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DRUG
SIDE EFFECTS PART II
Abbokinase
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Vitamin K levels are important to the
activity of this medication. The more vitamin K present, the greater
the chance of blood clotting. Since the purpose of this medication is
to lower clotting, foods high in vitamin K, such as spinach,
cauliflower, brussel sprouts, and egg yolk should be limited or used
with caution.1
• Consult with your pharmacist before
taking supplemental CoEnzyme Q10, which has a similar chemical
structure to vitamin K and may affect the effectiveness of this
medication.2
• Avoid high dosages of vitamin A (over
10,000 IUs) or vitamin E (over 400 Ius).3
• More than 5 gms (5,000 mg) of vitamin
C may reduce the absorption of this medication.4
• Absorption and activity of this
medication may be altered by supplemental use of iron, magnesium, and
zinc. Use of these minerals should be spaced at least two hours apart
from the taking of this medication.5
• Please consult with your physician or
pharmacist before taking nutritional supplements containing chondroitin
sulfate.6
• More than 60 grams of onions (2 oz’s)
may affect the activity of this drug.7
• Avoid excessive consumption of
garlic, ginger, and avocado, due to their blood thinning properties.8
• Taking high doses of Grapefruit juice
with this medication may interfere with drug therapy.9
• The following herbs may contribute to
blood thinning and should not be used with this drug: Angelica, anise,
arnica, asafoetida, bogbean, capsicum, celery, chamomile, danshen,
fenugreek, feverfew, garlic, ginger, ginkgo, ginseng (Panax), Gotu
kola, horse chestnut, licorice, meadowsweet, papain, prickly ash,
poplar, quassia, red clover, rue, and willow.10
• According to an Italian study, these
herbs: Passionflower, hydroalcoholic extracts, Juniper and Verbena
officinalis contain vitamin K and may interefere with drug therapy.
Avoid their use together.11
References
1 Weibert RT, Le DT, Kayser SR, et al.
Correction of excessive anticoagulation with low-dose oral vitamin K.
Ann Intern Med 1997;125:959-62
1 United States Pharmacopeia Drug Index (USPDI). 8th ed.
Rockville, Md: US Pharmacopeial Convention, Inc; 1988:259-268.
1 Harris JE. Interaction of dietary factors with oral
anticoagulants: Review and applications. J Am Dietet Assoc
1995;95:580-84 [review].
2 Harris JE. Interaction of dietary factors with oral
anticoagulants: Review and applications. J Am Dietet Assoc
1995;95:580-84 [review].
2 Landbo C & Almdal TP [Interaction between warfarin
and coenzyme Q10.] Ugeskr Laeger, 1998 May, 160:22, 3226-7.
2 Spigset O. Reduced effect of warfarin caused by
ubidecarenone. Lancet 1994;344:1372-73 [letter].
2 Heck AM, DeWitt BA, Lukes AL. Potential interactions
between alternative therapies and warfarin. Am J Health Syst Pharm.
2000 Jul 1;57(13):1221-7; quiz 1228-30
2 Holt GA. Food & Drug Interactions. Chicago: Precept
Press, 1998, 286.
3 Wells, PS et al., Interactions of Warfarin with drugs and
food. Ann. Int. Med. 1994, 121:676-683.
3 Heck AM, DeWitt BA, Lukes AL. Potential interactions
between alternative therapies and warfarin. Am J Health Syst Pharm.
2000 Jul 1;57(13):1221-7; quiz 1228-30.
3 Holt GA. Food & Drug Interactions. Chicago: Precept
Press, 1998, 286.
4 Holt GA. Food & Drug Interactions. Chicago: Precept
Press, 1998, 286.
4 Wells, PS et al., Interactions of Warfarin with drugs and
food. Ann. Int. Med. 1994, 121:676-683.
5 Wells, PS et al., Interactions of Warfarin with drugs and
food. Ann. Int. Med. 1994, 121:676-683.
5 Harris JE. Interaction of dietary factors with oral
anticoagulants: Review and applications. J Am Dietet Assoc
1995;95:580-84 [review].
5 Holt GA. Food & Drug Interactions. Chicago: Precept
Press, 1998, 286.
6 Chavez, M: Glucosamine sulfate and chondroitin sulfates.
Hospital Pharmacy, 1997, 52(9): 1,275-1,285.
7 Menon, I.S. et al: Effect of onions on blood fibrinolytic
activity. BMJ, 1968,3:351.
7 Pronsky, Z Food Medication Interactions, 11th edition, 1999
7 Holt GA. Food & Drug Interactions. Chicago: Precept
Press, 1998, 286.
8 Blickstein, D et al, "Warfarin antagonism by avocado",
1991, The Lancet 337:914-915.
8 Gadkari JV, Joshi VD. Effect of ingestion of raw garlic on
serum cholesterol level, clotting time and fibrinolytic activity in
normal subjects. J Postgrad Med 1991;37:128-31.
8 Burnham BE. Garlic as a possible risk for postoperative
bleeding. Plast-Reconst-Surg 1995;95:213.
9 Bartle, W. Grapefruit juice might still be factor in
warfarin response (letter). American Journal of Health-System Pharmacy
1999; 56 (April 1): 676.
9 Sullivan D, et al. Grapefruit juice and the response to
warfarin. American Journal of Health-System Pharmacy 1998; 55:
1581-1583.
10 Gadkari, et al. Effect of ingestion of raw garlic on serum
cholesterol levels, clotting time and fibrinolytic activity in normal
subjects. J Postgrad Med 1991;37:128-31.
10 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
10 Janetsky, K et al. Probably interaction between warfarin
and ginseng. Am J Health-Syst Pharm 1997;54:692-93.
10 Kleijnen J, Knipschild P. Ginkgo biloba. Lancet
1992;340:1136-39.
10 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
10 Heck AM, DeWitt BA, Lukes AL. Potential interactions
between alternative therapies and warfarin. Am J Health Syst Pharm.
2000 Jul 1;57(13):1221-7; quiz 1228-30.
11 Argento A, Tiraferri E, Marzaloni M. [Oral anticoagulants
and medicinal plants. An emerging interaction]. Ann Ital Med Int. 2000
Apr-Jun;15(2):139-43. Review. Italian.
Accolate
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Do not take this medication and fiber
supplements at the same time. Separate their use by at least two hours.1
• Food has been shown to reduce the
absorption of Accolate. Take Accolate two to four hours before or after
a meal.2
• Accolate may interact with a Japanese
herbal formula, Saiboku-to. This formula contains the herbs Ogon,
Koboku, and Kanzo.3
References
1 Adkins JC & Brogden RN:
Zafirlukast. A review of its pharmacology and therapeutic potential in
the management of asthma. Drugs, 1998 Jan, 55:1, 121-44.
1 Suissa S et al., Effectiveness of the leukotriene receptor
antagonist zafirlukast for mild-to-moderate asthma. A randomized,
double-blind, placebo-controlled trial. Ann Intern Med, 1997 Feb,
126:3, 177-83.
2 Adkins JC & Brogden RN: Zafirlukast. A review of
its pharmacology and therapeutic potential in the management of asthma.
Drugs, 1998 Jan, 55:1, 121-44.
2 Suissa S et al., Effectiveness of the leukotriene receptor
antagonist zafirlukast for mild-to-moderate asthma. A randomized,
double-blind, placebo-controlled trial. Ann Intern Med, 1997 Feb,
126:3, 177-83.
3 Kobayashi I et al., Saiboku-To, a herbal extract mixture,
selectively inhibits 5-lipoxygenase activity in leukotriene synthesis
in rat basophilic leukemia-1 cells. J Ethnopharmacol, 1995 Aug, 48:1,
33-41.
3 Kobayashi I et al., [Inhibitory effects of saiboku-to and
compornent herbs on the production of peptide leukotrienes (LTs) and
LTB4]. Arerugi, 1996 Jun, 45:6, 577-83.
Accupril
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• The use of alcohol should be limited.1
• Accupril may contribute to zinc
deficiency with long term use. Discuss the need for supplementation
with a pharmacist.2
• Avoid consuming excessive potassium
in foods and supplements while taking Accupril. Ask your physician or
pharmacist for more information about electrolyte balance.3
• Some herbs possess cardiac activity
and they may interact with Accupril to increase side effects: black
hellebore, calamus, cereus, cola, coltsfoot, devil's claw, European
mistletoe, fenugreek, fumitory, digitalis leaf, hedge mustard, figwort,
lily of the valley roots, motherwort, pleurisy root, squill bulb leaf
scales, white horehound, mate, scotch broom flower, shepherd's purse,
and wild carrot4
• Avoid natural licorice products,
Ginseng, and Ephedra (Ma huang) which may interfere with
antihypertensive therapy.5
• These herbs may possess diuretic
properties which could result in additive effects with accupril. They
include: Alfalfa, Angelica, Astragalus, Basil, Bean Pod, Buckthorn,
Burdock, Butcher’s Broom, Buchu, Celery, Cleavers, Dandelion,
Elecampane, Elder, Goat's Rue, Hempnettle, Horsetail, Indian-Hemp,
Juniper, Marigold, Meadowsweet, Parsley, Rauwolfia, Sarsaparilla, Sweet
clover, Turmeric, and Vervain6
References
1 Pronsky, ZM: Food-Medication
Interactions, 11th edition, 1999
1 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
2 Golik A, Zaidenstein R, Dishi V, et al: Effects of
captopril and enalapril on zinc metabolism in hypertensives, J Am Coll
Nutr, 1998, 17(1):75-8.
2 Golik A, Modai D, Averbukh Z, et al: Zinc metabolism in
patients treated with captopril versus enalapril, Metabolism, 1990,
39(7): 665-7.
3 Burnakis TG & Mioduch HJ: Combined therapy with
captopril and potassium supplementation. A potential for hyperkalemia.
Arch Intern Med 1984; 144:2371-2372.
3 Good CB, McDermott L, McCloskey B. Diet and serum potassium
on ACE inhibitors. JAMA 1995;274:538.
3 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
4 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
4 The Review of Natural Products, Clinisphere 2.0, Wolters
Kluwer Company, 2000
4 Blumenthal M, et al. ed. The Complete German Commission E
Monographs: Therapeutic Guide to Herbal Medicines. Trans. S. Klein.
Boston, MA: American Botanical Council, 1998.
4 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
5 Pronsky, ZM: Food-Medication Interactions, 11th edition,
1999
5 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
6 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
6 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
6 Blumenthal M, et al. ed. The Complete German Commission E
Monographs: Therapeutic Guide to Herbal Medicines. Trans. S. Klein.
Boston, MA: American Botanical Council, 1998.
Accutane
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Take with food or milk to avoid
stomach upset.1
• Avoid alcohol2
• Avoid vitamin A, beta carotene or multivitamin supplements
with this drug.3
• Use with caution in diabetes4
• There are no known herbal
considerations at this time.5
References
1 Facts and Comparisons, Clinisphere
2.0, Wolters Kluwer Company, 2000
1 Pronsky, Z Food Medication Interactions, 11th edition, 1999
2 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
2 Pronsky, Z Food Medication Interactions, 11th edition, 1999
3 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
3 Pronsky, Z Food Medication Interactions, 11th edition, 1999
4 Pronsky, Z Food Medication Interactions, 11th edition, 1999
Aceon
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Avoid consuming excessive potassium
in foods and supplements when taking this medication, including salt
substitutes1
• Alcohol intake should be limited2
• This medication may contribute to a
deficiency in zinc. Supplementation may be considered3
• Avoid arginine in conjunction with
these agents, because there is a potential for hyperkalemia to develop4
• N-acetylcysteine may have additive
blood pressure lowering effects with this medication5
• Olive oil has been shown to reduce
blood pressure, if used on a regular basis, antihypertensive drug
dosage adjustment may need to be made6
• CoQ10 may decrease blood pressure,
therefore if combining this supplement with this medication, a dosage
adjustment may need to be made.7
• Some herbs possess cardiac properties
that may interact with the action of this drug and may result in an
excessive lowering of blood pressure or increased side effects. Such
herbs include: black hellebore, calamus, cereus, cola, coltsfoot,
devil's claw, European mistletoe, fenugreek, fumitory, digitalis leaf,
hedge mustard, figwort, lily of the valley roots, motherwort, pleurisy
root, squill bulb leaf scales, white horehound, mate, and shepherd's
purse.8
• Avoid natural licorice products,
Ginseng, and Ephedra (Ma huang) which may contribute to high blood
pressure9
References
1 Good CB, McDermott L, McCloskey B.
Diet and serum potassium in patients on ACE inhibitors. JAMA
1995;274:538
1 Burnakis TG & Mioduch HJ: Combined therapy with
captopril and potassium supplementation. A potential for hyperkalemia.
Arch Intern Med 1984; 144:2371-2372
2 Pronsky, ZM: Food-Medication Interactions, 11th edition,
1999
3 Golik A, Modai D, Averbukh Z, et al: Zinc metabolism in
patients treated with captopril versus enalapril, Metabolism, 1990,
39(7): 665-7
3 Golik A, Zaidenstein R, Dishi V, et al: Effects of
captopril and enalapril on zinc metabolism in hypertensive s, J Am Coll
Nutr, 1998, 17(1):75-8
4 McKevoy GK, ed. AHFS Drug Information. Bethesda, MD:
American Society of Health-System Pharmacists, 1998
5 Ruiz FJ, Salom MG, Ingles AC, Quesada T, Vicente E,
Carbonell LF.N-acetyl-L-cysteine potentiates depressor response to
captopril and enalaprilat in SHRs. Am J Physiol. 1994 Sep;267(3 Pt
2):R767-72
5 Suárez C, Del Arco C, Lahera V, Ruilope LM.
N-Acetylcysteine potentiates the antihypertensive effect of angiotensin
converting enzyme inhibitors [letter]. Am J Hypertens. 1995;8:859-861
6 Ruiz-Gutierrez V, Muriana FJ, Guerrero A, Cert AM, Villar
J. Plasma lipids, erythrocyte membrane lipids and blood pressure of
hypertensive women after ingestion of dietary oleic acid from two
different sources. J Hypertens 1996 Dec;14(12):1483-90
6 Baroni SS, Amelio M, Sangiorgi Z, Gaddi A, Battino M. Solid
monounsaturated diet lowers LDL unsaturation trait and oxidisability in
hypercholesterolemic (type IIb) patients. Free Radic Res. 1999
Apr;30(4):275-85
6 Ferrara LA, Raimondi AS, d'Episcopo L, et al. Olive oil and
reduced need for antihypertensive medications. Arch Intern Med
2000;160(6):837-842
7 Langsjoen P, Langsjoen P, Willis R, Folkers K. Treatment of
essential hypertension with coenzyme Q10. Mol Aspects Med. 1994;15
Suppl:S265-72
8 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
8 Facts and Comparisons, The Review of Natural Products,
Clinisphere 2.0, Wolters Kluwer Company, 2000
8 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996
9 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
9 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
9 Pronsky, ZM: Food-Medication Interactions, 11th edition,
1999
Acetaminophen
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• N-acetyl cysteine has been shown to
improve liver damage caused by acetaminophen overdose.1
• Use of over three grams of vitamin C
has been associated with decreased acetaminophen clearance time.2
• Foods high in carbohydrates, pectin
and vegetables like broccoli, brussel sprouts, cabbage, etc. can
interfere with acetaminophen absorption.3
• Acetaminophen consumption is
especially risky for individuals who regularly consume excess amounts
of alcohol as they can develop liver toxicity at lower levels of
acetaminophen intake.4
• Individuals taking acetaminophen
should refrain from fasting, Being in a fasting state greatly increases
the chance of liver damage5
• In a study involving five healthy
adult volunteers Houston and Levy found that oral administration of 3 g
of ascorbic acid 1.5 hours after an oral dose of 1 g of acetaminophen
caused a rapid and pronounced decrease in the excretion rate of
acetaminophen sulfate. Later research by Mitra et al using rodents
supported the conclusion that ascorbyl stearate provided protection
against acetaminophen-induced hepatotoxicity by reducing the reactive
intermediate back to the parent compound. They also note that the
combination enhanced therapeutic efficacy against fever.These initial
studies indicate that individuals with conditions commonly treated by
acetaminophen might be able to use lower doses of the drug, achieve
equal or superior clinical results, and reduce side effects from the
drug by combining it with some form of vitamin C. In fact, a survey of
current clinical reality might reveal that such a combination is often
the unsupervised practice of many patients. Nevertheless, individuals
taking acetaminophen should consult with their physician and/or
pharmacist before reducing doses of the drug based on simultaneous use
of vitamin C.6
• Many studies have looked into the
efficacy and appropriateness of using NAC to treat patients suffering
from acute toxic effects of acetaminophen. Such treatment of
acetaminophen intoxication with N-acetylcysteine (NAC), both oral and
intravenous, is standard hospital protocol in many countries. NAC is
generally considered safe with relatively few side effects. However,
individuals suffering from acetaminophen intoxication require emergency
care and use of NAC in this capacity is only appropriate in such a
setting7
• Acetaminophen is generally well
tolerated with few short-term side effects. However, the drug is
inherently toxic to the liver, and to some degree the kidneys also, and
an overdose of acetaminophen can result in liver toxicity, liver
failure, and even death. The signs and symptoms of liver toxicity may
not become apparent for 2-3 days after a toxic overdose. Patients with
liver and kidney disease should exercise special caution in taking
acetaminophen to avoid toxicity.8
• Overdosage of acetaminophen causes
fatal hepatic failure and acute renal failure.9
• Acetaminophen may interfere with home
blood-glucose-measurement systems.10
• Oral administration of 3 g of
ascorbic acid 1.5 hr after an oral dose of 1 g of acetaminophen caused
a rapid and pronounced decrease in the excretion rate of acetaminophen
sulfate in five healthy adult volunteers. There was a statistically
significant increase in the fractions of the dose of acetaminophen
excreted as such as as acetaminophen glucuronide but a decrease in the
fraction excreted as acetaminophen sulfate. Ascorbic acid, which itself
is metabolized in part to the sulfate, inhibits the conjugation of
acetaminophen with sulfate by competing for available sulfate in the
body.11
• Avoid or limit alcohol intake Those
who take acetaminophen more than occasionally should avoid drinking
alcohol because of the increased risk of liver damage.12
• Milk Thistle Extract helps prevent
liver damage from hepatotoxins, including acetaminophen research:
Acetaminophen exerts several toxic effects upon the liver, perhaps most
importantly through lipid peroxidation and its depletion of
glutathione. Numerous studies, primarily with animals, have
demonstrated that Silybum marianum, particularly silymarin, a key set
of flavonoids, can reduce oxidative stress, inhibit lipid peroxidation
and support glutathione levels. Several teams of researchers have found
positive results when focusing on the efficacy of Silybum and its
constituents in reducing or reversing the toxic effects of
acetaminophen on the liver.herbal support: Silymarin appears capable of
providing specific benefits against the types of liver damage most
closely associated with long-term use of acetaminophen. However, as of
yet, no clinical studies involving humans have confirmed the efficacy
of such a therapeutic approach or established protocols for dosage.
Nevertheless, in such circumstances, many practitioners of natural
medicine advise taking 200 mg Silybum, standardized to contain 70-80%
silymarin, three times per day. Individuals using acetaminophen on a
regular basis for extended periods of time, especially over one year,
should consult their prescribing physician and/or a healthcare
professional trained in herbal medicine to discuss possible benefits of
taking Silybum, or an extract such as silymarin.13
• Tobacco decreases blood levels of
acetaminophen14
• Several studies have been conducted
examining the hepatoprotective effects of various species of Artemesia
used in Chinese medicine, specifically an extract identified as
DA-9601. Using rats Ryu et al found that DA-9601, from Artemisia
asiatica, reduced liver damage induced by acetaminophen (APAP) and
carbon tetrachloride (CCl4) as evidenced by serum ALT, AST, LDH and
histopathological changes such as centrilobular necrosis, vacuolar
degeneration and inflammatory cell infiltration dose-dependently. They
also found that DA-9601 also prevented APAP-induced hepatic glutathione
(GSH) depletion in a dose-dependent manner.While these research
findings are encouraging and consistent with other studies of Artemisia
species, inadequate clinical research with human subjects has been
conducted to confirm the value of Artemisia as a therapy against the
toxic side effects of acetaminophen. Individuals using acetaminophen on
a regular basis for extended periods of time, especially over one year,
should consult their prescribing physician and a healthcare
professional trained in Chinese herbal medicine to determine whether
the use of Artemisia, alone or as part of a traditional formula, would
be appropriate. However, the particular species of Artemesia used in
this study are not typically used in Chinese herbal medicine, or at
least not known by the names cited.15
• Acetaminophen is well known for its
toxic effects, especially upon the liver. Specifically acetaminophen
induces elevation of serum aminotransferase activity and hepatic
lipoperoxides content. It is also associated with observable
histological damage to the liver cells. Schisandra is an herb commonly
used in Chinese herbal medicine. Researchers have investigated the use
of gomisin A, a lignan component of Schisandra fruits, in the treatment
of acetaminophen-induced liver damage. Using rats, Yamada found that
gomisin A inhibited the elevation of serum aminotransferase activity
and hepatic lipoperoxides content and reduced the occurrence of adverse
changes such as degeneration and necrosis of hepatocytes. Lin et al
found that pathological changes of hepatic lesions in rats caused by
three hepatotoxicants were improved after administration of certain
fractions of Schisandra. However, gomisin A did not prevent
gluatathione depletion as compared to Silymarin which provided such
protection. Takeda et al have suggested that gomisin A facilitates
liver protein synthesis and causes liver enlargement as an adaptive
response involving the induction of drug-metabolizing enzymes.herbal
support: While these research findings are encouraging and consistent
with other studies of Schisandra, inadequate clinical research with
human subjects has been conducted to confirm the value of Schisandra as
a therapy against the toxic side effects of acetaminophen. Individuals
using acetaminophen on a regular basis for extended perioods of time,
especially over one year, should consult their prescribing physician
about alternatives methods of addressing the symptoms and their
underlying cause. Further, a healthcare professional trained in Chinese
herbal medicine might help determine whether the use of Schisandra,
alone or as part of a traditional formula, would be appropriate.16
References
1 Vale JA, Proudfoot AT. Paracetamol
(acetaminophen) poisoning. Lancet 1995;346:547-52
2 Houston JB, Levy G. Drug biotransformation interactions in
man. VI: Acetaminophen and ascorbic acid. J Pharm Sci 1976;65:121-21.
3 Holt GA. Food & Drug Interactions. Chicago: Precept
Press, 1998, 2.
4 Whitcomb DC, Block GD. JAMA 1994 Dec 21;272(23):1845-1850
5 Whitcomb DC, Block GD. JAMA 1994 Dec 21;272(23):1845-1850
6 Houston JB, Levy G. J Pharm Sci 1976;65:1218-1221; Mitra A,
et al. J Biochem Toxicol. 1991 Summer;6(2):93-100; Mitra A, et al.
Toxicol Lett. 1988 Nov;44(1-2):39-46.)
7 Zed PJ, Krenzelok EP. Am J Health Syst Pharm 1999 Jun
1;56(11):1081-1091; Salgia AD, Kosnik SD. Postgrad Med. 1999
Apr;105(4):81-84, 87, 90; Montoya-Cabrera MA, et al. Gac Med Mex. 1999
May-Jun;135(3):239-243; Schmidt LE, Dalhoff KP. Ugeskr Laeger. 1999 May
3;161(18):2669-2672
8 Brzeznicka EA, Piotrowski JK. Pol J Occup Med.
1989;2(1):15-22; Kamiyama T, et al. Toxicol Lett. 1993 Jan;66(1):7-12;
Vale JA, Proudfoot AT. Lancet 1995;346:547-552; Fairhurst S, et al.
Toxicology. 1982;23(2-3):249-259.)
9 Fukuoka Igaku Zasshi 1997 Nov;88(11):352-7 -- The risk
factors of death from the acetaminophen poisoning with
antipyretic-analgesic drugs in Japan. -- Washio M, Inoue N.
10 Am J Hosp Pharm 1985 Oct;42(10):2202-7 -- In vitro drug
interference with home blood-glucose-measurement systems. -- Rice GK,
Galt KA.
11 J Pharm Sci 1976 Aug;65(8):1218-21 -- Drug
biotransformation interactions in man VI: acetaminophen and ascorbic
acid. -- Houston JB, Levy G.
12 Pronsky, Z Food Medication Interactions, 11th edition, 1999
12 Whitcomb DC, Block GD. JAMA 1994 Dec 21;272(23):1845-1850
13 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
13 Campos, R. et al. Silybin Dihemisuccinate protects against
glutathione depletion and lipid peroxidation induced by acetaminophen
on rat liver. Planta Medica. 1989: 55:417.
13 Campos R, et al. Prog Clin Biol Res. 1988;280:375-378;
Campos R, et al. Planta Med. 1989 Oct;55(5):417-419; Garrido A, et al.
Pharmacol Toxicol. 1991 Jul;69(1):9-12; Muriel P, et al. J Appl
Toxicol. 1992 Dec;12(6):439-442; Chrungoo VJ, et al. Indian J Exp Biol.
1997 Jun;35(6):611-617
14 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
15 Janbaz KH, Gilani AH. J Ethnopharmacol 1995 Jun
23;47(1):43-47; Ryu BK, et al. Arch Pharm Res 1998 Oct;21(5):508-513.)
16 Takeda S, et al. Nippon Yakurigaku Zasshi. 1986
Feb;87(2):169-187; Yamada S, et al. Biochem Pharmacol
1993;46:1081-1085; Shiota G, et al. Res Commun Mol Pathol Pharmacol.
1996 Nov;94(2):141-146; Lin CC, et al. J Ethnopharmacol 1997
May;56(3):193-200
Acetaminophen-Codeine
Phosphate
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Drinking alcohol can dangerously
interact with this medication.1
• Codeine can cause constipation and
increased fiber in the diet can help with this condition, however
separate their use by at least two hours.2
• Take with food to avoid stomach upset.3
• Herbs with sedative properties may
intensify the effects of codeine and should not be used concurrently.
These herbs include Chamomile, Black cohosh, Hops, Kava kava, Lobelia,
Motherwort, Passion flower, Skullcap, St. John’s wort, and Valerian.4
References
1 Graedon J, Graedon T: The People’s
Guide to Deadly Drug Interactions, 1995, 234.
1 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
2 Pronsky, Food-Medication Interactions, 11th edition, 1999.
2 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
3 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
4 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
4 Facts and Comparisons, The Review of Natural Products,
Clinisphere 2.0, Wolters Kluwer Company, 2000
4 PDR for Herbal Products, 2nd edition, Medical Economics
Company, 2000
Actonel
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Calcium supplementation
may affect the absorption of this medication. Conversely, people being
treated with this medication may have low calcium blood
levels. Check with your physician or pharmacist prior to taking
supplements containing calcium or vitamin D
and, if taking, make sure to take the supplement at least two hours
prior to or after taking this medication.1
• Taking any antacid containing calcium or magnesium
may also affect the absorption of this medication and should be
separated by at least two hours prior or after the taking of this
medication.2
• As many foods also contain high
levels of minerals, taking this medication at the same time may reduce
the absorption of the medication. Separate the taking of this
medication from your food intake, according to the advice of your
physician or pharmacist.3
• Magnesium, zinc, iron and other trace
minerals may affect the absorption of this medication. When taking this
or other medications, it is wise to consult your physician or
pharmacist about your supplements and to separate the taking of all
supplements at least two hours prior or after taking the medication.4
• Herbs containing high levels of
certain minerals may affect the absorption of this medication. Ask your
pharmacist if your herbal supplements may interact with this medication.5
References
1 Reasner CA, Stone MD, Hosking DJ, et
al. Acute changes in calcium homeostasis
during treatment of primary hyperparathyroidism with risedronate. J
Clin Endocrinol Metab 1993;77:1067-71
1 Sifton DW, ed. Physicians’ Desk Reference. Montvale, NJ:
Medical Economics Company, Inc., 2000, 2504-6.
2 Reasner CA, Stone MD, Hosking DJ, et al. Acute changes in calcium homeostasis
during treatment of primary hyperparathyroidism with risedronate. J
Clin Endocrinol Metab 1993;77:1067-71.
2 Sifton DW, ed. Physicians’ Desk Reference. Montvale, NJ:
Medical Economics Company, Inc., 2000, 2504-6.
3 Reasner CA, Stone MD, Hosking DJ, et al. Acute changes in calcium homeostasis
during treatment of primary hyperparathyroidism with risedronate. J
Clin Endocrinol Metab 1993;77:1067-71.
3 Sifton DW, ed. Physicians’ Desk Reference. Montvale, NJ:
Medical Economics Company, Inc., 2000, 2504-6.
4 Sifton DW, ed. Physicians’ Desk Reference. Montvale, NJ:
Medical Economics Company, Inc. 2000, 2504-6.
5 Sifton DW, ed. Physicians’ Desk Reference. Montvale, NJ:
Medical Economics Company, Inc. 2000, 2504-6.
Adalat
CC
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Avoid or limit alcohol use.1
• Grapefruit and grapefruit juice may
increase the effects of calcium channel
blockers and possibly cause an excessive lowering of blood pressure.2
• Magnesium and potassium supplements
may contribute to lowering of blood pressure when used with this
medication. Discuss supplementation with a pharmacist.3
• Avoid natural Licorice products,
Ginseng and Ephedra (Ma huang), which may interfere with
antihypertensive therapy.4
• Some herbs possess cardiac activity
which may interact with Adalat: black hellebore, calamus, cereus, cola,
coltsfoot, devil's claw, European mistletoe, fenugreek, fumitory,
digitalis leaf, hedge mustard, figwort, lily of the valley roots,
motherwort, pleurisy root, squill bulb leaf scales, white horehound,
mate, scotch broom flower, shepherd's purse, and wild carrot.5
References
1 Mindell, E, Hopkins V: Prescription
Alternatives. New Canaan, CT: Keats Publishing, Inc, 1998; p 143.
1 Pronsky, Z Food Medication Interactions, 11th edition, 1999
2 Edgar, B et al: Acute effects of drinking grapefruit juice
on the pharmacokinetics and dynamics of Felodipine - and its potential
clinical relevance. Eur. J. Clin. Pharm. 1992, 42:313-317.
2 Bailey DG, et al. "Interaction of citrus juices with
felodipine and nifedipine." Lancet, 1991; 337: 268-69.
2 Fuhr U. "Drug Interactions with Grapefruit Juice." Drug
Safety 1998; (4): 251-272.
3 Rybacki, JJ. The Concise Essential Guide to Prescription
Drugs, 1997. HarperCollins.
3 Ono A, Shibaoka M, Yano J, Asai Y, Fujita T. Eating habits
and intensity of medication in elderly hypertensive outpatients.
Hypertens Res. 2000 May;23(3):195-200.
3 Geleijnse JM, Witteman JC, den Breeijen JH, Hofman A, de
Jong PT, Pols HA, Grobbee DE. Dietary electrolyte intake and blood
pressure in older subjects: the Rotterdam Study. J Hypertens. 1996
Jun;14(6):737-41.
3 Van Leer EM, Seidell JC, Kromhout D. Dietary calcium,
potassium, magnesium and blood pressure in the Netherlands. Int J
Epidemiol. 1995 Dec;24(6):1117-23.
4 Farese, RV et al., Licorice-induced
hypermineralcorticoidism. NEJM. 1991, 325:1,1223-1,227.
4 Pronsky, Z Food Medication Interactions, 11th edition, 1999
4 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
5 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
5 Facts and Comparisons, The Review of Natural Products,
Clinisphere 2.0, Wolters Kluwer Company, 2000
5 Blumenthal M, et al. ed. The Complete German Commission E
Monographs: Therapeutic Guide to Herbal Medicines. Trans. S. Klein.
Boston, MA: American Botanical Council, 1998.
5 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
Adderall
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Large doses of caffeine should be
limited or avoided with this medication.1
• Magnesium Dextroamphetamine can
increase blood levels of magnesium, which causes significant lowering
of the calcium to magnesium
ratio in the blood. The change in this ratio may in part explain the
effectiveness of stimulants like dextroamphetamine in hyperactive
boys.1 Another magnesium-amphetamine interaction involves supplements
of magnesium hydroxide, which are known to cause retention of
amphetamines in the body.2 This could theoretically result in increased
blood levels of these drugs. Finally, animal studies have suggested
that magnesium supplements can increase learning and enhance the
behavioral response to stimulants.3 For these reasons, the use of
magnesium along with amphetamines may enhance the effectiveness of
these drugs in the treatment of ADD, but controlled studies of this
possibility are needed.2
• Vitamin C Ingestion of some types of
vitamin C results in acidification of the intestinal contents and thus
a decreased absorption of amphetamines.4 Supplements containing vitamin
C should be taken an hour before or two hours after taking amphetamines.3
• Tyrosine is an amino acid used by the
body to produce brain chemicals stimulated by amphetamines. Reduced
stimulant effects of amphetamines were observed in individuals who had
been made tyrosine deficient.5 It is possible that a dietary deficiency
of tyrosine may reduce the effectiveness of amphetamines. Tyrosine
deficiency is not common unless a protein deficiency exists. Adequate
tyrosine intake from dietary protein or supplements is necessary in
individuals taking amphetamines.4
• Lithium is a mineral that may be
present in some supplements and is also used in large amounts to treat
mood disorders such as bipolar disorder (manic depression). Taking
lithium at the same time as amphetamines may inhibit the appetite
suppressant and stimulatory effects of the amphetamines.6 Therefore,
people taking amphetamines should take lithium only under the
supervision of a doctor.5
• Vitamin B6 Occasionally, individuals
taking amphetamines develop compulsive behavior and anxiety, even after
the drug is discontinued. When this side effect occurred in an
eight-year-old boy,7 supplementation with 200 mg vitamin B6 each day
for one week followed by 100 mg daily, reduced the compulsive behavior
and anxiety within three weeks. The symptoms were eliminated after a
few months of treatment. Controlled research is needed to determine
conclusively the usefulness of vitamin B6 supplementation for
preventing and treating this side effect.6
• L-tryptophan In an uncontrolled study
of schizophrenic patients, 200 mg per day of L-tryptophan reduced
disturbances in thinking, as well as hallucinations caused by
dextroamphetamine.8 Symptoms of psychosis rarely occur in people who
take amphetamines and are not schizophrenic. Controlled research is
needed to establish the benefits of L-tryptophan and related
supplements for people taking amphetamines.7
• Fruit juices may acidify the
intestinal contents, causing reduced absorption of amphetamines.11
Therefore, juices should be consumed an hour before or two hours after
administration of amphetamines.8
• The combination of alcohol and
methamphetamine makes the heart work harder and consume more oxygen,
which may produce unwanted effects.12 Alcohol consumption may also
suppress the breakdown of amphetamines, causing elevations in blood
levels of the drug.13 Individuals taking amphetamines should avoid
alcoholic beverages, especially if they have known heart problems.9
• The following herbs may have
cardioactive or sedative properties that could interact dangerously
with Adderall: Astragalus, Catnip, Dong quai, Feverfew, Fo-ti, Guarana,
Kava, Kelp plant, Lady’s slipper, Lavender, Linden tree, Lobelia,
Marigold, Passion flower, Chamomile, Slippery elm, St. John’s wort, and
Yohimbe.10
• Eucalyptus may decrease the
effectiveness of drugs like Adderall by increasing its clearance from
the body.11
• It may be advisable to avoid ginseng
with Adderall due to its stimulant properties.12
• Ephedra sinica contains a compound
called ephedrine. A seven-year-old boy who had 12 mg of ephedrine twice
daily added to his dextroamphetamine therapy experienced improvement in
hyperactive behavior.9 He also experienced relief from symptoms, such
as headaches and spots before his eyes, that may have been caused by
dextroamphetamine. However, concurrent use of amphetamines with other
stimulants such as ephedrine or Ephedra sinica could cause excessive
stimulation of the heart or nervous system. For this reason, such
combinations should be used with great caution, and only under the
supervision of a doctor.13
• Veratrum (Hellebore) is an herb used
by doctors of natural medicine to treat high blood pressure;however,
amphetamines can inhibit this effect.10 Therefore, people taking
veratrum to treat hypertension should avoid amphetamines.14
References
1 Pronsky, Z Food Medication
Interactions, 11th edition, 1999
2 1. Schmidt ME, Kruesi MJ, Elia J, et al. Effect of
dextroamphetamine and methylphenidate on calcium and
magnesium concentration in hyperactive boys. Psychiatry Res
1994;54:199–210.
2 2. Hurwitz A. Antacid therapy and drug kinetics. Clin
Pharmacokinet 1977;2:269–80
2 3. Reviewed in Schmidt ME, Kruesi MJ, Elia J, et al. Effect
of dextroamphetamine and methylphenidate on calcium and
magnesium concentration in hyperactive boys. Psychiatry Res
1994;54:199–210.
3 4. Sifton DW, ed. Physicians Desk Reference. Montvale, NJ:
Medical Economics Company, Inc., 2000, 2953–4.
4 5. McTavish SF, McPherson MH, Sharp T, Cowen PJ.
Attenuation of some subjective effects of amphetamine following
tyrosine depletion. J Psychopharmacol 1999;13:144–7.
5 6. Sifton, DW, ed. Physicians Desk Reference. Montvale, NJ:
Medical Economics Company, Inc., 2000, 2953–4.
6 7. Frye PE, Arnold LE. Persistent amphetamine-induced
compulsive rituals: response to pyridoxine (B6). Biol Psychiatry
1981;16:583–7.
7 8. Irwin MR, Marder SR, Fuentenebro F, Yuwiler A.
L-5-hydroxytryptophan attenuates positive psychotic symptoms induced by
D-amphetamine. Psychiatry Res 1987;22:283–9.
8 11. Sifton DW, ed. Physicians Desk Reference. Montvale, NJ:
Medical Economics Company, Inc., 2000, 2953–4.
9 12. Mendelson J, Jones RT, Upton R, Jacob P 3rd.
Methamphetamine and ethanol interactions in humans. Clin Pharmacol Ther
1995;57:559–68.
9 13. Shimosato K. Urinary excretion of p-hydroxylated
methamphetamine metabolites in man. II. Effect of alcohol intake on
methamphetamine metabolism. Pharmacol Biochem Behav 1988;29:733–40.
10 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
10 Blumenthal, M (Ed.): The Complete German Commission E
Monographs: Therapeutic Guide to Herbal Medicines. American Botanical
Council. Austin, TX. 1998.
10 Facts and Comparisons, The Review of Natural Products,
Clinisphere 2.0, Wolters Kluwer Company, 2000
11 Jori A, Bianchetti A, Prestini PE, Garattini S: Effects of
eucalyptol on the metabolism of other drugs in rats and in man, Eur. J.
pharmacol, 9:362-6, 1970
11 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
12 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
13 9. Scanlon J. Treatment of hyperkinetic child with
dextroamphetamine and ephedrine. Pediatrics 1970;46:975–6.
14 10. Sifton DW, ed. Physicians Desk Reference. Montvale,
NJ: Medical Economics Company, Inc., 2000, 2953–4.
Adriamycin
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• nutrient affected by drug: Vitamin B2
(Riboflavin) Doxorubicin can interfere with the normal metabolism and
function of vitamin B2 and increase it urinary excretion. Doxorubicin
has been shown to form a 1:1 stoichiometric complex with riboflavin, as
well as to compete for binding to tissue proteins.1
• Research with rats has demonstrated
riboflavin deficiency due to doxorubicin, even when dietary sources of
riboflavin have been sufficient. Studies by Pinto et al has
demonstrated that the increased levels in aldosterone associated with
doxorubicin are the result of the drug's inhibition of flavin coenzyme
biosynthesis. They concluded that their findings with rat studies
suggest that flavins play a decisive role in regulating the levels of
aldosterone and raise the possibility that the doxorubicin-induced
increase in serum aldosterone may be part of the pathogenetic
mechanisms of cardiovascular toxicity and overall muscular weakness.
Research looking at adverse effects, especially doxorubicin-induced
mortality, has indicated that supplementation with riboflavin may
reduce adverse side effects and enhance survival rates.2
• Antioxidant action reduces cardiac
toxicity. However, as a strong antioxiidant and as an effective
promoter of glutathione activity, vitamin C could potentially inhibit
the therapeutic mechanism of doxorubicin which relies upon the
cytotoxic effect of free radical formation.3
• Animal studies, using mice and guinea
pigs, indicated that vitamin C significantly increased life expectancy
by reducing the cardiotoxicity of doxorubicin; this positive effect was
gained without interfering with the drug's anticancer effects. However,
the relationship between these findings based on animal studies and
human clinical cardiac toxicity is uncertain. Supplementation of
vitamin C at doses of one or more grams per day is prescribed by some
practitioners as nutritional support for patients taking doxorubicin,
even though the practice lacks conclusive data based on human studies4
• Initial research by Prasad et al
suggested that supplementation with vitamin E might reduce cardiac and
skin toxicity due to doxorubicin. Research studies with animals have
found that vitamin E's potent antioxidant activity can protect against
Adriamycin-induced cardiotoxicity; hence reducing the risk of heart
failure which is a serious side effect associated with doxorubicin.5
• No conclusive evidence has come forth
confirming the cardioprotective effect of vitamin E in human trials.
Nevertheless, some evidence suggests that supplementation with vitamin
E may allow use of higher doses of doxorubicin without correspondingly
increasing toxicity.6
• Anecdotal reports indicate that very
high doses of vitamin E (1600 IU) may reduce the amount of alopecia
(hair loss) resulting from use of doxorubicin. (Wood LA. N Engl J Med
1985;312:1060 ) As of yet, no research on humans has duplicated the
protective effect against hair loss found in one study with rabbits
nutritional support: Supplementation of vitamin E at doses of 800 IU or
more is prescribed by some practitioners as nutritional support for
patients taking doxorubicin, even though no decisive evidence has
emerged showing that the vitamin reduces drug toxicity or protects
against hair loss.7
• In vitro evidence suggests that
vitamin E enhances the growth inhibitory effect of doxorubicin, at
least in a test tube.8
• Research has found that N-acetyl
cysteine (NAC) exerts a protective effect from the cardiotoxicity of
doxorubicin, at least in animals; no research with human has yet
confirmed these results. The prescription of oral NAC for individuals
receiving doxorubicin therapy is not a common practice among
nutritionally-oriented physicians.9
• Coenzyme Q10 reduces free radical
formation induced by doxorubicin. Studies with both animals and humans
have found that pretreating with coenzyme Q10, at levels of 100 mg per
day, reduces cardiac toxicity caused by doxorubicin. Coenzyme Q10
reduces free radical formation induced by doxorubicin.10
• Individuals taking doxorubicin
(Adriamycin) may benefit from supplementation with coenzyme Q10 at some
point in their treatment protocol. However, such supplementation should
only be started after consultation with and under the close supervision
of the prescribing physician and/or a nutritionally trained healthcare
professional. Nutrients with antioxidant potential should generally be
avoided during the course of treatment with doxorubicin as there is
concern that the effectiveness of the medication might be diminished
since it relies upon free radical formation for its cytotoxic effect.
Should use of coenzyme Q10 be
agreed upon a dosage in the range of 50-100 mg three times daily would
be in the range many nutritionally oriented healthcare professionals
would use.11
• One of the vital roles of ascorbic
acid (vitamin C) is to act as an antioxidant to protect cellular
components from free radical damage. Ascorbic acid has been shown to
scavenge free radicals directly in the aqueous phases of cells and the
circulatory system. Ascorbic acid has also been proven to protect
membrane and other hydrophobic compartments from such damage by
regenerating the antioxidant form of vitamin E. In addition, reduced
coenzyme Q, also a resident of hydrophobic compartments, interacts with
vitamin E to regenerate its antioxidant form. The mechanism of vitamin
C antioxidant function, the myriad of pathologies resulting from its
clinical deficiency, and the many health benefits it provides, are
reviewed12
• nutrient affecting drug toxicity:
N-acetyl Cysteine (NAC), a precursor to Glutathione. Antioxidant action
reduces cardiac toxicity of doxorubicin13
• There are no Herbal considerations at
this time14
References
1 Pinto J, et al. Cancer 1986 Oct
15;58(8 Suppl):1911-1914
2 Ogura R, et al. J Nutr Sci Vitaminol (Tokyo). 1991
Oct;37(5):473-477; Raiczyk GB, et al. Proc Soc Exp Biol Med 1988
Sep;188(4):495-499; Pinto JT, et al. Endocrinology 1990
Sep;127(3):1495-1501
3 Labriola D, Livingston R. Oncology (Huntingt). 1999
Jul;13(7):1003-1008.
4 Fujita, K, et al. Cancer Res 1982;42:309-316; Shimpo K, et
al. Am J Clin Nutr 1991 Dec;54(6 Suppl):1298S-1301S; Ellison, NM,
Londer H. 1981
5 Prasad KN, et al. Proc Soc Exp Biol Med 1980
Jun;164(2):158-163; Ellison NM. Cancer Bull 1985;37(3):112-113; Am
Heart J 1986;lll:95; Myers C, et al. Cancer Treat Rep 1976;60:961-962;
Sonneveld P. Cancer 1978;62:1033-1036
6 Ellison, NM, Londer H. 1981; Weiji NI, et al. Cancer
Treatment Rev 1997,23:209-210
7 Weiji NI, et al. Cancer Treatment Rev 1997;23:209-240.
8 Ripoll EAP, et al. J Urol 1986;136:529-531
8 Ellison, NM. Relationship between vitamin E and cancer -
facts, not fancy. Cancer Bull 1985;37(3):112-113
8 Ellison, NM, Londer H. Vitamin E and C and their
relatiuonship to cancer. In: Newell GR, Ellison NM, eds. Nutrition and
Cancer: Etiology and Treatment. New York: Raven Press, 1981.
9 Schmitt-Graff A, et al. Pathol Res Pract. 1986
May;181(2):168-74; Martinez E, Domingo P. Lancet 1991;338:249; Doroshow
JH, et al. J Clin Invest 1981;68:1053-1064; Meyers C, et al. Semin
Oncol 1983;10:53-55
10 Gaby, AR.1987; Judy WV, et al. 1984,231-241; Ogura R, et
al. J Appl Biochem 1979,1:325;
10 Folkers K. 1985; Gaby, AR. 1987; Anonymous. Nutr Rev
1988;46:1367; Beyer RE. Biochem Cell Biol 1992 70(6):390-403
10 Shinozawa S, et al. Biol Pharm Bull. 1993
Nov;16(11):1114-1117; Shinozawa S, et al. Acta Med Okayama. 1991
Jun;45(3):195-199; Shinozawa S, et al. Acta Med Okayama.
10 Acta Med Okayama. 1991 Jun;45(3):195-199; Shinozawa S, et
al. Acta Med Okayama. 1987 Feb;41(1):11-17; Shinozawa S, et al. Acta
Med Okayama. 1984 Feb;38(1):57-63; Labriola D, Livingston R. Oncology
(Huntingt). 1999 Jul;13(7):1003-1008
11 Anonymous. Vitamin E and cell injury. Nutr Rev
1988;46:1367.
11 Doroshow JH, Locker GY, Ifrim I, Myers CE. Prevention of
doxorubicin cardiac toxicity in the mouse by N-acetylcysteine. J Clin
Invest 1981 Oct;68(4):1053-1064
11 Beyer RE. An analysis of the role of coenzyme Q in free
radical generation, and as an antioxidant. Biochem Cell Biol 1992
70(6):390-403
11 Doroshow JH, Locker GY, Ifrim I, Myers CE. Prevention of
doxorubicin cardiac toxicity in the mouse by N-acetylcysteine. J Clin
Invest 1981 Oct;68(4):1053-1064.
11 Ellison, NM. Relationship between vitamin E and cancer -
facts, not fancy. Cancer Bull 1985;37(3):112-113.
11 Ellison, NM, Londer H. Vitamin E and C and their
relatiuonship to cancer. In: Newell GR, Ellison NM, eds. Nutrition and
Cancer: Etiology and Treatment. New York: Raven Press, 1981.
11 Folkers K. Basic chemical research on coenzyme Q10 and
integrated clinical research on therapy of diseases. In: Lenaz G, ed.
Coenzyme Q. John Wiley and Sons, 1985.
11 Fujita K, Shinpo K, Yamada K, Sato T, Niimi H, Shamoto M,
Nagatsu T, Takeuchi T, Umezawa H. Reduction of Adriamycin toxicity by
ascorbate in mice and guinea pigs. Cancer Res 1982 Jan;42(1):309-316.
11 Judy, WV, Hall, JH, Dugan, W, et al. Coenzyme Q10
reduction of Adriamycin cardiotoxicity. In Biomedical and Clinical
Aspects of Coenzyme Q, vol.4, ed. Folkers, K, Yamamura, Y. Amsterdam:
Elsevier/North Holland Biomedical Press, 1984,231-241.
11 Labriola D, Livingston R. Possible interactions between
dietary antioxidants and chemotherapy. Oncology (Huntingt). 1999
Jul;13(7):1003-1008; discussion 1008, 1011-1012.
11 Martinez, E, Domingo, P. N-acetylcysteine as
chemoprotectant in cancer chemotherapy. Lancet 1991 Jul
27;338(8761):249. (Letter)
11 Myers C, Bonow R, Palmeri S, Jenkins J, Corden B, Locker
G, Doroshow J, Epstein S. A randomized controlled trial assessing the
prevention of doxorubicin cardiomyopathy by N-acetylcysteine. Semin
Oncol 1983 Mar;10(1 Suppl 1):53-55.
11 Myers, C, McQuire, W, Young, R. Adriamycin amelioration of
toxicity by alpha-tocopherol. Cancer Treat Rep 1976 Jul;60(7):961-962.
11 Ogura R, Ueta H, Hino Y, Hidaka T, Sugiyama M. Riboflavin
deficiency caused by treatment with adriamycin. J Nutr Sci Vitaminol
(Tokyo). 1991 Oct;37(5):473-477
11 Ogura R, Toyama H, Shimada T, Murakami M. The role of ubiquinone (Coenzyme
Q10) in preventing Adriamycin-induced mitochondrial disorders in rat
heart. J Appl Biochem 1979,1:325.
11 Okamoto K, Ogura R. Effects of vitamins on lipid
peroxidation and suppression of DNA synthesis induced by adriamycin in
Ehrlich cells. J Nutr Sci Vitaminol (Tokyo) 1985 Apr;31(2):129-137.
11 Pinto JT, Delman BN, Dutta P, Nisselbaum J.
Adriamycin-induced increase in serum aldosterone levels: effects in
riboflavin-sufficient and riboflavin-deficient rats. Endocrinology 1990
Sep;127(3):1495-1501.
11 Pinto J, Raiczyk GB, Huang YP, Rivlin RS. New approaches
to the possible prevention of side effects of chemotherapy by
nutrition. Cancer 1986 Oct 15;58(8 Suppl):1911-1914.
11 Prasad KN, Edwards-Prasad J, Ramanujam S, Sakamoto A.
Vitamin E increases the growth inhibitory and differentiating effects
of tumor therapeutic agents on neuroblastoma and glioma cells in
culture. Proc Soc Exp Biol Med 1980 Jun;164(2):158-163.
11 Ripoll, EAP, Rama, BN, Webber, MM. Vitamin E enhances the
chemotherapeutic effects of Adriamycin on human prostatic carcinoma
cells in vitro. J Urol 1986 Aug;136(2):529-531.
11 Raiczyk GB, Rivlin RS, Pinto J. Enhancement of
adriamycin-induced mortality during riboflavin administration and
riboflavin deficiency in rats. Proc Soc Exp Biol Med 1988
Sep;188(4):495-499.
11 Shinozawa S, Kawasaki H, Gomita Y. [Effect of biological
membrane stabilizing drugs (coenzyme Q10, dextran sulfate and reduced
glutathione) on adriamycin (doxorubicin)-induced toxicity and
microsomal lipid peroxidation in mice]. Gan To Kagaku Ryoho. 1996
Jan;23(1):93-98. [Article in Japanese]
11 Shinozawa S, Gomita Y, Araki Y. Protective effects of
various drugs on adriamycin (doxorubicin)-induced toxicity and
microsomal lipid peroxidation in mice and rats. Biol Pharm Bull. 1993
Nov;16(11):1114-1117.
11 Shinozawa S, Gomita Y, Araki Y. Tissue concentration of
doxorubicin (adriamycin) in mouse pretreated with alpha-tocopherol or
coenzyme Q10. Acta Med Okayama. 1991 Jun;45(3):195-199.
11 Shinozawa S, Gomita Y, Araki Y. Protection against
adriamycin (doxorubicin)-induced toxicity in mice by several clinically
used drugs. Acta Med Okayama. 1987 Feb;41(1):11-17.
11 Shinozawa S, Etowo K, Araki Y, Oda T. Effect of coenzyme Q10 on the
survival time and lipid peroxidation of adriamycin (doxorubicin)
treated mice. Acta Med Okayama. 1984 Feb;38(1):57-63.
11 Schmitt-Graff A, Scheulen ME. Prevention of adriamycin
cardiotoxicity by niacin, isocitrate or N-acetyl-cysteine in mice. A
morphological study. Pathol Res Pract. 1986 May;181(2):168-74.
11 Shimpo K, Nagatsu T, Yamada K, Sato T, Niimi H, Shamoto M,
Takeuchi T, Umezawa H, Fujita K. Ascorbic acid and adriamycin toxicity.
Am J Clin Nutr 1991 Dec;54(6 Suppl):1298S-1301S
11 Sonneveld, P. Effect of alpha-tocopherol on the
cardiotoxicity of Adriamycin in the rat. Cancer 1978
Jul;62(7):1033-1036.
11 Weiji NI, Cleton, F.T, Osanto S. Free radicals and
antioxidants in chemotherapy-induced toxicity. Cancer Treatment Rev
1997 Jul;23(4):209-240. (Review)
11 Wood, LA. Possible prevention of Adriamycin-induced
alopecia by tocopherol. N Engl J Med 1985;312:1060. (Letter)
12 J Bioenerg Biomembr. 1994 Aug;26(4):349-58
12 Department of Biology, University of Michigan, Ann Arbor
48109
12 PMID: 7844109 [PubMed - indexed for MEDLINE
13 Schmitt-Graff A, et al. Pathol Res Pract. 1986
May;181(2):168-74; Martinez E, Domingo P. Lancet 1991;338:249; Doroshow
JH, et al. J Clin Invest 1981;68:1053-1064; Meyers C, et al. Semin
Oncol 1983;10:53-55
Agenerase
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Agenerase Capsules - Each Agenerase
pill contains 109 IU of vitamin E per capsule. This means that if
you're taking Agenerase, you're also taking 1,744 IU of vitamin E per
day. Because vitamin E can thin the blood, you should not take any
other vitamin E supplements in addition to Agenerase. People taking
blood-thinning drugs should talk to their doctor about the amount of
vitamin E in Agenerase to make sure it isn't dangerous to your health.
If you are taking a blood-thinning medication or you have low vitamin
K, your doctor will decide if the amount of vitamin E in Agenerase
interferes with your treatment.1
• Agenerase may increase the amount of
fat in your body or you may notice changes in the location of your body
fat. Tell your doctor if you experience any changes like these.2
• Agenerase can be taken with or
without food. However, a high fat meal may decrease the absorption of
this medication.3
• Do not use St. John’s wort with this
medication.4
• Do not take this medication with
HMG-CoA reductase inhibitors, which would include the herb Red Yeast
Rice.5
• Due to the amount of vitamin E in
this medication, there may thinning of the blood. The following herbs
may contribute to blood thinning and should not be used while taking
this medication: Angelica, Anise, Arnica, Asafoetida, Bogbean,
Capsicum, Celery, Chamomile, Danshen, Fenugreek, Feverfew, Garlic,
Ginger, Ginkgo, Ginseng (Panax), Gotu kola, Horse chestnut, Licorice,
Meadowsweet, Papain, Prickly ash, Poplar, Quassia, Red clover, Rue, and
Willow.6
References
1 Reference: GlaxoSmithKline studies
on Agenerase. October 2002.
2 Reference: GlaxoSmithKline studies on Agenerase. October
2002.
3 Reference: GlaxoSmithKline studies on Agenerase. October
2002.
4 Reference: GlaxoSmithKline studies on Agenerase. October
2002.
5 Reference: GlaxoSmithKline studies on Agenerase. October
2002.
6 Gadkari, et al. Effect of ingestion of raw garlic on serum
cholesterol levels, clotting time and fibrinolytic activity in normal
subjects. J Postgrad Med 1991;37:128-31.
6 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
6 Janetsky, K et al. Probably interaction between warfarin
and ginseng. Am J Health-Syst Pharm 1997;54:692-93.
6 Kleijnen J, Knipschild P. Ginkgo biloba. Lancet
1992;340:1136-39.
6 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
Akineton
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Avoid alcohol with this medication.1
• Take with food for stomach upset.2
• Take plenty of fluids with this
medication, unless otherwise directed by a physician.3
• The following herbs have sedative
qualities and could intensify the effects of this medication: calamus,
calendula, chamomile, California poppy, catnip, couch grass,
elecampane, ginseng Siberian, goldenseal, gotu kola, hops, Jamaican
dogwood, kava, lemon balm, sage, St. John's wort, sassafras, scullcap,
shepherd's purse, stinging nettle, valerian, withania root, and yerba
mansa.4
• Anticholinergic side effects and
adverse reactions may increase if chinese club moss, henbane and thorn
apple are used with anticholinergic drugs.5
References
1 Facts and Comparisons, Clinisphere
2.0, Wolters Kluwer Company, 2000
2 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
3 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
4 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
4 The Review of Natural Products, Clinisphere 2.0, Wolters
Kluwer Company, 2000
4 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
5 Blumenthal, M (Ed.): The Complete German Commission E
Monographs: Therapeutic Guide to Herbal Medicines. American Botanical
Council. Austin, TX. 1998.
5 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
5 The Review of Natural Products, Clinisphere 2.0, Wolters
Kluwer Company, 2000
Albuterol
Sulfate
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• This drug may induce hyperglycemia.
It is important to limit sugar intake and strictly monitor blood
glucose levels, particularly if you are diabetic.1
• The use of caffeine should be limited
when using this medication.2
• Albuterol may interact with these
herbs to increase cardiovascular side effects. They include Blue
Cohosh, Goldenseal, Hawthorn, and Motherwort3
• Albuterol may interact with Licorice,
Ginseng and Ephedra (Ma Huang) to overstimulate the cardiovascular
system.4
References
1 Smith AP, Banks J, Cheong, B,
Gunawardena: Mechanisms of abnormal glucose metabolism during the
treatment of acute severe asthma. Quart J Med. 1992; NS82:71-80.
1 Pronsky, Z Food Medication Interactions, 11th edition, 1999
2 Pronsky, Z Food Medication Interactions, 11th edition, 1999
2 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
3 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
3 Facts and Comparisons, The Review of Natural Products,
Clinisphere 2.0, Wolters Kluwer Company, 2000
3 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
4 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
4 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
Alesse
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Extended use of Allese-28 may cause
deficiencies in folic acid, iron, magnesium, zinc, and vitamins B2, B6,
B12, and C. Supplementation may be recommended with long term use of
the medication.1
• Allese-28 may cause levels of vitamin
A ,K, iron and copper to increase. Discuss dietary considerations in
relation to these increases with your physician or pharmacist.2
• Caffeine intake should be limited.
Hormonal contraceptive agents may increase the effect of caffeine.3
• Herbs that may affect Allese-28
include Blue cohosh, Licorice, Red Sage, Skullcap.4
• The following herbs may be hormonally
active and could disturb the action of Allese-28: Agnus Castus, Black
Cohosh, Ginseng, Motherwort, Pleurisy Root, Red Clover, Saw
Palmetto,and Vervain5
References
1 Van Nostrand Reinhold: Oral
contraceptives and nutrient interactions, 1988:38.
1 Lindenbaum J, Whitehead N, Reyner F. Oral contraceptive
hormones, folate metabolism,
and the cervical epithelium. Am J Clin Nutr 1975;28:346-53.
1 Frassinelli-Gunderson EP, Margen S, Brown JR. Iron stores
in users of oral contraceptive agents. Am J Clin Nutr 1985;41(4):703.
1 Adams PW, Wynn V, Rose DP, et al. Effect of pyridoxine
hydrochloride (vitamin B6) upon depression associated with oral
contraception. Lancet 1973;I:897-904.
1 Wynn V. Vitamins and oral contraceptive use. Lancet
1975;1:561-64.
1 Holt GA. Food & Drug Interaction. Chicago: Precept
Press, 1998, 197-98.
1 Werbach MR. Foundations of Nutritional Medicine. Tarzana,
CA: Third Line Press, 1997, 210-11 [review].
1 Kornberg A, Segal R, Theitler J, et al: Folic acid deficiency,
megaloblastic anemia and peripheral polyneuropathy due to oral
contraceptives, Isr J Med Sci, 1989, 25 (3): 142-5.
1 Harper JM, Levine AJ, Rosenthal DL, et al: Erythrocyte folate levels, oral
contraceptive use and abnormal cervical cytology, Acta Cytol, 1994, 38
(3): 324-30.
1 Blum M, Kitai E, Ariel Y, Et Al: Oral Contraceptive Lowers
Serum Magnesium, Harefuah, 1991, 121 (10):363-4.
1 Seelig Ms, Interrelationship Of Magnesium And Estrogen In
Cardiovascular And Bone Disorders, Eclampsia, Migraine, And
Premenstrual Syndrome, J Am Coll Nutr, 1993, 12(4):442-58.
1 Webb JL, Nutritional effects of oral contraceptive use, a
review, J Reprod Med, 1980, 25 (4): 150-6.
1 Prasad AS, Lei KY, Moghissi KS, et al: Effect of oral
contraceptives on nutrients III - Vitamins B6, B12, and folic acid, Am
J Obstet Gynecol, 1976, 125(8):1063-9.
1 Bhagavan HN, Brin M: Drug-Vitamin B6 Interaction, Curr
Concepts Nutr, 1983, 12:1-12.
1 Kishi H, Kishi T, Williams RH, et al: Deficiency of vitamin
B6 in women taking contraceptive formulations, Res Commun Chem Pathol
Pharmacol, 1997, 17(2):283-93.
1 Rivers JM: Oral contraceptives and ascorbic acid, Am J Clin
Nutr, 1975, 28(5):550-4.
1 Weininger J, King JC: Effect of oral contraceptive agents
on ascorbic acid metabolism in the rhesus monkey, Am J Clin Nutr, 1982,
35(6):1408-16.
1 Muneyvirci-Delale O, Nacharaju VL, Altura BM, et al: Sex
steroid hormones modulate serum ionized magnesium and calcium levels
throughout the menstrual cycle in women, Gertil Steril, 1998,
69(5):958-62.
2 Werbach MR. Foundations of Nutritional Medicine. Tarzana,
CA: Third Line Press, 1997, 210-11 [review].
2 Wynn V. Vitamins and oral contraceptive use. Lancet
1975;1:561-64.
2 Horwitt MK, Harvey CC, Dahm CH Jr. Relationship between
levels of blood lipids, vitamins C, A, and E, serum copper compounds,
and urinary excretions of tryptophan metabolites in women taking oral
contraceptive therapy. Am J Clin Nutr. 1975 Apr;28(4):403-12.
2 Smith JL, Goldsmith GA, Lawrence JD. Effects of oral
contraceptive steroids on vitamin and lipid levels in serum. Am J Clin
Nutr. 1975 Apr;28(4):371-6.
2 Webb JL. Nutritional effects of oral contraceptive use: a
review. J Reprod Med. 1980 Oct;25(4):150-6. Review.
3 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
4 Zava, DT: Estrogen and progestin bioactivity of foods,
herbs and spices. Proc. Soc. Exp. Biol. Med. 1998, 217:369-378.
4 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
5 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
5 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
Aleve
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Folate and vitamin C
supplementation may be helpful with long term use of the medication.1
• Vitamin E intake with NSAIDs may
increase risk of bleeding.2
• Chondroitin sulfate has some
anti-platelet properties; consult a pharmacist prior to using NSAID's
and chondroitin together due to the increased potential for bleeding.3
• Take with food to avoid stomach upset.4
• Ulcers induced by NSAIDs may be
minimized by Licorice.5
• Due to their blood-thinning
properties, taking angelica, anise, arnica, asafoetida, bogbean, boldo,
danshen, fenugreek, feverfew, garlic, ginger, ginkgo, ginseng (Panax),
horse chestnut, meadowsweet, prickly ash, passionflower, poplar,
quassia, red clover, turmeric, and willow with NSAIDs may increase
adverse reactions and side effects.6
• Avoid feverfew with NSAID's, the
herbs' effect may theoretically be reduced.7
References
1 Baggott JE, Morgan SL, Ha T, et al.
Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs.
Biochem J 282: 197-202, 1992.
1 Lawrence VA, Loewenstein JE, and Eichner ER. Aspirin and folate binding: in
vivo and in vitro studies of serum binding and urinary excretion of
endogenous folate. J Lab Clin Med 103: 944-948, 1984.
1 Molloy TP and Wilson CW. Protein-binding of ascorbic acid.
Interaction with acetylsalicylic acid. Int J Vitam Nutr Res 50:
387-392, 1980.
1 Das N and Nebioglu S. Vitamin C-aspirin interactions in
laboratory animals. J Clin Pharm Ther 17: 343-346, 1992.
2 Liede KE, Haukka JK, Saxen LM, et al. Increased tendency
toward gingival bleeding caused by joint effect of alpha-tocopherol
supplementation and acetylsalicylic acid. Ann Med 30: 542-546, 1998.
2 Steiner M. Vitamin E, a modifier of platelet function:
rationale and use in cardiovascular and cerebrovascular disease. Nutr
Rev. 1999 Oct;57(10):306-9.
3 Griffith, Winter H MD Vitamins, herbs, minerals and
supplements- the complete guide. Revised edition. Fisher books, 1998.
3 McKevoy GK, ed. AHFS Drug Information. Bethesda, MD:
American Society of Health-System Pharmacists, 2000.
4 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
4 Pronsky, Z Food Medication Interactions, 11th edition, 1999
5 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
5 Rees WDW, Rhodes J, Wright JE, et al. Effect of
deglycyrrhizinated liquorice on gastric mucosal damage by aspirin.
Scand J Gastroenterol 14: 605-607, 1979.
6 Rosenblatt M and Mindel J. Spontaneous hyphema associated
with ingestion of Ginkgo biloba extract. N Engl J Med 336(15): 1108,
1997.
6 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
6 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
6 The Review of Natural Products, Facts and Comparisons,
Clinisphere 2.0, Wolters Kluwer Company, 2000
7 Miller LG. Herbal medicinals: selected clinical
considerations focusing on known or potential drug-herb interactions.
Arch Int Med 1998;158(20):2200-11.
7 The Review of Natural Products, Facts and Comparisons,
Clinisphere 2.0, Wolters Kluwer Company, 2000
Allegra
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• These types of agents may increase
thirst, drink plenty of fluids, unless otherwise directed.1
• Avoid or limit alcohol use with these
agents.2
• Avoid calamus, calendula, California
poppy, catnip, couch grass, elecampane, gotu kola, hops, Jamaican
dogwood, kava, lemon balm, sage, St. John's wort, sassafras, shepherd's
purse, stinging nettle, valerian, wild carrot, wild lettuce, withania
root, and yerba mansa while taking Allegra due to possible increased
sedative effects.3
References
1 Facts and Comparisons, Clinisphere
2.0, Wolters Kluwer Company, 2000
2 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996:21,45,63,282.
2 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
3 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
3 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
3 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
Allopurinol
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Consume adequate fluids, unless
otherwise directed to keep urine alkaline.1
• Allopurinol may contribute to iron
depletion, and iron supplementation may be beneficial.2
• Take with food or milk to reduce
stomach upset.3
• Avoid large doses of vitamin C, this
may contribute to an increased risk of kidney stones with allopurinol.4
• Allopurinol may theoretically
increase the length of action of anticoagulant herbs, based on its
known interaction with warfarin. These herbs include : Angelica, anise,
arnica, asafoetida, bogbean, boldo, danshen, fenugreek, feverfew,
garlic, ginger, ginkgo, ginseng (Panax), horse chestnut, licorice,
meadowsweet, prickly ash, passionflower, poplar, quassia, red clover,
turmeric, and willow.5
References
1 Pronsky, Z Food Medication
Interactions, 11th edition, 1999
1 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
2 Park GD, Berlinger WG, Spector R, Kitt TM, Tsalikian E:
Sustained reductions in oxypurinol renal clearance during a restricted
diet, Clinical Pharmacol Ther, 1987; 41:616-621.
2 Lin YW, Okazaki S, Hamahata K, Watanabe K, Usami I,
Yoshibayashi M, Akiyama Y, Kubota M. Acute pure red cell aplasia
associated with allopurinol therapy. Am J Hematol. 1999
Jul;61(3):209-11.
3 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
3 Pronsky, Z Food Medication Interactions, 11th edition, 1999
4 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
4 Pronsky, Z Food Medication Interactions, 11th edition, 1999
5 Brinker, Francis: Herb Contraindications and Drug
Interactions, Eclectic Medical Publications, 1998
5 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
Alora
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Studies have shown that grapefruit
juice significantly increases estradiol levels in the blood. Do not
drink grapefruit juice or eat grapefruit while taking this medication.1
• It may also be possible that
supplements containing quercetin also increase the levels of estradiol
in the blood. Talk to your pharmacist if you are taking any supplements
that contain this nutrient.2
• This drug may increase risk of folic acid deficiency,
which could affect reproductive and cardiovascular health.
Supplementation is considered beneficial.3
• Vitamin C may result in increased
estrogen effects.4
• The following herbs may affect
hormone levels: Agnus Castus (Vitex), Alfalfa, Bayberry, Black Cohosh,
Dong Quai, Ginseng, Horseradish, Licorice Root, Pleurisy Root, Red
Clover, Red Sage, Saw Palmetto, Tobacco, Vervain, and Wild Yam. Consult
your pharmacist for more information.5
References
1 Schubert W, Cullberg G, Edgar B,
Hedner T. Inhibition of 17 beta-estradiol metabolism by grapefruit
juice in ovariectomized women. Maturitas 1994;20:155-63.
1 Schubert W, Eriksson U, Edgar B, et al. Flavonoids in
grapefruit juice inhibit the in vitro hepatic metabolism of 17
beta-estradiol. Eur J Drug Metab Pharmacokinet 1995;3:219-24.
1 Weber A, Jager R, Borner A, et al. Can grapefruit juice
influence ethinylestradiol bioavailability? Contraception 1996;53:41-7.
2 Kuiper GG, Lemmen JG, Carlsson B, et al. Interaction of
estrogenic chemicals and phytoestrogens with estrogen receptor beta.
Endocrinology 1998;139:4252-63.
3 Kornberg A, Segal R, Theitler J, et al: Folic acid deficiency,
megaloblastic anemia and peripheral polyneuropathy due to oral
contraceptives, Isr J Med Sci, 1989, 25 (3): 142-5.
3 Harper JM, Levine AJ, Rosenthal DL, et al: Erythrocyte folate levels, oral
contraceptive use and abnormal cervical cytology, Acta Cytol, 1994, 38
(3): 324-30.
4 Blum M, Kitai E, Ariel Y, Et Al: Oral Contraceptive Lowers
Serum Magnesium, Harefuah, 1991, 121 (10):363-4.
5 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
5 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
Alprazolam
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Alcohol can increase both the
sedative and the intoxifying effects of Alprazolam. Use of alcohol
should be avoided.1
• Melatonin levels may be diminished
with long term use of benzodiazepines like alprazolam. Consult a
pharmacist or physician regarding the need for melatonin
supplementation and the benefits of using melatonin to withdraw the use
of benzodiazepines.2
• Tobacco may increase the rate of
elimination of Alprazolam and thereby decrease its effects. Avoid using
both together.3
• The following herbs have sedative
qualities and could intensify the effects of Alprazolam: calamus,
calendula, chamomile, California poppy, catnip, couch grass,
elecampane, ginseng Siberian, goldenseal, gotu kola, hops, Jamaican
dogwood, kava, lemon balm, sage, St. John's wort, sassafras, scullcap,
shepherd's purse, stinging nettle, valerian, withania root, and yerba
mansa.4
References
1 Pronsky, ZM: Food-Medication
Interactions, 11th edition, 1999
1 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
2 Kabuto M, Namura I, Saitoh Y. Nocturnal enhancement of
plasma melatonin could be suppressed by benzodiazepines in humans.
Endocrinol Jpn. 1986 Jun;33(3):405-14.
2 McIntyre IM, Norman TR, Burrows GD, Armstrong SM.
Alterations to plasma melatonin and cortisol after evening alprazolam
administration in humans. Chronobiol Int. 1993 Jun;10(3):205-13.
2 Garfinkel D, Zisapel N, Wainstein J, et al. Facilitation of
benzodiazepine discontinuation by melatonin: a new clinical approach.
Arch Intern Med 159: 2456-2460, 1999.
3 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
4 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
4 Almeida JC. Coma from the health food store: Interaction
between kava and alprazolam. Ann Intern Med 1996;125:940-41.
4 Brinker F. Herb contraindications and drug interactions,
2nd ed. Sandy, OR: Eclectic Medical Publications, 1998
4 Speroni E, et al. Sedative effects of crude extract of
Passiflora incarnata after oral administration. Phytother Res 10:
S92-94, 1996.
4 PDR for Herbal Medicine, 2nd edition, Medical Economics
Company, 2000
4 The Review of Natural Products, Clinisphere 2.0, Wolters
Kluwer Company, 2000
Altace
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Avoid consuming excessive potassium
in foods and supplements when taking Altace. Be careful with salt
substitutes which contain potassium. Ask your physician or pharmacist
about the importance of electrolyte balance.1
• Avoid or limit alcohol use.2
• ACE inhibitors like Altace may
contribute to a deficiency in zinc. Ask your pharmacist regarding the
need for supplementation.3
• Avoid using antacids or supplements
containing iron or magnesium within two hours of the medication.4
• Some herbs possess cardiac properties
that may intensify the action of Altace, resulting in an excessive
lowering of blood pressure or other cardiac side effects. Such herbs
include: black hellebore, calamus, cereus, cola, coltsfoot, devil's
claw, European mistletoe, fenugreek, fumitory, digitalis leaf, hedge
mustard, figwort, lily of the valley roots, motherwort, pleurisy root,
squill bulb leaf scales, white horehound, mate, scotch broom flower,
shepherd's purse, and wild carrot5
• These herbs possess diuretic
properties which may intensify the effects of altace: Alfalfa,
Angelica, Astragalus, Basil, Bean Pod, Buckthorn, Burdock, Butcher’s
Broom, Buchu, Celery, Cleavers, Cornflower, Dandelion, Elecampane,
Elder, Goat's Rue, Hempnettle, Horsetail, Indian-Hemp, Juniper,
Marigold, Meadowsweet, Parsley, Rauwolfia, Sarsaparilla, Sweet clover,
Turmeric, and Vervain.6
References
1 Burnakis TG & Mioduch HJ:
Combined therapy with captopril and potassium supplementation. A
potential for hyperkalemia. Arch Intern Med 1984; 144:2371-2372.
1 Good CB, McDermott L, McCloskey B. Diet and serum potassium
in patients on ACE inhibitors. JAMA 1995;274:538.
1 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
1 Pronsky, Z Food Medication Interactions, 11th edition, 1999
2 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
2 Pronsky, Z Food Medication Interactions, 11th edition, 1999
3 Golik A, Zaidenstein R, Dishi V, et al: Effects of
captopril and enalapril on zinc metabolism in hypertensive patients, J
Am Coll Nutr, 1998, 17(1):75-8.
3 Golik A, Modai D, Averbukh Z, et al: Zinc metabolism in
patients treated with captopril versus enalapril, Metabolism, 1990,
39(7): 665-7.
4 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
4 Campbell NR and Hasinoff BB. Iron supplements: A common
cause of drug interactions. Br J Clin Pharmacol 31: 251-255, 1991.
5 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
5 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
5 Blumenthal M, et al. ed. The Complete German Commission E
Monographs: Therapeutic Guide to Herbal Medicines. Trans. S. Klein.
Boston, MA: American Botanical Council, 1998.
5 PDR for Herbal Medicines. 2nd ed. Montvale, NJ: Medical
Economics Company, Inc., 2000.
6 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
6 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
Amaryl
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• There is some evidence that
metformin, a sulfonylurea class drug may cause vitamin B12 deficiency.
Amaryl may also have similar effects, monitor blood levels periodically
with long term use of this medication.1
• High doses of niacin may increase
blood glucose levels, and excessive use of this nutrient should be
avoided in diabetes.2
• Alcohol use should be limited as it
can interfere with diabetes management.3
• Vitamin E may play a beneficial role
in protecting against diabetic complications. However, because it can
lower blood sugar levels do not supplement large doses of the vitamin
without consulting a pharmacist.4
• Potatoes can interfere with blood
sugar levels and Amaryl dosage may require adjustment.5
• The following herbs may lower blood
sugar levels: Alfalfa, Aloe vera, Bilberry, Bitter melon, Burdock,
Celery, Cornsilk, Eucalyptus, Fenugreek, Garlic, Ginger, Panax Ginseng,
Juniper, Marshmallow, Myrrh, Nettle, Onions, Sage and Tansy.6
• Licorice is contraindicated in
diabetes.7
References
1 Adams JF, Clark JS, Ireland JT, et
al: Malabsorption of vitamin B12 and intrinsic
factor secretion during biguanide therapy, Diabetologia, 1983,
24(1):16-8.
1 Berger W, Incidence of severe side effects during therapy
with sulfonylureas and biguanides, Horm Metab Res Suppl, 1985, 15:111-5.
1 Rieder HP, Berger W, and Fridrich R: Vitamin status in
diabetic neuropathy, Z Ernahrungswiss, 1980, 19 (1):1-13.
1 Carpentier JL, Bury J, Luyckx A, et al: Vitamin B12 and folic acid serum
levels in diabetics under various therapeutic regimens, Diabete Metab,
1976, 2(4):187-90.
2 McKevoy GK, ed. AHFS Drug Information. Bethesda, MD:
American Society of Health-System Pharmacists, 1998.
2 Schwartz ML. Severe reversible hyperglycemia as a
consequence of niacin therapy. Arch Intern Med. 1993 Sep
13;153(17):2050-2.
2 Roe DA. Drug and nutrient interactions in the elderly
diabetic. Drug Nutr Interact. 1988;5(4):195-203. Review.
3 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
3 Pronsky, Z Food Medication Interactions, 11th edition, 1999
4 Paolisso G, D'Amore A, Giugliano D, et al. Pharmacologic
doses of vitamin E improve insulin action in healthy subjects and
non-insulin-dependent diabetic patients. Am J Clin Nutr 57:650-656, 1993
4 Ceriello A, Giugliano D, Quatraro A, Donzella C, Dipalo G,
Lefebvre PJ. Vitamin E reduction of protein glycosylation in diabetes.
New prospect for prevention of diabetic complications? Diabetes Care.
1991 Jan;14(1):68-72.
4 Tutuncu NB, Bayraktar M, Varli K. Reversal of defective
nerve conduction with vitamin E supplementation in type 2 diabetes: a
preliminary study. Diabetes Care. 1998 Nov;21(11):1915-8.
5 Gannon MC, et al. Diabetes Care 1993;16:874.
5 The Review of Natural Products, Facts and Comparisons,
Clinisphere 2.0, Wolters Kluwer Company, 2000
6 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
6 Brinker F. Herb contraindications and drug interactions,
2nd ed. Eclectic Medical Publications, 1998.
6 Welihinda J, et al. Effect of Momordica charantia on the
glucose tolerance in maturity onset diabetes. J Ethnopharmacol 17:
277-282, 1986.
7 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
7 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
Ambien
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Do not drink alcohol with this
medication. Alcohol could intensify the effects of Ambien.1
• Many herbs have sedative qualities
and could intensify the effects of Ambien. They include: calamus,
calendula, chamomile, California poppy, catnip, couch grass,
elecampane, ginseng Siberian, goldenseal, gotu kola, hops, Jamaican
dogwood, kava, lemon balm, sage, St. John's wort, sassafras, scullcap,
shepherd's purse, stinging nettle, valerian, withania root, and yerba
mansa.2
References
1 Facts and Comparisons, Clinisphere
2.0, Wolters Kluwer Company, 2000
1 Pronsky, Z Food Medication Interactions, 11th edition, 1999
2 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
2 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
2 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
2 The Review of Natural Products, Clinisphere 2.0, Wolters
Kluwer Company, 2000
Amikacin
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• reports: Animal studies and case
reports indicate that renal tubular damage due to aminoglycosides, such
as gentamicin, can lead to hypokalemia combined with hypocalcemia,
hypomagnesemia and alkalosis. adverse effects: The toxicities of
aminoglycosides include toxicity to the kidneys and ears (vestibular
and auditory) and, rarely, neuromuscular blockade and hypersensitivity
reactions. These adverse reactions are more common when aminoglycosides
are given in combination with vancomycin. Nephrotoxicity results from
renal cortical accumulation resulting in tubular cell degeneration and
sloughing. Ototoxicity is usually irreversible. The prescribing
physician should closely monitor (draw aminoglycoside and vancomycin
serum levels) patients for these potential side effects.1
• research: Akbar et al have noted that
this phenomenon may be especially common among children with cystic
fibrosis who have a history of repeated use of aminoglycosides2
• nutritional support: Individuals
using aminoglycosides, especially on a repeated or chronic basis,
should consult with their prescribing physician and/or a nutritionally
oriented healthcare professional about nutritional support to restore
normal levels of these important minerals. Patients undergoing extended
treatment with aminoglycosides may need to have their doctor regularly
monitor their kidney function along with magnesium and potassium
status. Serum creatinine, BUN and creatinine clearance should be
measured prior to initiating therapy and should be monitored throughout
treatment. In this regard, many nutritionally-oriented practitioners
find that testing magnesium levels in red blood cells is far more
reliable than testing serum magnesium. Only after such assessment
should supplementation with magnesium or potassium be undertaken and
then only under close supervision by the prescribing physician. Calcium supplementation
in the range of 800-1000 mg per day may beneficial for individuals
being treated with aminoglycosides. Slow-K® and Micro-K® are typical
examples of the potassium supplementation suggested by most physicians.
Potassium levels can be further enhanced by eating several pieces of
fruit each day. However, increasing potassium intake by any means is
usually contraindicated and often dangerous in patients with reduced
kidney function, especially those on dialysis. Supplementation of
magnesium in the dosage range of 300-500 mg per day is usually
appropriate but should be done in consultation with the prescribing
doctor or a nutritionally-oriented physician. Magnesium supplementation
can be risky in patients with kidney damage and is usually
contraindicated in such cases. It is also important to note that
magnesium is needed to maintain intracellular potassium.3
• : Free radical generation due to
aminoglycosides plays an important role in drug-induced damage to the
liver, kidneys and inner ear. Alpha-lipoic acid is a powerful
antioxidant and free radical scavenge4
• Sandhya et al found that lipoic acid
administration brought about a decrease in the degree of lipid
peroxidation due to gentamicin in rats. Conlon et al conducted studies
using guinea pigs to the investigate the ability of the alpha-lipoic
acid (100 mg/kg/day) to attenuate the cochlear damage induced by 450
mg/kg/day, i.m. of the aminoglycoside amikacin. Their results showed
that animals receiving alpha-lipoic acid in combination with amikacin
demonstrated a significantly less severe changes in cochlear function
compared with animals receiving amikacin alone.5
• Since the preliminary research on
this topic has involved animals and not human patients no conclusive
recommendations can be offered. However, a diverse set of clinical
studies have demonstrated alpha-lipoic acid's role as a potent
anti-oxidant and its ability to enhance protective systems in the liver
and kidney in a variety of situations. Therefore, while supplementation
with alpha-lipoic acid might be advisable for individuals using
aminoglycosides, the available research literature provides no specific
indications as to the appropriate dosage for this particular situation.
However, any individual using alpha-lipoic acid in relation to
gentamicin should do so only under supervision of a the prescribing
physician and a nutritionally-trained healthcare professional.6
• During the course of eliminating
disease-causing bacteria, antibiotics also usually destroy
normally-occurring beneficial bacterial flora that form an integral
part of the healthy intestinal ecology and assist digestive and immune
functions. Diarrhea and yeast infections, including vaginal yeast, are
common side-effects of the disruption of intestinal ecology and the
creation of an environment more susceptible to proliferation of
pathogenic levels of opportunistic yeast. • nutritional support:
Supplementation of beneficial "probiotic" bacterial flora, such as
Lactobacillus acidophilus, Bifidobacterium bifidus and
Lactobacillus cassei, preferably in the form of a varied, vigorous and
abundant culture, will restore the healthy intestinal ecology and
stabilize the mucosal lining of the gut. A supplemental dosage of at
least one billion organisms per day is necessary to achieve the
critical mass of bacterial restoration and successfully reinvigorate
healthy intestinal ecology.7
• Hypomagnesaemia in children with
cystic fibrosis (CF) is under-recognized. We report a child with CF who
developed significant hypomagnesaemia following intravenous (i.v.)
treatment with aminoglycosides for exacerbations of Pseudomonas
aeruginosa infection. Three additional cases have also been observed.
Investigations in two patients have revealed excessive renal loss of
magnesium. It is postulated that renal tubular damage secondary to the
cumulative effects of repeated courses of aminoglycosides resulted in
hypomagnesaemia, and we suggest screening for this problem by
monitoring serum magnesium regularly in all patients with CF receiving
multiple courses of aminoglycosides.8
• : Free radical generation is
increasingly implicated in a variety of pathological processes,
including drug toxicity. Recently, a number of studies have
demonstrated the ability of gentamicin to facilitate the generation of
radical species both in vivo and in vitro, which suggests that this
process plays an important role in aminoglycoside-induced ototoxicity.
Free radical scavengers are compounds capable of inactivating free
radicals, thereby attenuating their tissue damaging capacity. In this
study we have determined the ability of the powerful free radical
scavenger alpha-lipoic acid (100 mg/kg/day) to attenuate the cochlear
damage induced by a highly ototoxic regimen of the aminoglycoside
amikacin (450 mg/kg/day, i.m.). Experiments were carried out on
pigmented guinea pigs initially weighing 200-250 g. Changes in cochlear
function were characterized as shifts in compound action potential
(CAP) thresholds, estimated every 5 days, by use of chronic indwelling
electrodes implanted at the round window, vertex, and contralateral
mastoid. Results showed that animals receiving alpha-lipoic acid in
combination with amikacin demonstrated a significantly less severe
elevation in CAP thresholds compared with animals receiving amikacin
alone (P < 0.001; t-test). These results provide further
evidence of the recently reported intrinsic role of free radical
generation in aminoglycoside ototoxicity, and highlight a potential
clinical therapeutic use of alpha-lipoic acid in the management of
patients undergoing aminoglycoside treatment.9
• Gentamicin causes isolated,
reversible calciuria in rats by an unknown mechanism. We hypothesized
that gentamicin calciuria is related to nonantibacterial properties
that may interfere with transtubular calcium transport
(calcium channel blockade, Na,K-ATPase inhibition or competition with calcium for binding
to the brush-border membrane). The calciuric effect of gentamicin was
compared to the calcium channel
blockers lanthanum and cobalt, the Na,K-ATPase inhibitor ouabain and
the polycation aprotinin (which competes with gentamicin for
brush-border membrane binding). Although gentamicin 0.02 mmol/kg caused
a 6-8-fold increase in urine calcium concentration,
none of the other agents was calciuric. We also found that the
calciuric effects of gentamicin and furosemide were additive, whereas
the noncalciuric diuretic chlorothiazide had no effect on gentamicin
calciuria. We also determined the effect of poly-L-aspartic acid (PAA),
which binds gentamicin and prevents nephrotoxicity. PAA caused isolated
calciuria similar in magnitude and character to gentamicin. However,
PAA pretreatment decreased the magnitude of gentamicin calciuria to
insignificance. PAA pretreatment did not prevent furosemide
calciuresis. These results indicate that: 1) gentamicin and furosemide
calciuria are caused by different mechanisms; 2) gentamicin calciuria
is probably not mediated by calcium channel
blockade, Na,K-ATPase inhibition or displacement of brush-border
membrane-bound calcium; 3) gentamicin and PAA calciuria may reflect
interference with intracellular events related to transtubular calcium transport.10
• Two independent techniques were used
in anesthetized rats in an attempt to locate the nephron site of the
reduced tubular calcium reabsorption
accompanying acute gentamicin infusion. The first technique was that of
lithium clearance used to assess proximal sodium (and secondarily
calcium) handling. Observations that lithium clearance was comparable
in control and gentamicin-treated animals (1.83 +/- 0.39 vs. 1.46 +/-
0.14 ml.min-1 for first experimental period) suggests a lack of
proximal effect of the drug. The second technique was that of tracer
microinjection whereby superficial nephrons were injected with 45Ca and
tubule calcium transport
was assessed from the recovery of radioactivity in the final urine.
45Ca recovery values from distal microinjections were comparable in
control and gentamicin-treated groups (81.1 +/- 2.0 vs. 77.7 +/- 4.6%).
However, 45Ca recovery values from proximal microinjections were
significantly higher in the gentamicin group (9.4 +/- 1.0 vs. 3.5 +/-
0.8%; P < .001). These data suggest that the effects of
gentamicin on renal calcium handling are
mediated at a nephron site proximal to the distal tubule (i.e., loop of
Henle or proximal tubule itself). Closer examination of individual
proximal micropuncture data may point to an effect occurring
predominantly in the pars recta of the proximal tubule or loop of
Henle. Taken together, the results of both parts of the present study
suggest that the early physiological effects of gentamicin on the
kidney occur in a different nephron segment from any subsequent
nephrotoxicity.11
• Seven patients (3 females, 4 males)
developed symptomatic hypomagnesemia, hypocalcemia, and hypokalemia
following gentamicin therapy. The excessive and inappropriate urinary
excretion of magnesium and potassium in the presence of subnormal serum
concentrations was noted. A significant correlation was found between
the total cumulative dose of gentamicin and serum Mg concentration (r =
0.76, p less than 0.05), as well as between the renal wasting of Mg and
the total cumulative dose of gentamicin administered (r = 0.89, p less
than 0.01). The gentamicin-induced Mg depletion is a very rare but
important complication which is most likely to occur when the drug is
given to older patients in large doses over extended periods of time12
• 1. Standard renal clearance
techniques were used to assess the dose-response relationship between
acute gentamicin infusion and the magnitude of hypercalciuria and
hypermagnesiuria in the anaesthetized Sprague-Dawley rat. Also
investigated were whether these effects occurred independently of renal
tubular cell injury. 2. Acute gentamicin infusion was associated with a
significant hypercalciuria and hypermagnesiuria evident within 30 min
of drug infusion. The magnitude of these responses was related to the
dose of drug infused (0.14-1.12 mg kg(-1) min[-1]). Increased urinary
electrolyte losses resulted from a decreased tubular reabsorption of calcium and
magnesium. 3. A rapid dose-related increase in urinary
N-acetyl-beta-D-glucosaminidase (NAG) excretion was also observed in
response to gentamicin infusion. However, there was no evidence of
renal tubular cell injury and no myeloid bodies were observed within
the lysosomes of the proximal tubular cells. Gentamicin may thus
interfere with the mechanisms for cellular uptake and intracellular
processing of NAG causing increased NAG release into the tubular lumen.
4. The absence of changes in renal cellular morphology indicates that
the excessive renal losses of calcium and
magnesium were an effect of gentamicin per se and not the result of
underlying renal tubular injury. The renal effects described in this
paper were apparent after administration of relatively low total drug
doses, and with plasma concentrations calculated to be within the
clinical range. These findings suggest that disturbances of plasma
electrolyte homeostasis could occur in the absence of overt renal
injury in patients receiving aminoglycoside antibiotics.13
• Because calcium has been
reported to modify gentamicin binding to its proximal tubular brush
border membrane receptor, we studied the effects of dietary calcium loading and
subsequent hypercalciuria on experimental gentamicin nephrotoxicity.
Male Fischer 344 rats were fed one of two diets that were identical
except for calcium carbonate
content: normal (0.5%) and high (4%). The high-calcium diet made rats
hypercalciuric but there were no differences between the two groups in
inulin clearance, sodium or osmolar excretion, or serum calcium prior to
gentamicin administration. Animals on both diets were treated with
gentamicin, 20 mg/kg b.i.d., for periods of 3 to 21 days. Both groups
developed acute renal failure, but animals on the high-calcium diet had
less severe acute toxic injury, as evidenced by studies of inulin
clearance, renal histology, and in vitro cortical uptake of NMN and
PAH. Furthermore, calcium-loaded animals tended to have lower peak
renal cortical gentamicin levels during the period of acute toxicity.
The mechanism by which increased dietary calcium protects
against gentamicin nephrotoxicity remains speculative. Calcium and
gentamicin may compete for the same brush border receptor or
alternatively parathyroid suppression may result in diminution in
tubular cell membrane drug binding sites. The possibility that
high-calcium diets exert a nonspecific salutory effect on proximal
tubular cell integrity has not been excluded.14
• The intraperitoneal administration of
gentamicin (100 mg kg[-1] day[-1]) to rats is associated with an
increased production of malondialdehyde (MDA), which is an end product
of lipid peroxidation in the kidney. The level of glutathione (GSH) and
the activity of three antioxidant systems--superoxide dismutase (SOD),
catalase (CAT) and glutathione peroxidase (GPx)--were also decreased in
the kidney. The liver, however, did not show any such alterations.
Gentamicin (100 mg kg[-1] day[-1]) plus lipoic acid administration (25
mg kg[-1] day[-1]) by gastric intubation brought about a decrease in
the degree of lipid peroxidation. An increase in the GSH level and in
the activity of SOD, CAT and GPx was also observed. From these
observations it can be concluded that administration of DL-alpha-lipoic
acid prevents lipid peroxidation, which may, at least partly, play an
important role in the injury cascade of gentamicin-induced
nephrotoxicity15
• The effect of the nephrotoxic
aminoglycoside antibiotic, gentamicin, on calcium uptake by
renal cortical mitochondria was assessed in vitro. Gentamicin was found
to be a competitive inhibitor of mitochondrial Ca++ uptake. This effect
displayed a dose response with a Ki of 233 microM and occurred at
gentamicin concentrations below those that inhibit mitochondrial
electron transport. These results further demonstrate the potential for
gentamicin to alter membrane function and thereby contribute to toxic
cell injury via its interactions with divalent cations.16
• A retrospective study in coronary
artery bypass graft patients was undertaken to assess the effect of
gentamicin and a bypass prime with a high calcium on the
incidence of renal failure. Patients who received both Haemaccel
(polygeline, Hoechst Marion Roussel) (calcium concentration 6.25
mmol/l) in the bypass prime and gentamicin perioperatively had a higher
incidence of renal failure compared with those who received only
Haemaccel (P = 0.005), only gentamicin (P = 0.002) or neither (P =
0.0001). We suggest that the combination be avoided in this group of
patients.17
• There are no Herbal considerations at
this time18
References
1 Mazze RI, Cousins MJ. Br J Anaesth.
1973 Apr;45(4):394-398; Valdivieso A, et al. Rev Med Chil. 1992
Aug;120(8):914-919; Kes P, et al. Magnes Trace Elem. 1990;9(1):54-60;
Parsons PP, et al. Br J Pharmacol 1997 Oct;122(3):570-576.)
1 Conlon BJ, Aran JM, Erre JP, Smith DW. Attenuation of
aminoglycoside-induced cochlear damage with the metabolic antioxidant
alpha-lipoic acid. Hear Res. 1999 Feb;128(1-2):40-44.
2 Akbar A, et al. Acta Paediatr. 1999 Jul;88(7):783-785
3 Reference not Available
4 Tran Ba Huy P, Deffrennes D. Acta Otolaryngol [Stockh]
1988;105:511-515
5 Sandhya P, et al. J Appl Toxicol 1997
Nov-Dec;17(6):405-408; Conlon BJ, et al. Hear Res. 1999
Feb;128(1-2):40-44
6 Sandhya P, et al. J Appl Toxicol 1997
Nov-Dec;17(6):405-408; Conlon BJ, et al. Hear Res. 1999
Feb;128(1-2):40-44
7 Akbar A, Rees JH, Nyamugunduru G, English MW, Spencer DA,
Weller PH. Aminoglycoside-associated hypomagnesaemia in children with
cystic fibrosis. Acta Paediatr. 1999 Jul;88(7):783-785
8 Bolsin S, Jones S. Acute renal failure potentiated by
gentamicin and calcium. Anaesth Intensive Care 1997 Aug;25(4):431-432.
(Letter)
9 Elliott WC, Patchin DS. Effects and interactions of
gentamicin, polyaspartic acid and diuretics on urine calcium concentration.
J Pharmacol Exp Ther 1995 Apr;273(1):280-284.
10 Garland HO, Phipps DJ, Harpur ES. Gentamicin-induced
hypercalciuria in the rat: assessment of nephron site involved. J
Pharmacol Exp Ther. 1992 Oct;263(1):293-297
11 Humes HD, Sastrasinh M, Weinberg JM. Calcium is a
competitive inhibitor of gentamicin-renal membrane binding interactions
and dietary calcium supplementation
protects against gentamicin nephrotoxicity. J Clin Invest 1984
Jan;73(1):134-147.
12 Kosek JC, Mazze RI, Cousins MJ. Nephrotoxicity of
gentamicin. Lab Invest. 1974 Jan;30(1):48-57.
12 Mazze RI, Cousins MJ. Combined nephrotoxicity of
gentamicin and methoxyflurane anaesthesia in man. A case report. Br J
Anaesth. 1973 Apr;45(4):394-398.
12 McLean, R. Magnesium and its therapeutic uses: A review.
Am J Med 1994 Jan;96(1):63-76. (Review)
12 Montie T, Patamasucon P. Aminoglycosides: the complex
problem of antibiotic mechanisms and clinical applications. Eur J Clin
Microbiol Infect Dis 1995;14:85-87. (Editorial)
12 Parsons PP, Garland HO, Harpur ES, Old S. Acute
gentamicin-induced hypercalciuria and hypermagnesiuria in the rat:
dose-response relationship and role of renal tubular injury. Br J
Pharmacol 1997 Oct;122(3):570-576
13 Quarum ML, Houghton DC, Gilbert DN, McCarron DA, Bennett
WM. Increasing dietary calcium moderates
experimental gentamicin nephrotoxicity. J Lab Clin Med 1984
Jan;103(1):104-114.
14 Sandhya P, Varalakshmi P. Effect of lipoic acid
administration on gentamicin-induced lipid peroxidation in rats. J Appl
Toxicol 1997 Nov-Dec;17(6):405-408.
15 Sastrasinh M, Weinberg JM, Humes HD. The effect of
gentamicin on calcium uptake by
renal mitochondria. Life Sci. 1982 Jun 28;30(26):2309-2315
16 Schneider M, Valentine S, Clarke GM, Newman MA, Peacock J.
Acute renal failure in cardiac surgical patients, potentiated by
gentamicin and calcium. Anaesth Intensive Care 1996 Dec;24(6):647-650.
17 Tran Ba Huy P, Deffrennes D. Aminoglycoside ototoxicity:
influence of dosage regimen on drug uptake and correlation between
membrane binding and some clinical features. Acta Otolaryngol [Stockh]
1988;105:511-515.
17 Valdivieso A, Mardones JM, Loyola MS, Cubillos AM.
[Hypomagnesemia associated with hypokalemia, hyponatremia and metabolic
alkalosis. Possible complication of gentamycin therapy]. Rev Med Chil.
1992 Aug;120(8):914-919. [Article in Spanish]
18 N/A
Amiloride
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• According to preliminary studies
involving rats amiloride has a magnesium-sparing effect in addition to
its potassium-sparing effect. Consequently there is the possibility
that individuals who take a magnesium supplement while also taking
amiloride could build up excessively high levels of magnesium. The
concurrent use of hydrochlorothiazide and amiloride would make this
accumulation unlikely given the magnesium-depleting action of
hydrochlorothiazide.1
• Individuals taking amiloride should
refrain from taking supplemental magnesium without first consulting
their prescribing physician, pharmacist, or a healthcare professional
experienced in nutritional therapies.2
• Amiloride intentionally reduces
urinary excretion of potassium. As a result of its role as a
potassium-sparing diuretic, amiloride can produce a state of
inappropriately elevated potassium levels.3
• : Individuals using potassium-sparing
diuretics such as amiloride should limit their dietary intake of
potassium to avoid excessive levels. Potassium supplements and
potassium-containing salt substitutes, such as Lite Salt®, Morton's
Salt Substitute and No Salt®, are designed for individuals suffering
from potassium depletion due to other types of diuretics and should be
avoided when taking potassium-sparing diuretics such as amiloride. For
some individuals, foods with high potassium content may need to be
limited. Several pieces of fruit per day may provide adequate potassium
to elevate serum levels. Individuals taking amiloride should work with
their prescribing physician to monitor potassium levels and modify
their diet accordingly to avoid elevated potassium levels and
associated problems.4
• The basic function of diuretics is to
reduce the amount of water in the body. Therefore, by their very nature
and intent diuretics, such as amiloride, increase the amount of sodium
excreted in the urine.5
• Since the reduction of sodium levels
in the body is purposeful, supplementation to reduce lost sodium would
be counterproductive. However, if dietary changes undertaken to
restrict sodium intake are successful the dosage of diuretic
medications will need to be reevaluated and possibly modified. Thus,
individuals with hypertension who are using a diuretic such as
amiloride while also strictly limiting their salt intake should work
closely with their prescribing physician to monitor and revise their
prescription based on changes in their blood pressure.6
• Amiloride reduces meal-stimulated
colonic absorption through inhibition of both Na+ channels and Na+/H+
exchange in colonocytes. Constipation is also a common side effect of
amiloride.7
• For best therapeutic effect and
safest use, amiloride should be taken consistently at least two hours
apart from food, preferably at the same time each day. Individuals
concerned about the timing of their meals should consult with their
prescribing doctor or pharmacist.8
• Licorice can offset the
pharmacological effect of amiloride. 11 beta-hydroxysteroid
dehydrogenase (11 beta-DH) is the enzyme that oxidizes cortisol to
inactive cortisone and prevents cortisol from acting like a
mineralocorticoid at the aldosterone receptor site in the kidney. Some
kinds of licorice contain glycyrrhetic acid which inhibits the action
of 11 beta-DH (e.g. in the kidney) and causes cortisol to behave like
aldosterone. Thus, licorice consumption can induce a mineralocorticoid
excess state, most likely due to an acquired inhibition of this key
enzyme, decreased transformation of cortisol into cortisone, and
resultant increased cortisol levels at the mineralocorticoid receptor.
In states of 11 beta-DH deficiency such as the syndrome of apparent
mineralocorticoid excess (AME) and licorice ingestion, cortisol acts as
a potent mineralocorticoid. Thus, by acting to enhance aldosterone
effects licorice would oppose the therapeutic intent of amiloride as an
aldosterone antagonist or aldosterone-inhibiting agent. Furthermore,
this increased mineralocorticoid action of cortisol can cause a drop in
serum potassium and an increase in serum sodium concentration, together
with a metabolic alkalosis, and lead to water retention, weight gain,
and increased risk of hypertension.9
• The research cited above has focussed
on concentrated extracts and intravenous forms of licorice. Common
"licorice" candy usually contains no actual Glycyrrhiza, other than
perhaps a minute amount as flavoring. No solid conclusions can be drawn
as to how much these findings relate to the use of licorice in the
forms commonly used by practitioners of Western and Chinese herbal
medicine. A product known as DGL (Deglycyrrhizinated Licorice) is
available which retains the anti-inflammatory actions
of whole licorice root without pseudo-aldosterone side effects.
Individuals using amiloride should consult with their prescribing
physician and/or a qualified practitioner of herbal medicine about the
potential risks involved in using any form of licorice.10
References
1 Devane J, Ryan MP. Br J Pharmacol.
1983 Aug;79(4):891-896; Devane J, Ryan MP. Br J Pharmacol. 1981
Feb;72(2):285-289.)
1 Whang EE, et al. J Surg Res. 1996 Feb 1;60(2):303-306
1 Devane J, Ryan MP. Urinary magnesium excretion during
amiloride administration in saline-loaded rats. Br J Pharmacol. 1979
Nov;67(3):493P.
1 Gomez-Sanchez EP, Gomez-Sanchez CE. Effect of central
amiloride infusion on mineralocorticoid hypertension. Am J Physiol 1994
Nov;267(5 Pt 1):E754-758.
1 Kleyman TR and Cragoe EJ Jr, The Mechanism of Action of
Amiloride. Semin Nephrol, 1988, 8(3):242-248.
1 Miller LG. Herbal medicinals: selected clinical
considerations focusing on known or potential drug-herb interactions.
Arch Intern Med 1998 Nov 9;158(20):2200-2211. (Review)
1 Pratesi C, Scali M, Zampollo V, Zennaro MC, De Lazzari P,
Lewicka S, Vecsei P, Armanini D. Effects of licorice on urinary
metabolites of cortisol and cortisone. J Hypertens Suppl 1991
Dec;9(6):S274-275.
1 Roe DA. Diet and Drug Interactions. New York, Van Nostrand
Reinhold, 1989: 146.
1 Threlkeld DS, ed. Diuretics and Cardiovasculars,
Potassium-Sparing Diuretics, Spironolactone. In: Facts and Comparisons
Drug Information. St. Louis, MO: Facts and Comparisons, Jul 1993.
2 N/A
3 N/A
4 Stepan VM, et al. Eur J Gastroenterol Hepatol 1997
Oct;9(10):1001-1004
5 N/A
6 Roe DA. 1989:146
7 N/A
8 Threlkeld DS, ed. Jul 1993
9 Miller LG. Arch Intern Med 1998 Nov 9;158(20):2200-2211;
Lee YS, et al. Clin Pharmacol Ther 1996 Jan;59(1):62-71; Pratesi C, et
al. J Hypertens Suppl 1991 Dec;9(6):S274-275; Nanahoshi M. Nippon
Naibunpi Gakkai Zasshi 1967 Mar 20;42(12):1312-1319.)
10 Devane J, Ryan MP. Evidence for a magnesium-sparing action
by amiloride during renal clearance studies in rats. Br J Pharmacol.
1983 Aug;79(4):891-896. Abstract: The potassium-sparing diuretic,
amiloride, reduced the fractional excretion of magnesium in
anaesthetized rats. Alterations in glomerular filtration rate (GFR),
the filtered load of magnesium, arterial blood pressure, the status of
the extracellular fluid volume, plasma aldosterone concentration and
acid-base balance were not involved. It was concluded that amiloride
exerted a magnesium-sparing effect by a direct renal action. Devane J,
Ryan MP. The effects of amiloride and triamterene on urinary magnesium
excretion in conscious saline-loaded rats. Br J Pharmacol. 1981
Feb;72(2):285-289. Abstract: 1 The potassium-sparing diuretics,
triamterene and amiloride, reduced urinary magnesium excretion in
conscious saline-loaded rats. 2 Urinary magnesium-conservation was also
detected when amiloride was used in combination with the potent
'loop-blocking' diuretic, frusemide.
Amiodarone
HCl
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Monitor magnesium and potassium
levels while on this medication.1
• Vitamin E may prevent pulmonary
artery damage caused by amiodarone.2
• Avoid Ma huang with amiodarone
because the herb could cause irregular heartbeats.3
• Night-blooming Cereus has approval
status by the German Commission E regarding its ability to stabilize
arrhythmia, however the herb should not be used together with an
antiarrhythmic drug without consulting a pharmacist or physician due to
possible additive effects.4
• The German Commission E also notes
the possibility for chronic use of rhubarb, or senna to deplete
potassium resources thereby potentiating the effects of antiarrhythmic
drugs.5
• It may be advisable to avoid these
herbs with cardiac activity: black hellebore, calamus, cereus, cola,
coltsfoot, devil's claw, European mistletoe, fenugreek, fumitory,
digitalis leaf, hedge mustard, figwort, lily of the valley roots,
motherwort, pleurisy root, squill bulb leaf scales, white horehound,
mate, scotch broom flower, shepherd's purse, and wild carrot6
References
1 Pronsky, Z Food Medication
Interactions, 11th edition, 1999.
1 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
2 Kachel DL et al. Amiodarone-induced injury of human
pulmonary artery endothelial cells: Protection by alpha-tocopherol. J
Pharmacol Exp Ther 1990;254:1107-12.
2 Honegger UE, Scuntaro I, Wiesmann UN. Vitamin E reduces
accumulation of amiodarone and desethylamiodarone and inhibits
phospholipidosis in cultured human cells. Biochem Pharmacol. 1995 Jun
16;49(12):1741-5.
3 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998.
4 Blumenthal, M (Ed.): The Complete German Commission E
Monographs: Therapeutic Guide to Herbal Medicines. American Botanical
Council. Austin, TX. 1998
5 Blumenthal, M (Ed.): The Complete German Commission E
Monographs: Therapeutic Guide to Herbal Medicines. American Botanical
Council. Austin, TX. 1998
6 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
6 The Review of Natural Products, Clinisphere 2.0, Wolters
Kluwer Company, 2000
6 Blumenthal M, et al. ed. The Complete German Commission E
Monographs: Therapeutic Guide to Herbal Medicines. Trans. S. Klein.
Boston, MA: American Botanical Council, 1998.
Amitriptyline
Hydrochloride
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Avoid alcohol with this medication.1
• Vitamins B1, B2 and B6 as well as Co-Q-10 may become
deficient with long term use of tricyclic antidepressants.2
• The following herbs may have sedative
qualities and could intensify the effects of Amitriptyline: Calendula,
Chamomile, Hops, Kava kava, Nettle, Passion Flower, Skullcap,
Shepherd’s Purse, St. John’s Wort, Valerian, Wild Carrot Seed and Wild
Lettuce.3
• Avoid Panax ginseng with
antidepressants like amitriptyline due to the possibility of it
triggering manic episodes.4
• Avoid combining yohimbine with
tricyclic antidepressants because it could cause an increase in blood
pressure.5
• Avoid St. John's Wort with
antidepressants, it may have additive effects or increase side effects
of the drugs.6
References
1 Hudson CJ: Tricyclic antidepressants
and alcoholic blackouts. J Nerv Ment Dis 1981; 169:381.
1 Marco LA & Randels RM: Drug interactions in
alcoholic patients. Hillside J Clin Psychiatry 1981; 3:27-44.
1 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
1 Pronsky, Z Food Medication Interactions, 11th edition, 1999
2 Bell IR, Edman JS, Morrow FD, et al: Brief communication -
Vitamin B1, B2, and B6 augmentation of tricyclic antidepressant
treatment in geriatric depression with cognitive function, J Am Coll
Nutr, 1992, 11(2):159-63.
2 Pinto, J.T. & Rivlin, R.S. : Drugs that promote
renal excretion of riboflavin. Drug Nutrient Interactions, 1987, 5:
143-151.
2 Tinguely D, Jonzier M, Schopf J, et al: Determination of
compliance with riboflavin in an antidepressive therapy,
Arzneimittelforschung, 1985, 35(2):536-8.
2 Kishi T, et al: Inhibition of myocardial respiration by
psychotherapeutic drugs and prevention by Coenzyme Q10, Biomedical and
Clinical Aspects of Coenzyme Q10, 1980, 2:139-54.
2 Edelbroek PM, Zitman FG, Schreuder JN, et al: Amitriptyline
metabolism in relation to antidepressive effect, Clin Pharmacol Ther,
1984, 35(4):467-73.
3 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
3 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
3 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
4 Fugh-Berman A. Herb-drug interactions. Lancet. 2000 Jan
8;355(9198):134-8. Review.
5 Fugh-Berman A. Herb-drug interactions. Lancet. 2000 Jan
8;355(9198):134-8. Review.
5 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
6 Cupp MJ. Herbal remedies: adverse effects and drug
interactions. Am Fam Physician. 1999 Mar 1;59(5):1239-45. Review.
6 Lantz MS, Buchalter E, Giambanco V. St. John's wort and
antidepressant drug interactions in the elderly. J Geriatr Psychiatry
Neurol. 1999 Spring;12(1):7-10.
Amoxicillin
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Amoxicillin may hinder the production
of B vitamins and vitamin K in the intestine. Supplementation may be
beneficial with long term use of the drug.1
• Antibiotics kill bacteria, including
beneficial flora in the gut, which may affect digestion and/or
elimination. Supplementation with acidophilus or bifidus may aid in
restoring beneficial flora.2
• Bromelain may increase absorption of
Amoxicillin and other antibiotics.3
• Food can decrease absorption of the
drug, take on an empty stomach 1 hr before or 2hrs after a meal.4
References
1 Hill MJ: Intestinal flora and
endogenous vitamin synthesis, Eur J Cancer Prev, 1997, 6 (Suppl 1):
S43-5.
1 Deguchi Y, et al: Comparative studies on synthesis of
water-soluble vitamins among human species of Bifidobacteria, Argic
Biol Chem, 1985, 19 (1):13-19.
1 Conly J and Stein K: Reduction of vitamin K2 concentrations
in human liver associated with the use of broad spectrum
antimicrobials, Clin Invest Med, 1994, 17 (6):531-9.
1 Cummings JH and Macfarlane G, The Role of Intestinal
Bacteria in Nutrient Metabolism, J Parenter Enter Nutr, 1997, 21(6):
357-65.
2 Fuller R. Probiotics in human
medicine. Gut 1991;32:439-42 .
2 Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents.
A neglected modality for the treatment and prevention of selected
intestinal and vaginal infections. JAMA 1996;275:870-76.
2 Cummings JH, Macfarlane G: Role of intestinal bacteria in
nutrient metabolism, JPEN J Parenter Enteral Nutr, 1997, 21(6): 357-65.
2 Gorbach SL: Bengt E. Gustafsson Memorial Lecture, Function
of the Normal Human Microflora, Scand J Infect Dis Suppl, 1986,
49:17-30.
3 Tinozzi S, Venegoni A. Effect of bromelain on serum and
tissue levels of amoxicillin. Drugs Exp Clin Res 1978;4:39-44.
3 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
4 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
4 Pronsky, Z Food Medication Interactions, 11th edition, 1999
Ampicillin
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Food can decrease absorption of the
drug, take on an empty stomach 1 hr before or 2 hrs after a meal.1
• Amoxicillin may hinder the production
of B vitamins and vitamin K. Supplementation may be beneficial with
long term use of the drug.2
• Antibiotics kill bacteria, including
beneficial flora in the gut, which may affect digestion and/or
elimination. Supplementation with acidophilus or bifidus may aid in
restoring beneficial flora.3
• Bromelain may increase ampicillin
metabolism.4
References
1 Facts and Comparisons, Clinisphere
2.0, Wolters Kluwer Company, 2000
1 Pronsky, Z Food Medication Interactions, 11th edition, 1999
2 Mindell, E, Hopkins V: Prescription Alternatives. New
Canaan, CT: Keats Publishing, Inc, 1998; p. 336.
2 Hill MJ: Intestinal flora and endogenous vitamin synthesis,
Eur J Cancer Prev, 1997, 6 (Suppl 1): S43-5.
2 Deguchi Y, et al: Comparative studies on synthesis of
water-soluble vitamins among human species of Bifidobacteria, Argic
Biol Chem, 1985, 19 (1):13-19.
2 Conly J and Stein K: Reduction of vitamin K2 concentrations
in human liver associated with the use of broad spectrum
antimicrobials, Clin Invest Med, 1994, 17 (6):531-9.
3 Bengmark S & Gianotti L: Nutritional support to
prevent and treat multiple organ failure. World J Surg, 1996 May, 20:4,
474-81.
3 Fuller R. Probiotics in human
medicine. Gut 1991;32:439-42 [review].
3 Cummings JH, Macfarlane G: Role of intestinal bacteria in
nutrient metabolism, JPEN J Parenter Enteral Nutr, 1997, 21(6): 357-65.
3 Gorbach SL: Bengt E. Gustafsson Memorial Lecture, Function
of the Normal Human Microflora, Scand J Infect Dis Suppl, 1986,
49:17-30.
4 Neuvonen PJ et al., Comparative effect of food on
absorption of ampicillin and pivampicillin. J Int Med Res 1977; 5:
71-76.
4 Tinozzi S, Venegoni A. Effect of bromelain on serum and
tissue levels of amoxicillin. Drugs Exp Clin Res 1978;4:39-44.
4 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
Aredia
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• It Is important to take this
medication only with water. Take this medication with 6-8 ounces of
water and wait 30 minutes before consuming any other fluids or food.1
• Supplementation with calcium and vitamin
D may aid in bone formation, and therefore may enhance the benefits of
Aredia. Take a supplement that contains calcium, vitamin D, and
phosphate, for best results. Do not take these supplements within two
hours of taking Aredia since drug malabsorption may occur.2
• None known at this time.3
References
1 Pronsky, Z Food Medication
Interactions, 11th edition, 1999
1 Rybacki JJ. The Concise Essential Guide to Prescription
Drugs. HarperCollins, 1997.
1 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
2 Pronsky, Z Food Medication Interactions, 11th edition, 1999
2 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
2 Jara A, Lee E, Stauber D, Moatamed F, Felsenfeld AJ,
Kleeman CR. Phosphate depletion in the rat: effect of bisphosphonates
and the calcemic response to PTH. Kidney Int. 1999 Apr;55(4):1434-43.
Armour
Thyroid
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Ingestion of soy products
simultaneously with thyroid hormones appears to reduce the absorption
of the hormones.1
• To be safe, people taking thyroid
medication should not consume soy products within three hours of taking
their medication. In addition, infants with congenital hypothyroidism
given thyroid medication must not be given increased or reduced amounts
of soy-based formula without consulting a pediatrician or pediatric
endocrinologist.2
• Calcium supplementation
should be separated by at least four hours from the taking of this
medication.3
• Iron deficiency may result in the
body's inability to produce thyroid hormones. Ask your physician if you
have an iron deficiency. Supplementation of this mineral may help your
body in its normal thyroid function, particularly if you are on a
restricted or low calorie diet.4
• Thyroid hormone medications taken
with food may result in a decrease absorption of the medication.
Separate taking this medication by at least two hours from foods.5
References
1 N/A
2 Jabbar MA, Larrea J, Shaw RA. Abnormal thyroid function
tests in infants with congenital hypothyroidism: The influence of
soy-based formulas. J Am Coll Nutr 1997;16:280–2
3 Schneyer CR. Calcium carbonate
and reduction of levothyroxine efficacy. JAMA 1998;279:750.
3 Singh N, Singh PN, Hershman JM. Effect of calcium carbonate on
the absorption of levothyroxine. JAMA 2000;283:2822-5.
4 Beard JL, Borel MJ, Derr J. Impaired thermoregulation and
thyroid function in iron deficiency anemia. Am J Clin Nutr
1990;52:813-9.
4 Beard J, Borel M, Peterson FJ. Changes in iron status
during weight loss with very-low-energy diets. Am J Clin Nutr
1997;66:104-10.
4 Campbell NR, Hasinoff BB. Iron supplements: A common cause
of drug interactions. Brit J Clin Pharmacol 1991;31:251-5.
4 Campbell NR, Hasinoff BB, Stalts H, et al. Ferrous sulfate
reduces thyroxine efficacy in patients with hypothyroidism. Ann Intern
Med 1992;117:1010-3.
5 Liel Y, Harman-Boehm I, Shany S. Evidence for a clinically
important adverse effect of fiber-enriched diet on the bioavailability
of levothyroxine in adult hypothyroid patients. J Clin Endocrinol Metab
1996;81:857-9.
5 Threlkeld DS, ed. Hormones, Thyroid Hormones. In Facts and
Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Jun
1991, 132-3c.
Artane
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Take with food to decrease stomach
upset.1
• Avoid alcohol2
• Anticholinergic side effects and
adverse reactions may increase if henbane and thorn apple are used with
anticholinergic drugs.3
• Avoid using areca or betel nut with
anticholinergics due to their antagonistic properties.4
References
1 Pronsky, Z Food Medication
Interactions, 11th edition, 1999
1 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
2 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
2 Pronsky, Z Food Medication Interactions, 11th edition, 1999
3 Blumenthal, M (Ed.): The Complete German Commission E
Monographs: Therapeutic Guide to Herbal Medicines. American Botanical
Council. Austin, TX. 1998
3 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
3 Gruenwald J, et. al. PDR for Herbal Medicines. 1st ed.
Montvale, NJ: Medical Economics Company, Inc., 1998.
4 The Review of Natural Products by Facts and Comparisons.
St. Louis, MO: Wolters Kluwer Co., 1999.
4 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
Arthrotec
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Folate and vitamin C
supplementation may be helpful with long term use of the medication.1
• Vitamin E intake with NSAIDs may
increase risk of bleeding.2
• Take with food or milk to decrease
stomach upset3
• Avoid alcohol.4
• Chondroitin sulfate has some
anti-platelet properties; consult a pharmacist prior to using NSAID's
and chondroitin together due to the increased potential for bleeding.5
• Ulcers induced by NSAIDs may be
minimized by Licorice.6
• Due to its blood-thinning properties,
taking Ginkgo with NSAIDs may not be advisable.7
• Anti-inflammatory properties
of diclofenac may be increased by Stinging Nettle.8
• Avoid feverfew with NSAID's, the
herbs' effect may theoretically be reduced.9
References
1 Baggott JE, Morgan SL, Ha T, et al.
Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs.
Biochem J 282: 197-202, 1992.
1 Lawrence VA, Loewenstein JE, and Eichner ER. Aspirin and folate binding: in
vivo and in vitro studies of serum binding and urinary excretion of
endogenous folate. J Lab Clin Med 103: 944-948, 1984.
1 Molloy TP and Wilson CW. Protein-binding of ascorbic acid.
Interaction with acetylsalicylic acid. Int J Vitam Nutr Res 50:
387-392, 1980.
1 Das N and Nebioglu S. Vitamin C-aspirin interactions in
laboratory animals. J Clin Pharm Ther 17: 343-346, 1992.
2 Liede KE, Haukka JK, Saxen LM, et al. Increased tendency
toward gingival bleeding caused by joint effect of alpha-tocopherol
supplementation and acetylsalicylic acid. Ann Med 30: 542-546, 1998.
2 Steiner M. Vitamin E, a modifier of platelet function:
rationale and use in cardiovascular and cerebrovascular disease. Nutr
Rev. 1999 Oct;57(10):306-9.
3 Pronsky, Z Food Medication Interactions, 11th edition, 1999.
3 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
4 Pronsky, Z Food Medication Interactions, 11th edition, 1999.
4 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
5 McKevoy GK, ed. AHFS Drug Information. Bethesda, MD:
American Society of Health-System Pharmacists, 2000.
5 Griffith, Winter H MD Vitamins, herbs, minerals and
supplements- the complete guide. Revised edition. Fisher books, 1998.
6 Rees WDW, Rhodes J, Wright JE, et al. Effect of
deglycyrrhizinated liquorice on gastric mucosal damage by aspirin.
Scand J Gastroenterol 14: 605-607, 1979.
6 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
6 Morgan AG, McAdam WAF, Pascoo C, Darnborough A. Comparison
between cimetidine and Caved-S in the treatment of gastric ulceration
and subsequent maintenance therapy. Gut 1982;23: 545-51.
7 Rosenblatt M and Mindel J. Spontaneous hyphema associated
with ingestion of Ginkgo biloba extract. N Engl J Med 336(15): 1108,
1997.
8 Chrubasik S, Enderlein W, Bauer R, Grabner W. "Evidence for
antirheumatic effectiveness of Herba Urticae dioicae in acute
arthritis: A pilot study," Phytomedicine, 4(2): 105-108, 1997.
8 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
9 The Review of Natural Products by Facts and Comparisons.
St. Louis, MO: Wolters Kluwer Co., 2000.
9 Miller LG. Herbal medicinals: selected clinical
considerations focusing on known or potential drug-herb interactions.
Arch Int Med 1998;158(20):2200-11.
Aspirin
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Aspirin increases urinary excretion
of vitamin C. Decreased vitamin status with respect to vitamin C as
well as folate have been
noted.1
• Take with food or milk to decrease
stomach upset2
• Avoid alcohol.3
• May cause glucose level changes,
caution with diabetes4
• Taking vitamin E together with
aspirin has been associated with bleeding problems.5
• The use of over three grams of
aspirin has been associated with zinc depletion.6
• The antithrombotic effect of garlic
plant, ginger, ginkgo or onion plant may be increased by concomitant
administration of salicylates like aspirin.7
• Licorice root reduces aspirin
absorption and protects gastric mucosa against aspirin toxicity8
• Due to presence of salicylates in
meadowsweet, poplar and white willow, it may potentiate the effects of
other anticoagulant agents, such as aspirin, and heparin.9
References
1 Pronsky, Z Food Medication
Interactions, 11th edition, 1999.
1 McKevoy GK, ed. AHFS Drug Information. Bethesda MD:
American Society of Health-System Pharmacists, 1998
1 Hansten PD, Horn JR. Drug Interactions Analysis and
Management. Vancouver, WA: Applied Therapeutics Inc., 1997 and updates.
1 Coffey G, Wilson CWM. Ascorbic acid deficiency and aspirin
induced haematemesis. BMJ 1975; I: 208.
1 Buist RA. Drug-nutrient interactions: an overview. Intl
Clin Nutr Rev 1984;4(3):114 .
2 Pronsky, Z Food Medication Interactions, 11th edition, 1999
3 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
3 Pronsky, Z Food Medication Interactions, 11th edition, 1999
4 Pronsky, Z Food Medication Interacations, 11th edition, 1999
5 Liede KE, Haukka JK, Saxén LM, Heinon OP. Increased
tendency towards gingival bleeding caused by joint effect of
alpha-tocopherol supplementation and acetylsalicylic acid. Ann Med
1998;30:542-46.
6 Ambanelli U, Ferraccioli GF, Serventi G, Vaona GL. Changes
in serum and urinary zinc induced by ASA and indomethacin. Scand J
Rheumatol 1982;11:63-64
7 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996
7 Pronsky, Z Food Medication Interactions, 11th editon, 1999
7 Rosenblatt M, Mindel . Spontaneous hyphema associated with
ingestion of Ginkgo biloba extract. J N Eng J Med 1997; 336: (15):1108
7 Rowin J, Lewis SL. Spontaneous bilateral subdural hematomas
associated with chronic Ginkgo biloba ingestion. Neurology
1996;46:1775-6.
8 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
8 Rees WDW, Rhodes J, Wright JE, et al. Effect of
deglycyrrhizinated liquorice on gastric mucosal damage by aspirin.
Scand J Gastroenterol 1979;14:605-7.
9 Facts and Comparisons, Review of Natural Products, Wolters
Kluwer Company, 2000.
9 Janssen PL: Acetylsalicylate and salicylates in foods.
Cancer Lett, 1997 Mar, 114:1-2, 163-4.
Atacand
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Potassium supplements and potassium
containing foods/salts should be avoided while taking this drug.1
• Long-term use of Licorice is known to
cause hypertension and water retention, therefore it may interfere with
antihypertensive therapies, such as atacand.2
• Many herbs have cardiac properties
that could intensify the effects of Atacand. Among these herbs are
black hellebore, calamus, cereus, cola, coltsfoot, devil's claw,
European mistletoe, fenugreek, fumitory, digitalis leaf, hedge mustard,
figwort, lily of the valley roots, motherwort, pleurisy root, squill
bulb leaf scales, white horehound, mate, scotch broom flower,
shepherd's purse, and wild carrot.3
References
1 Facts and Comparisons, Clinisphere
2.0, Wolters Kluwer Company, 2000.
2 Pronsky, Z Food Medication Interactions, 11th edition, 1999
2 Blumenthal M, Busse WR, Goldberg A, et al, eds. The
Complete Commission E Monographs: Therapeutic Guide to Herbal
Medicines. Boston, MA: Integrative Medicine Communications, 1998,
161-62.
2 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
3 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
3 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
3 The Review of Natural Products, Clinisphere 2.0, Wolters
Kluwer Company, 2000
Atenolol
side effects, nutrient depletions, herbal interactions and health notes:
Data
provided by Applied Health
• The use of
alcohol should be limited.1
• Atenolol may
also contribute to deficiencies in choline, and CoQ10. A quality multivitamin may be
recommended by your physician or pharmacist.2
• Calcium may
interfere with the absorption of Atenolol. Consider taking calcium supplements
separately from all medications.3
• Chromium
supplements taken with beta blockers may raise HDL cholesterol levels.4
• These herbs may
adversely affect the action of Atenolol: Blue Cohosh, Cola, Devil’s
Claw, Ephedra, Ginseng, Goldenseal, Hawthorn, Motherwort, Parsley,
Pleurisy Root, Shizandra, Shepherd’s Purse, Wild Carrot, and Wormseed.
Their use should be avoided while taking atenolol.5
• Natural
licorice products, Ginseng and Ephedra (Ma huang) may cause
hypertension and should be avoided by those with high blood pressure.6
• Some herbs
possess diuretic properties that may intensify the action of
antihypertensive drugs, which could result in an excessive lowering of
blood pressure. Such herbs include Buchu, Butcher's Broom and Juniper.7
• Cola, Guarana,
Mate are some caffeine containing herbs that should be avoided with
beta blockers.8
• Melatonin can
reverse the sleep effects of propranolol and Atenolol.9
• Beta Blockers
can help to prevent Yohimbe toxicity.10
References
1 Mindell, E, Hopkins V: Prescription
Alternatives. New Canaan, CT: Keats Publishing, Inc, 1998; p. 143.
1 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
2 Shand, D.G.: Clinical pharmacology of the beta-blocking
drugs: implications for the postinfarction patient. Circulation, 1983,
67(Supp 1): 12-15.
2 Product Information: Inderal, propranolol hydrochloride.
Wyeth-Ayerst Laboratories, PA. 1993.
2 Kishi H, Kishi T, Folkers K: Bioenergetics in clinical
medicine III - inhibition of coenzyme Q10-enzymes by clinically used
antihypertensive drugs, Res Commun Chem Pathol Pharmacol, 1975,
12(3):533-40.
3 The Medical Letter Handbook of Adverse Drug Interactions,
1995.
3 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
3 Pronsky, Z Food Medication Interactions, 11th edition, 1999
4 Roeback JR Jr, Hla KM, Chambless LE, Fletcher RH. Effects
of chromium supplementation on serum high-density lipoprotein
cholesterol levels in men taking beta-blockers. A randomized,
controlled trial. Ann Intern Med, 1991;115(12):917-924
5 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
5 Brinker, Francis, N.D. Herb Contraindications and Drug
Interactions, Eclectic Medical Publications. 1998
6 Pronsky, ZM: Food-Medication Interactions, 11th edition,
1999
6 Farese, RV et al., Licorice-induced
hypermineralcorticoidism. NEJM. 1991, 325:1,1223-1,227.
6 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
7 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
7 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
7 The Review of Natural Products, Clinisphere 2.0, Wolters
Kluwer Company, 2000
8 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
9 Stoschitzky K, Sakotnik A, Lercher P, et al. Influence of
beta-blockers on melatonin release. Eur J Clin Pharmacol
1999;55(2):111-115
9 Van Den Heuvel CJ, Reid KJ, Dawson D. "Effect of atenolol
on nocturnal sleep and temperature in young men: reversal by
pharmacological doses of melatonin." Physiol Behav, Jun. 1997;
61(6):795-802
10 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
Atrovent
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Avoid using this product if there is
a soy allergy1
• Atrovent can cause dry mouth,
metallic taste or nausea2
• Atrovent may have adverse
cardiovascular effects when combined with medications and herbs that
have cardioactive properties. Herbs that may be dangerous include:
black hellebore, calamus, cereus, cola, coltsfoot, devil's claw,
European mistletoe, fenugreek, fumitory, digitalis leaf, hedge mustard,
figwort, lily of the valley roots, motherwort, pleurisy root, squill
bulb leaf scales, white horehound, mate, scotch broom flower,
shepherd's purse, and wild carrot3
• Theoretically herbs with
anticholinergic properties like: henbane and belladonna, may interact
with Atrovent.4
• Soy Isoflavones and lecithin - Use of
soy isoflavones or extracts from soy could potentially increase the
absorption and utilization of this medication. People with soy
allergies should not take either the medication or the supplement.5
References
1 Facts and Comparisons, Clinisphere
2.0, Wolters Kluwer Company, 2000
2 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
2 Pronsky, Z Food Medication Interactions, 11th edition, 1999
3 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
3 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
3 The Review of Natural Products, Clinisphere 2.0, Wolters
Kluwer Company, 2000
4 Blumenthal M, et al. ed. The Complete German Commission E
Monographs: Therapeutic Guide to Herbal Medicines. Trans. S.Klein.
Boston, MA: American Botanical Council, 1998.
5 Threlkeld DS, ed. Respiratory Drugs, Respiratory Inhalant
Products, Anticholinergics, Ipratropium Bromide. In Facts and
Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Jun
1996, 182f–2g.
Augmentin
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Consume adequate amounts of fluids,
unless otherwise directed.1
• Augmentin may hinder the production
of B vitamins and vitamin K in the intestine. Supplementation may be
beneficial with long term use of the drug.2
• Antibiotics kill bacteria, including
beneficial flora in the gut, which may affect digestion and/or
elimination. Supplementation with acidophilus or bifidus may aid in
restoring this beneficial flora.3
• Bromelain may increase absorption of
Augmentin.4
References
1 Welling PG, Huang H, Koch PA, et al.
Bioavailability of ampicillin and amoxicillin in fasted and non-fasting
subjects. J Pharm Sci. 1977; 66:549-552.
2 Mindell, E, Hopkins V: Prescription Alternatives. New
Canaan, CT: Keats Publishing, Inc, 1998; p. 336.
2 Hill MJ: Intestinal flora and endogenous vitamin synthesis,
Eur J Cancer Prev, 1997, 6 (Suppl 1): S43-5.
2 Deguchi Y, et al: Comparative studies on synthesis of
water-soluble vitamins among human species of Bifidobacteria, Argic
Biol Chem, 1985, 19 (1): 13-19.
2 Conly J and Stein K: Reduction of vitamin K2 concentrations
in human liver associated with the use of broad spectrum
antimicrobials, Clin Invest Med, 1994, 17 (6):531-9.
3 Bengmark S & Gianotti L: Nutritional support to
prevent and treat multiple organ failure. World J Surg, 1996 May, 20:4,
474-81.
3 Fuller R. Probiotics in human
medicine. Gut 1991;32:439-42 [review].
3 Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents.
A neglected modality for the treatment and prevention of selected
intestinal and vaginal infections. JAMA 1996;275:870-76.
3 Cummings JH, Macfarlane G: Role of intestinal bacteria in
nutrient metabolism, JPEN J Parenter Enteral Nutr, 1997, 21(6): 357-65.
3 Gorbach SL: Bengt E. Gustafsson Memorial Lecture, Function
of the Normal Human Microflora, Scand J Infect Dis Suppl, 1986,
49:17-30.
4 Neuvonen PJ et al., Comparative effect of food on
absorption of ampicillin and pivampicillin. J Int Med Res 1977; 5:
71-76.
4 Tinozzi S, Venegoni A. Effect of bromelain on serum and
tissue levels of amoxicillin. Drugs Exp Clin Res 1978;4:39-44.
4 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
Avandia
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Limit or avoid alcohol.1
• Caution with high doses of nicotinic
acid as it raises glucose levels .2
• The supplement ipriflavone may
increase the blood levels of oral antidiabetic agents. This could cause
blood sugar to fall dangerously low. Consult a physician before taking
ipriflavone with oral hypoglycemic agents.3
• These supplements may reduce blood
sugar levels and require a dosage adjustment of Avandia: carnitine,
chromium, coenzyme Q10 and
vanadium.4
• Potatoes can interfere with blood
sugar levels and Avandia dosage may require adjustment.5
• The bulbs of the common onion plant
and common garlic plant, as well as leaves of bilberry and blueberry
have significant oral hypoglycemic action. Hypoglycemic medications may
require adjustment.6
• These herbs may reduce blood sugar
levels and therefore require an adjustment in the dosage of Avandia: :
bitter melon, burdock, dandelion, fenugreek, ginseng, and gymnema.7
References
1 Graedon J, Graedon T: The People's
Guide to Deadly Drug Interactions, 1995
1 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
2 Balch, J.F. & Balch, P.A.: Prescription for
Nutritional Healing. Second Edition. Avery, New York. 1996.
2 Schwartz ML. Severe reversible hyperglycemia as a
consequence of niacin therapy. Arch Intern Med. 1993 Sep
13;153(17):2050-2.
3 Monostory K, et al. Ipriflavone as an inhibitor of human
cytochrome P450 enzymes. Br J Pharmacol 123(4): 605-610, 1998.
4 Singh RB, Niaz MA, Rastogi SS, et al. Effect of
hydrosoluble coenzyme Q10 on
blood pressures and insulin resistance in hypertensive patients with
coronary artery disease. J Human Hypertens 13: 203-208, 1999.
4 Mingrone G. L-carnitine improves glucose disposal in type 2
diabetic patients. J Am Col Nutr 18: 77-82, 1999.
4 Jacob S, Ruus P, Hermann R, et al. Oral administration of
RAC-alpha-lipoic acid modulates insulin sensitivity in patients with
type-2 diabetes mellitus: a placebo-controlled pilot trial. Free Radic
Biol Med 27: 309-314, 1999.
4 Cohen N, et al. "Oral vanadyl sulfate improves hepatic and
peripheral insulin sensitivity in patients with non-insulin-dependent
diabetes mellitus." J Clin Invest, 1995; 95: 2501-509.
5 Gannon MC, et al. Diabetes Care 1993;16:874.
5 The Review of Natural Products, Facts and Comparisons,
Clinisphere 2.0, Wolters Kluwer Company, 2000
6 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
6 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996
6 Mathew PT and Augusti KT. Hypoglycaemic effects of onion,
Allium cepa Linn. on diabetes mellitus, a preliminary report. Indian J
Physiol Pharmacol 19: 213-217, 1975
7 Akhtar MS. Trial of Momordica charantia Linn (Karela)
powder in patients with maturity-onset diabetes. J Pak Med Assoc 32:
106-107, 1982.
7 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
7 Yaniv Z, Dafni A, Friedman J, et al. Plants used for the
treatment of diabetes in Israel. J Ethnopharmacol 19(2): 145-151, 1987.
7 Bever BO and Zahnd GR. Plants with oral hypoglycemic
action. Q J Crude Drug Res 17: 139-196, 1979.
7 Welihinda J, et al. Effect of Momordica charantia on the
glucose tolerance in maturity onset diabetes. J Ethnopharmacol 17:
277-282, 1986
7 Boden G, et al. Effects of vanadyl sulfate on carbohydrate
and lipid metabolism in patients with non-insulin-dependent diabetes
mellitus. Metabolism 45: 1130-1135, 1996
Avapro
side effects, nutrient depletions, herbal interactions and health notes:
Data
provided by Applied Health
• A diet low in
sodium and calories may be beneficial.1
• Potassium
supplements and potassium containing foods should be used with caution
while taking this drug. Monitor potassium levels.2
• Long-term use
of Licorice is known to cause hypertension and water retention,
therefore it may interfere with antihypertensive therapies.3
• Many herbs have
cardiac properties that could intensify the effects of Avapro. Among
these herbs are: black hellebore, calamus, cereus, cola, coltsfoot,
devil's claw, European mistletoe, fenugreek, fumitory, digitalis leaf,
hedge mustard, figwort, lily of the valley roots, motherwort, pleurisy
root, squill bulb leaf scales, white horehound, mate, scotch broom
flower, shepherd's purse, and wild carrot4
References
1 Pronsky, Z Food Medication
Interactions, 11th edition, 1999
2 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000.
3 Pronsky, Z Food Medication Interactions, 11th edition, 1999
3 Blumenthal M, Busse WR, Goldberg A, et al, eds. The
Complete Commission E Monographs: Therapeutic Guide to Herbal
Medicines. Boston, MA: Integrative Medicine Communications, 1998,
161-62.
4 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A
Guide for Health-care Professionals. London: The Pharmaceutical Press,
1996.
4 McGuffin M, et al., ed. American Herbal Products
Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press,
1997.
4 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
4 The Review of Natural Products, Clinisphere 2.0, Wolters
Kluwer Company, 2000
Avelox
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Consume adequate amounts of fluids,
unless otherwise directed.1
• Calcium, iron, magnesium, aluminum,
zinc may reduce absorption and hence the effectiveness of
fluoroquinolone antibiotics. Avoid consuming dairy products and/or
supplements containing calcium at least two
hours after ingesting this medication.2
• Bromelain, an enzyme found in
pineapple and dietary supplements may increase the absorption of this
medication.3
• Limit caffeine products (coffee, tea,
and caffeine-containing supplements).4
• Antibiotics kill bacteria, including
beneficial flora in the gut, which may affect digestion and/or
elimination. Supplementation with acidophilus and/or bifidus may help to
replace beneficial flora.5
• Avoid cola, guarana and mate with
this medication due to their caffeine content. There may be decreased
caffeine clearance.6
• Avoid cola, guarana and mate with
this medication due to their caffeine content. There may be decreased
caffeine clearance.7
References
1 Pronsky, ZM: Food-Medication
Interactions, 11th edition, 1999
2 Facts & Comparisons, Clinisphere 2.0, Wolters
Kluwer Company, 2000
2 Pronsky, Z Food Medication Interactions, 11th edition, 1999
2 Motoya T, Miyashita M, Kawachi A, Yamada K. Effects of
ascorbic acid on interactions between ciprofloxacin and ferrous
sulphate, sodium ferrous citrate or ferric pyrophosphate, in mice. J
Pharm Pharmacol. 2000 Apr;52(4):397-401.
3 Facts & Comparisons, Clinisphere 2.0, Wolters
Kluwer Company, 2000
3 Pronsky, Z Food Medication Interactions, 11th edition, 1999
3 Motoya T, Miyashita M, Kawachi A, Yamada K. Effects of
ascorbic acid on interactions between ciprofloxacin and ferrous
sulphate, sodium ferrous citrate or ferric pyrophosphate, in mice. J
Pharm Pharmacol. 2000 Apr;52(4):397-401.
4 Griffith, H. W. 1983. Complete Guide to Prescription and
Non-Prescription. Fisher Publishing, Inc., Tucson.
4 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
5 Bengmark S & Gianotti L: Nutritional support to
prevent and treat multiple organ failure. World J Surg, 1996 May, 20:4,
474-81.
5 Cummings JH, Macfarlane G: Role of intestinal bacteria in
nutrient metabolism, JPEN J Parenter Enteral Nutr, 1997, 21(6): 357-65.
5 Gorbach SL: Bengt E. Gustafsson Memorial Lecture, Function
of the Normal Human Microflora, Scand J Infect Dis Suppl, 1986, 49:17-30
6 Carbo M, et al. Effect of quinolones on caffeine
disposition, Clin Pharmacol Ther 1989;45:234-40.
6 Barnett G, Segura J, de la Torre R, Carbo M.
Pharmacokinetic determination of relative potency of quinolone
inhibition of caffeine disposition. Eur J Clin Pharmacol.
1990;39(1):63-9.
7 Carbo M, et al. Effect of quinolones on caffeine
disposition, Clin Pharmacol Ther 1989;45:234-40.
7 Barnett G, Segura J, de la Torre R, Carbo M.
Pharmacokinetic determination of relative potency of quinolone
inhibition of caffeine disposition. Eur J Clin Pharmacol.
1990;39(1):63-9.
Avonex
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• May cause anorexia, and changes in
weight.1
• Anemia and a susceptibility to
infections is possible.2
• N-acetyl cysteine may enhance
interferon's effectiveness if used together in the treatment of
hepatitis C.3
• The Japanese herbal compound
Sho-saiko-to has been shown to cause pneumonitis in patients on
interferon therapy with hepatitis. It may be advisable to avoid
combining interferon and this herbal product.4
• The active ingredient of licorice
(glycyrrhizin) may enhance the effectiveness of interferon in the
treatment of hepatitis.5
References
1 Pronsky, Z Food Medication
Interactions, 11th edition, 1999
2 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer
Company, 2000
2 Pronsky, Z Food Medication Interactions, 11th edition, 1999
3 Beloqui O, Prieto J, Sua’rez B, et al. N-Acetyl cysteine
enhances the response to interferon-alpha in chronic hepatitis C: A
pilot study. J Interferon Res 1993;13:279-82
4 Ishizaki T, Sasaki F, Ameshima S, et al. Pneumonitis during
interferon and/or herbal drug therapy in patients with chronic active
hepatitis. Eur Respir J 1996;9:2691-96
4 Sugiyama H, Nagai M, Kotajima F, et al. A case of
interstitial pneumonia with chronic hepatitis C following
interferon-alpha and sho-saiko-to therapy. Arerugi 1995;44:711-14 [in
Japanese].
5 Abe Y, Ueda T, Kato T, et al. Effectiveness of interferon,
glycyrrhizin combination therapy in patients with chronic hepatitis C.
Nippon Rinsho 1994;52:1817-22 ( Japanese].
5 Fujisawa K. Interferon therapy in hepatitis C virus induced
chronic hepatitis: Clinical significance of pretreatment with
glycyrhizin. Trop Gastroenterol 1991;12:176-79.
Axid
Pulvules
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Axid may increase the risk for
deficiencies in calcium, magnesium, iron, zinc, and vitamin D. Discuss
a supplementation plan with your physician.1
• Axid may affect levels of folic acid and
vitamin B12. Supplementation may be beneficial.2
• Alcohol and tobacco use should be
avoided.3
• Limit amounts of caffeine, including
chocolate, coffee, tea, and sodas. Avoid supplements that contain
caffeine.4
• Avoid black tea, cocoa, coffee, cola
nut, guarana, green tea and mate because the caffeine can interfere
with H2 antagonists.5
• Licorice may theoretically provide an
added protective effect with H2 antagonists.6
• Acacia, Black mustard, Capsicum,
Devil's Claw, Goldenseal,and Horseradish, all increase gastric acid and
could therefore theoretically interact with Axid.7
References
1 Aymard JP, Aymard B, Netter P, et
al. Haematological adverse effects of histamine H2-receptor
antagonists. Med Toxicol Adverse Drug Exp 1988;3:430-48.
1 Hakanson R, Persson P, Axelson J: Elevated serum gastrin
after food intake or acid blockade evokes hypocalcemia, Regul Pept,
1990, 28(2):131-6.
1 Ghishan FK, Walker F, Meneely R, et al: Intestinal calcium transport -
effect of cimetidine, J Nutr, 1981, 111(12): 2157-61.
1 Odes HS, Fraser GM, Krugliak P, et al: Effect of cimetidine
on hepatic vitamin D metabolism in humans, 1990, 46(2):61-4.
1 Skikne BS, Lynch SR, Cook JD: Role of gastric acid in food
iron absorption, Gastroenterology, 1981, 81(6):1068-71.
1 Sturniolo GC, Montino MC, Rossetto L, et al: Inhibition of
gastric acid secretion reduces zinc absorption in man, J Am Coll Nutr,
1991, 10(4):372-5.
2 Aymard JP, Aymard B, Netter P, et al. Haematological
adverse effects of histamine H2-receptor antagonists. Med Toxicol
Adverse Drug Exp 1988;3:430-48.
2 Force RW, Nahata MC: Effect of histamine-H2-Receptor
antagonists on vitamin B12 absorption, Ann
Pharmacother, 1992, 26(10):1283-6.
2 Russell RM, Golner BB, Krasinski SD, et al: Effect of
antacid and H2 receptor antagonists on the intestinal absorption of
folic acid, J Lab Clin Med, 1988, 112(4):458-63.
3 Pronsky, ZM: Food-Medication Interactions, 11th edition,
1999
3 Lieber, CS: Mechanisms of ethanol-drug-nutrition
interactions. J Toxicol Clin Toxicol 1994;32(6):631-81.
3 Schurer-Maly CC, Varga L, Koelze HR, Halter F. Smoking and
pH response to H2-receptor antagonists. Scand J Gastroenterol
1989;24:1172-78.
4 Pronsky, ZM: Food-Medication Interactions, 11th edition,
1999
5 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998
6 Brinker, F Herb Contraindications and Drug Interactions,
Eclectic Medical Publications, 1998.
7 PDR for Herbal Medicines, 2nd edition, Medical Economics
Company, 2000
Azathioprine
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• There are no known nutritional
considerations, at this time.1
• Based on pharmacology: Laboratory
studies have reported that constituents contained in shiitake mushroom
may increase immune function which may alter the effects of
Azathioprine and possibly the dose needed for treatment. Use with
caution.2
• Based on pharmacology: Laboratory
studies have reported that constituents contained in picrorhiza
root/rhizome may increase immune function which may alter the effects
of Azathioprine and possibly the dose needed for treatment. Use with
caution.3
• Based on pharmacology: Laboratory
studies have reported that constituents contained in larch
arabinogalactan may increase immune function which may alter the
effects of Azathioprine and possibly the dose needed for treatment. Use
with caution.4
• Based on pharmacology: Human and
laboratory studies have reported that constituents contained in
echinacea products may increase immune function which may alter the
effects of Azathioprine and possibly the dose needed for treatment. Use
with caution.5
• Based on pharmacology: Studies have
reported that cat's claw has immuno-stimulatory properties which may
alter the effects of Azathioprine and possibly the dose needed for
treatment. Use with caution.6
• Based on pharmacology: Laboratory
studies have reported that constituents contained in calendula flowers
may increase immune function which may alter the effects of
Azathioprine and possibly the dose needed for treatment. Use with
caution when taking this supplement internally.7
• Based on pharmacology: Laboratory
studies have reported that constituents contained in astragalus root
may increase immune function which may alter the effects of
Azathioprine and possibly the dose needed for treatment. Use with
caution.8
• Based on pharmacology: Studies have
reported that arabinoxylane may increase immune function and therefore
may alter the effects of Azathioprine and possibly the dose needed for
treatment. Use with caution.9
• Based on pharmacology: Studies have
reported that constituents contained in St. John's wort flowers may
alter the function of certain cytochrome P450 isoenzyme systems which
may change the effects of Azathioprine and possibly the dose needed for
treatment. A case report found that St. John's wort decreased the
effects of this medication. Use with caution.10
References
1 N/A
2 Suzuki H, et al. Immunopotentiating Substances in Lentinus
edodes Mycelial Extract(LEM)-- Activation of Macrophage and
Proliferation of Bone Marrow Cell. Nippon Shokakibyo Gakkai Zasshi.
Jul1988;85(7): 1430.
2 Suzuki H, et al. Inhibition of the Infectivity and
Cytopathic Effect of Human Immunodeficiency Virus by Water-soluble
Lignin in an Extract of the Culture Medium of Lentinus edodes Mycelia
(LEM). Biochem Biophys Res Commun. Apr1989;160(1):367-73.
3 Atal CK, et al. Immunomodulating Agents of Plant Origin. I:
Preliminary Screening. J Ethnopharmacol. Nov1986;18(2):133-41.
3 Sharma ML, et al. Immunostimulatory Activity of Picrorhiza
kurroa Leaf Extract. J Ethnopharmacol. Feb1994;41(3):185-92.
4 Hauer J, et al. Mechanism of Stimulation of Human Natural
Killer Cytotoxicity by Arabinogalactan from Larix occidentalis. Cancer
Immunol Immunother. 1993;36(4):237-44.
5 Vomel VT. The Effect of a Nonspecific Immunostimulant on
the Phagocytosis of Erythrocytes and Ink by the Reticulohistiocyte
System in the Isolated, Perfused Liver of Rats of Various Ages. Arzneim
Forsch/Drug Res. 1984;34:691-95.
5 See DM, et al. In Vitro Effects of Echinacea and Ginseng on
Natural Killer and Antibody-dependent Cell Cytotoxicity in Healthy
Subjects and Chronic Fatigue Syndrome or Acquired Immunodeficiency
Syndrome Patients. Immunopharmacology. 1997;35(3):229-35.
6 Wagner H, et al. The Alkaloids of Uncaria tomentosa and
Their Phagocytosis-stimulating Action. Planta Med. 1995;5:419-23.
7 Wagner H, et al. Immunostimulating action of
polysaccharides (heteroglycans) from higher plants.
Arzneimittelforschung. 1985;35(7):1069-75.
8 Zhao KS, et al. Enhancement of the Immune Response in Mice
by Astragalus membranaceus Extracts. Immunopharmacology.
1990;20(3):225-33.
8 Chu DT, et al. Immune Restoration of Local Xenogeneic
Graft-versus-host Reaction in Cancer Patients in In-vitro and Reversal
of Cyclophosphamide-induced Immune Suppression in the Rat in Vivo by
Fractionated Astragalus membranaceus. Chung Hsi I Chieh Ho Tsa Chih.
Jun1989;9:351-54.
9 Ghoneum M, et al. NK IMMUNOMODULATORY FUNCTION IN 27 CANCER
PATIENTS BY MGN-3, A MODIFIED ARABINOXYLANE FROM RICE BRAN, 87th Annual
Meeting of the American Association for Cancer Research. Washington DC.
Apr1996.
9 Ghoneum M. ENHANCEMENT OF HUMAN NATURAL KILLER CELL
ACTIVITY BY MODIFIED ARABINOXYLANE FROM RICE BRAN (MGN-3).
INTERNATIONAL JOURNAL OF IMMUNOTHERAPY XIV(i). 1998;89-99.
10 Ruschitzka F, et al. Acute Heart Transplant Rejection Due
to St. John's Wort. Lancet. Feb2000;355(9203): 548-49.
Azmacort
side effects, nutrient depletions, herbal interactions and health notes:
Data provided by Applied
Health
• Chronic use of Azmacort in higher
doses may impair calcium absorption
and bone formation. Supplementation with calcium and vitamin
D is strongly encouraged. Inform your pharmacist if you have
osteoporosis.1
• Chronic, long-term use of Azmacort at
higher doses may also compromise the immune system and deplete several
important nutrients. Supplementation with vitamins A, C, E, selenium,
magnesium, potassium, vitamin B6 and zinc may be beneficial.2
• Ephedra (Ma huang) may increase the
clearance of Azmacort and thereby may decrease its effectiveness.3
• Licorice may decrease the clearance
of Azmacort and may possibly intensify the duration of its activity and
side effects.4
References
1 Sambrook PN: Calcium and vitamin
D therapy in corticosteroid bone loss: what is the evidence? J
Rheumatol 1996; 23:963-964.
1 Buckley LM, Leib ES, Cartularo KS, et al. Calcium and vitamin
D3 supplementation prevents bone loss in the spine secondary to
low-dose corticosteroids in patients with rheumatoid arthritis. A
randomized, double-blind, placebo-controlled trial. Ann Intern Med
1996;125:961-68.
1 Lems WF, Van Veen GJ, Gerrits MI, et al: Effect of low-dose
prednisone (with calcium and
calcitrol supplementation) on calcium and bone
metabolism in healthy volunteers, Br J Rheumatol, 1998, 37(1):27-33.
1 Lems WF, Jacobs JW, Netelenbos JC, et al: Pharmacological
prevention of osteoporosis in patients on corticosteroid mediciation,
Ned Tijdschr Geneeskd, 1998, 142(34):1905-8.
1 Gennari C, Differential effect of glucocorticoids on calcium absorption
and bone mass, Br J Rheumatol, 1993, 32 (suppl 2):11-4.
1 Reid IR, Ibbertson HK, Calcium supplements
in the prevention of steroid-induced osteoporosis, Am J Clin Nutr,
1986, 44 (2):287-90.
1 Weryha G, Klein M, Guillemin F, et al: Corticosteroids
osteoporosis in the adult, Presse Med, 1998, 27(32):1641-6.
1 Hachulla E, Cortet B: Prevention of glucocorticoid-induced
osteoporosis, Rev Med Interne, 1998, 19(7): 492-500.
1 Gerster JC, So AK, Burkhardt P: Systemic corticosteroid
therapy in rheumatology - advantages and risks, Schweiz Rundsch Med
Prax, 1998, 87(33):1024-7.
2 AMA Drug Evaluations, 1995 Annual, American Medical
Association.
2 Holt GA. Food & Drug Interactions. Chicago: Precept
Press, 1998, 83.
2 Thelkeld DS, ed. Hormones, Adrenal Cortical Steroids,
Glucocorticoids. In Facts and Comparisons , Clinisphere 2.0, Wolters
Kluwer Company, 2000
2 Trovato A et al. Drug-nutrient interactions. Am Family Phys
1991;44:1651-58 [review].
2 Chesney RW et al. Reduction of
serum-1,25-dihydroxyvitamin-D, in children receiving glucocorticoids.
Lancet 1978;ii:1123-25.
2 Widmer P, Maibach R, Kunzi UP, et al: Diuretic-Related
hypokalaemia - the role of diuretics, potassium supplements,
glucocorticoids, and beta-2-adrenoceptor agonists - results from the
Comprehensive Hospital Drug Monitoring program, Berne (CHDM), Eur J
Clin Pharmacol, 1995, 49(1-2): 31-6.
2 Shenfield GM, Knowles GK, Thomas N, et al: Potassium
supplements in patients treated with corticosteroids, Br J Dis chest,
1975, 69:171-6.
2 Gol’berg ED, Eshchenko VA, Bovt VD, et al: The effect of
immunosuppressive substances on the zinc content in cells, Biull Eksp
Biol Med, 1993, 116(10):412-3.
2 Yunice AA, Czerwinski AW, Lindeman RD: Influence of
synthetic corticosteroids on plasma zinc and copper levels in humans,
Am J Med Sci, 1981, 282(2):68-74.
2 Fodor L, Ahnefeld FW, Fazekas AT: Studies on the
glucocorticoid control of zinc metabolism, Infusionsther Klin Ernahr,
1975, 2(3):210-3.
2 Atkinson SA, Halton JM, Bradley C, et al: Bone and mineral
abnormalities in childhood acute lymphoblastic leukemia - influence of
disease, drugs, and nutrition, Int J Cancer Suppl, 1998, 11:35-9.
2 Simeckova A, Neradilova M, Reisenauer R: Effect of
prednisolone on the rat bone calcium, phosphorus, and magnesium
concentration, Physiol Bohemoslov, 1985, 34(2):155-60.
2 Frequin ST, Wevers RA, Braam M, et al: Decreased vitamin B12 and folate levels in
cerebrospinal fluid and serum of multiple sclerosis patients after
high-dose intravenous methylprednisone, J Neurol, 1993, 240(5):305-8.
2 Peretz A, Neve J, Vertongen F, et al: Selenium status in
relation to clinical variables and corticosteroid treatment in
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