitors)- ACE inhibitors alone or with other medicines lower blood pressure or treat heart failure. They relax blood vessels so blood flows more smoothly and the heart can pump blood better. Examples can include Captopril, Enalapril, Lisinopril, and Ramipril. ACE inhibitors can increase the amount of potassium in your body. Too much potassium can be harmful and can cause an irregular heartbeat and heart palpitations (rapid heart beats). Avoid eating large amounts of foods high in potassium, such as bananas, oranges, tomatoes, green leafy vegetables such as spinach, sweet potatoes, and salt substitutes that contain potassium. Tell your doctor if you are taking salt substitutes with potassium, potassium supplements, or diuretics (water pills) because these can add to the amount of potassium in your body.

• Beta Blockers- Beta blockers can be used alone or with other medicines to treat high blood pressure. They are also used to prevent angina (chest pain) and treat heart attacks. They work by slowing the heart rate and relaxing the blood vessels so the heart doesn’t have to work as hard to pump blood. Don’t suddenly stop taking a beta blocker without talking to your doctor. If you stop a beta blocker suddenly, you can get chest pain, an irregular heartbeat, or a heart attack. Your doctor might tell you to decrease your dose gradually. Examples include Carvedilol (Coreg) and Metoprolol (Lopressor). Take Carvedilol with food to decrease the chance that it will lower your blood pressure too much. Take Carvedilol extended release capsules in the morning with food; don’t crush, chew, or divide the capsule. Take Metoprolol with a meal or right after a meal.

• Diuretics- Sometimes called “water pills,” diuretics help remove water, sodium, and chloride from the body. Diuretics reduce sodium and the swelling and excess fluid caused by some medical problems such as heart or liver disease. Diuretics can also treat high blood pressure. Examples include Bumetanide, Furosemide (Lasix), Hydrochlorothiazide, Triamterene. Take your diuretic with food if it upsets your stomach. Some diuretics cause loss of potassium, calcium, and magnesium from the body. Other diuretics, like Triamterene lower the kidneys’ ability to remove potassium, which can cause high levels of potassium in the blood stream. Too much potassium can be harmful and can cause an irregular or rapid beating of the heart. When you use diuretics that can increase potassium in your body, avoid eating large amounts of foods high in potassium, such as bananas, oranges, tomatoes, green leafy vegetables, and salt substitutes that contain potassium. Tell your doctor if you are taking salt substitutes with potassium or potassium supplements because they can add to the amount of potassium in your body.

• Glycosides- Glycosides treat heart failure and abnormal heart rhythms. They help control the heart rate and help the heart work better. One common example is Digoxin. Take Digoxin one hour before or two hours after eating food. Try to take it at the same time every day and carefully follow the label and directions from your doctor. Foods high in fiber may decrease the Digoxin in your body, so take Digoxin at least two hours before or two hours after eating foods high in fiber (such as bran). Avoid taking Digoxin with Senna and St. John’s Wort since they may decrease the amount and action of Digoxin in your body. Avoid taking Digoxin with black licorice (which contains the glycyrrhizin used in some candies, cakes and other sweets). Digoxin with glycyrrhizin can cause irregular heart beat and heart attack.

• Lipid-Altering Agents (also called Statins)- Statins lower cholesterol by lowering the rate of production of LDL (sometimes called “bad cholesterol”). Some of these medicines also lower triglycerides. Some statins can raise HDL-C (sometimes called “good cholesterol”), and lower the chance of heart attack and stroke. Examples include Atorvastatin (Lipitor), Lovastatin, Pravastatin, Simvastatin (Zocor), and Rosuvastatin. You can take most statins on a full or empty stomach. Some statins will work better if you take them with an evening meal. Don’t drink more than one quart of grapefruit juice a day if you are taking Atorvastatin, Lovastatin, or Simvastatin. Large amounts of grapefruit juice can raise the levels of those statins in your body and increase the chance of side effects. Some statins don’t interact with grapefruit juice. Ask your doctor or pharmacist if you have any questions. Avoid alcohol because it can increase the chance of liver damage.

• Vasodilators/Nitrates- Nitrates prevent or treat chest pain (angina). They work by relaxing the blood vessels to the heart, which improves the blood and oxygen flow to the heart. Examples include Isosorbide Dinitrate (Isordil) or Mononitrate Nitroglycerin (Imdur). You can take all forms of nitrates on a full or empty stomach. Avoid alcohol. Alcohol may add to the blood vessel-relaxing effect of nitrates and lead to a dangerously low blood pressure.

• Vitamin K Agonists/ Anticoagulants- Anticoagulants are also called “blood thinners.” They lower the chance of blood clots forming or growing larger in your blood or blood vessels. Anticoagulants are used to treat people with certain types of irregular heartbeat, people with prosthetic (replacement or mechanical) heart valves, and people who have had a heart attack. Anticoagulants also treat blood clots that have formed in the veins of the legs or lungs. An example is Warfarin. You can take Warfarin on a full or empty stomach. Vitamin K in food can make the medicine less effective. It blocks the effects of these blood-thinning medications putting you at risk for developing blood clots. Eat a normal balanced diet with a steady amount of leafy green vegetables, and talk to your doctor before making changes in your diet. Foods high in vitamin K include broccoli, cabbage, collard greens, spinach, kale, turnip greens, and brussel sprouts. Avoid cranberry juice or cranberry products while using anticoagulants because they can change the effects of Warfarin. Many dietary supplements and vitamins such as garlic, ginger, vitamin E, and fish oil can interact with anticoagulants and can reduce the benefit or increase the risk of Warfarin which in turn can put you at risk for excessive bleeding. Tell your doctor and pharmacist if you drink alcohol. Avoid alcohol because it can affect your dose of Warfarin.

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 3 of food/medication interactions.

Source: https://www.fda.gov/downloads/Drugs/.../.../UCM229033.pdf