ciprofloxacin food: moderate

Concurrent ingestion of dairy products (milk, yogurt) or calcium-fortified foods (i.e., cereal, orange juice)
may decrease the activity of certain oral fluoroquinolone antibiotics. The mechanism is chelation of
calcium and the quinolone, resulting in decreased bioavailability. In the case of orange juice, inhibition of
intestinal transport mechanisms (P-glycoprotein or organic anion-transporting polypeptides) by flavones
may also be involved. One study reported an average 41% decrease in maximum plasma concentrations
and a 38% decrease in AUC when ciprofloxacin was given with calcium-fortified orange juice instead of
water. Administration of ciprofloxacin tablets with enteral nutrition may reduce its bioavailability and
maximum serum concentrations. Data have been conflicting and variable by the type of enteral nutrition
product, location of the feeding tube, and patient characteristics. Decreased absorption is expected if
ciprofloxacin is given by jejunostomy tube.
n ng thi sn phm t b, sa (sa, yogurt)hoc thc n cha nhiu canxi (ng cc, nc cam) c th
tng hot ng ca khng sinh fluoroquinolone ng ung. C ch l to phc ca canxi v quinolone,
kt qu l gim SKD. Trong trng hp nc cam, c ch c ch vn chuyn ng tiu ha bi flavon.
Dng vin ciprofloxacin vi thc n ng tiu ha c th lm gim SKD ca n v nng huyt thanh
cc i (Cmax)
Oral ciprofloxacin should not be taken with dairy products or calcium-fortified foods alone, but may be
taken with meals that contain these products. When taken alone, dairy products or calcium-fortified foods
should be ingested at least 2 hours before or after ciprofloxacin administration. When ciprofloxacin
tablets are administered to patients receiving continuous enteral nutrition, some experts recommend that
the tube feeding should be interrupted for at least 1 hour before and 2 hours after the dose of ciprofloxacin
is given. Patients should be monitored for altered antimicrobial efficacy and switched to intravenous
ciprofloxacin if necessary. If no enteral route besides a jejunostomy tube is available, it is also
recommended to switch to intravenous ciprofloxacin. According to the manufacturer, ciprofloxacin oral
suspension should not be administered via nasogastric or feeding tubes due to its physical characteristics.
Ciprofloxacin ng ung khng nn dng cng vi mt mnh cc sn phm t b, sa hoc thc n
cha nhiu canxi, nhng c th dng vi ba n cha sn phm ny. Khi dng ch vi cc sn phm t
b, sa hoc thc n cha nhiu canxi , th chng nn dng trc t nht 2h hoc sau ung
ciprofloxacin.khi vin ciprofloxacin c ch nh vi bnh nhn nhn dinh dng qua ng rut, th
ng cho n nn b ngt t nht trc 1h hoc 2h sau liu ciprofloxacin. C th i qua ciprofloxacin
ng tim nu cn thit

2. enalapril food: moderate

GENERALLY AVOID: Moderate-to-high dietary intake of potassium can cause hyperkalemia in

some patients who are using angiotensin converting enzyme (ACE) inhibitors. In some cases,
affected patients were using a potassium-rich salt substitute. ACE inhibitors can promote
hyperkalemia through inhibition of the renin-aldosterone-angiotensin (RAA) system.
ch n c lng kali trung bnh n cao c th gy tng kali mu bnh nhn ang dng
ACEI (thuc CMC) . ACEI c th thc y tng kali mu qua s c ch h RAA (reninaldosterone-angiotensin)
MANAGEMENT: It is recommended that patients who are taking ACE inhibitors be advised to
avoid moderately high or high potassium dietary intake. Particular attention should be paid to the
potassium content of salt substitutes.
bnh nhn ang dng ACEI khuyn trnh ch n c lng kalicao va phi n cao. Ch
n lng kali ca cht thay th mui (salt substitutes contain potassium chloride in place of
sodium chloride)

3.methylprednisolone food: moderate

MONITOR: Grapefruit juice may increase the plasma concentrations of orally administered
drugs that are substrates of the CYP450 3A4 isoenzyme. However, the interaction seems to affect
primarily those drugs that undergo significant presystemic metabolism by CYP450 3A4 (i.e.,
drugs with low oral bioavailability), presumably due to the fact that grapefruit juice inhibits
intestinal rather than hepatic CYP450 3A4. Because pharmacokinetic interactions involving
grapefruit juice are often subject to a high degree of interpatient variability, the extent to which a
given patient may be affected is difficult to predict.
Nc bi (Grapefruit juice) c th lm tng nng trong mu ca thuc ng ung m l
cht nn (substrates) ca isoenzyme CYP450 3A4. Tuy nhin tng tc nh hng ch yu
nhng thuc tri qua chuyn ha trc tun han (Presystemic metabolism) bi CYP450 3A4
( vd: nhng thuc SKD ng ung thp) , c l do nc bi c ch CYP450 3A4 rut hn
gan. Tuy nhin tng tc ny cn ph thuc bnh nhn nn kh d on BN no s b nh hng
MANAGEMENT: Patients who regularly consume grapefruit or grapefruit juice should be
monitored for adverse effects and altered plasma concentrations of drugs that undergo significant
presystemic metabolism by CYP450 3A4. Grapefruit and grapefruit juice should be avoided if an
interaction is suspected. Orange juice is not expected to interact with these drugs.
Nhng ngi thng dng bi hay nc bi nn gim st tc dng ph v thay i nng
trong mu ca thuc tri qua chuyn ha trc tun han (Presystemic metabolism) bi
CYP450 3A4. Nn khng dng nu nghi ng c th c tng tc

atorvastatin food

Applies to: atorvastatin

GENERALLY AVOID: Coadministration with grapefruit juice may increase the plasma
concentrations of atorvastatin. The proposed mechanism is inhibition of CYP450 3A4-mediated
first-pass metabolism in the gut wall by certain compounds present in grapefruit. When a single
40 mg dose of atorvastatin was coadministered with 240 mL of grapefruit juice, atorvastatin peak
plasma concentration (Cmax) and systemic exposure (AUC) increased by 16% and 37%,
respectively. Greater increases in Cmax (up to 71%) and/or AUC (up to 2.5 fold) have been
reported with excessive consumption of grapefruit juice (>=750 mL to 1.2 liters per day).
Clinically, high levels of HMG-CoA reductase inhibitory activity in plasma is associated with an
increased risk of musculoskeletal toxicity. Myopathy manifested as muscle pain and/or weakness
associated with grossly elevated creatine kinase exceeding ten times the upper limit of normal
has been reported occasionally. Rhabdomyolysis has also occurred rarely, which may be
accompanied by acute renal failure secondary to myoglobinuria and may result in death.
S dng vi nc bi c th tng nng trn mu ca atorvastain. C ch c a ra l s
c ch chuyn ha vng tun hon u lin quan CYP450 3A4 ca cht no trong nc bi.
trn lm sng mc cao ca s c ch enzym HMG-CoA reductase trong mu lin quan tng
nguy c c tnh c xng khp. Bnh v c nh au c v/ hoc yu c lin quan tng creatine
kinase vt qu 10 ln cn trn gii hn bnh thng. Tiu c vn xy ra him
ADJUST DOSING INTERVAL: Fibres such as oat bran and pectin may diminish the
pharmacologic effects of HMG-CoA reductase inhibitors by interfering with their absorption
from the gastrointestinal tract.
MANAGEMENT: Patients receiving therapy with atorvastatin should limit their consumption of
grapefruit juice to no more than 1 liter per day. Patients should be advised to promptly report any
unexplained muscle pain, tenderness or weakness, particularly if accompanied by fever, malaise
and/or dark colored urine. Therapy should be discontinued if creatine kinase is markedly
elevated in the absence of strenuous exercise or if myopathy is otherwise suspected or diagnosed.
In addition, patients should either refrain from the use of oat bran and pectin or, if concurrent use
cannot be avoided, to separate the administration times by at least 2 to 4 hours
Hn ch dng nc bi 1lit/ ngy.BN nn khuyn bo co lp tc bt c triu chng bt
thngno. Vic ch nh nn ngng li nu creatine kinase tng r rng trong Therapy should
be discontinued if creatine kinase is markedly elevated in the absence of strenuous exercise or if
myopathy is otherwise suspected or diagnosed Nn trnh dng cm yn mch hoc pectin , nu
khng trnh c chia nhiu ln dng m cch t nht 2-4 h