Medicine Chest: Drugs and
Food
Glen Pietrandoni, R.Ph.
Anti-retroviral drug therapy
is just one way to help keep the immune system in check for
people living with HIV. Other
factors like stress reduction and good nutrition can help
strengthen your body’s own defenses against disease and
some of those side effects of medication. Eating healthy,
managing stress, exercise and integrating natural or alternative
therapies are all important additions to the prescription
drugs that your doctor may prescribe for you.
Because HIV speeds up your body’s metabolism, you need
more vitamins and minerals than food can provide even when
you are eating well. We have to be very careful that these
vitamin supplements or meal replacements do not interfere
with the way the pharmaceutical drugs work. The goal is to
get the most of the food you eat while achieving proper levels
of the medication that are prescribed. If you are a regular
reader of this column, you already know about the importance
of adherence to the drug cocktails and treatment success.
Alternative therapies, like
herbal products and vitamins, can be an effective way to give
your body a little extra boost.
Unfortunately, natural vitamins and supplements do not have
to be tested or studied as pharmaceutical agents do. We
don’t know how these agents interact with prescription
drugs. There can be a large variation in the potency of natural
products from batch to batch and between manufacturers. Because
of these reasons, extra caution must be used when adding any
supplements to your daily food and drug regimen. Something
else to remember is the cost of supplements. The price has
to be weighed against the benefit of the product. It is not
uncommon to hear a patient spent hundreds of dollars on pretty
brown bottles of vitamins and natural “immune system
boosters.” Spending that money on a good, balanced diet
may be cheaper and better for you in the long run.
Certain foods themselves can
interact with the drugs that are prescribed by physicians.
To avoid upsetting your stomach, some prescription drugs can
be taken with food. It is not that simple with the drugs used
to treat HIV infection. The presence of food, in the case
of Videx, can cause the drug to be destroyed by the acidity
in the stomach. Other drugs like Fortovase require food to
be resent in order to achieve proper absorption. The effect
that food or alternative therapies can make on the blood levels
of the HIV drugs can mean the difference between success and
failure of the drug combo.
Here are a few tips to remember
when planning your medication regimen. However, please be
advised that this is just a sample list, it is not an all-inclusive
list.
Food - Drug interactions
• Grapefruit juice -
decreases absorption of non-nukes and PIs
• Caffeine - Crixivan (may increase dehydration and kidney
stones)
• Alcohol - Crixivan (may increase dehydration and kidney
stones)
Supplement-drug interactions
• Garlic - decreases
Fortovase levels
• St. Johns wort - decreases absorption of Crixivan and
other protease inhibitors
• Vitamin E - high levels already included in Agenerase
(amprenavir)
Drugs that need to be
taken WITH FOOD:
• Norvir (ritonavir)
• Kaletra (lopinavir/ritonavir)
• Viracept (nelfinavir)
• Crixivan/Norvir (when dosed together)
• Fortovase (saquinavir) and Fortovase/Norvir (when dosed
together)
• Viread (tenofovir)
Drugs that need to be
taken on an EMPTY STOMACH:
• Videx (didanosine,
ddI) all formulations should be taken 30 minutes before or
2 hours after meals
• Crixivan (indinavir)
can be taken with a light, low-fat snack
• Sustiva (efavirenz)
200 mg capsules or 600 mg tablets (new formulation). Food
can increase blood levels, side
effects
Drugs that can be taken
WITH OR WITHOUT FOOD:
• Epivir (lamivudine,
3TC)
• Retrovir (zidovudine, AZT)
• Combivir (lamivudine/zidovudine)
• Ziagen (abacavir sulfate)
• Trizivir (abacavir/lamivudine/zidovudine)
• Zerit (stavudine, d4T)
• Viramune (nevirapine)
• Rescriptor (delavirine)
Prescription drugs can cause
side effects that change your appetite and digestion. Speak
to your health care provider or pharmacist about tips that
may help avoid these unwanted side effects. HIV disease or
opportunistic infections can also interfere with eating or
absorbing the nutrients you do get. Sometimes, thrush can
cause a problem eating and enjoying food. Try rinsing your
mouth or brushing your teeth before eating. Smoking and alcohol
use can irritate the inside of your mouth. Hard candy and
being well hydrated can help when you have a dry mouth.
Some of the most common questions
I get as a pharmacist involve the use of herbal supplements
and natural products. In general, it is always best to speak
with your health care provider or pharmacist about using these
products along with your prescription drugs. Make a list of
all the items you take including over-the-counter drugs, vitamins,
sports drinks, as well as all of the prescription drugs. Your
health care provider can make a complete evaluation of any
potential problems that may exist. When you are ready to buy,
always make sure you purchase high quality products from reputable
stores or buying clubs, but don’t waste your money on
“miracle cures” or high-pressure sales people. If
it sounds too good to be true, it probably is.
Glen Pietrandoni is director
of Clinical Pharmacy Services for the Walgreen Specialty Pharmacy,
focusing on HIV,
located in the Howard Brown Health Center of Chicago. Contact:
Glen.Pietrandoni@walgreens.com.
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