What medicines are not combined with is somehow not accepted to discuss. The patient comes home and, having opened the package, throws out the insert. As unnecessary. As a result, drugs are taken at the wrong time and washed down with anything.
Grapefruit detective
Are fresh juices good for you? Undoubtedly. Although with the proviso "not always and not to everyone." Knowing this, some people, in the hope of enhancing the positive effect, prefer to wash down medications with fresh. Plus and plus, in their opinion, should give 2 pluses.
In fact, this approach does not take into account the possible interaction of drugs with a huge amount of biologically active substances contained in any natural product. The most famous example is grapefruit juice, which can dramatically slow down the metabolism of a number of drugs in the patient's body, which can lead to unpredictable consequences, including death. Here is a brief history of this find.
year 2000. The first reports appeared that grapefruit juice does not work well with various drugs. American scientists from the Mayo Clinic noticed that if you drink heart drugs with this drink, their concentration in the blood becomes dangerously high.
2004 year. The alarming observation was confirmed. In an article published in The American Journal of Nursing, a fatal outcome was described after drinking grapefruit juice with lipid-lowering drugs.
The story is like a fairy tale with a sad ending. A certain patient with hypercholesterolemia was prescribed atorvastatin. After 2 months, the patient moved from North America to sunny Florida, the land of fruits and the sun. It would seem good for his health! However, after a while, the man develops muscle pain, weakness, fever, he ends up in intensive care and dies from acute renal failure. During the "debriefing" they found out that the only change in the patient's life after moving to the south was that he began to drink 2-3 glasses of freshly squeezed grapefruit juice daily.
The researchers then suggested that the ingredients of the drink compete with some drugs for one of the liver microsomal enzymes - cytochrome P450 3A4, which metabolizes both substances contained in the juice and drugs. The result of this is a significant change in the pharmacokinetics of the drug, which immediately affects the duration of its action and the provided effect.
2006 year. A hazardous substance has been identified. It turned out to be furanocoumarin, which gives grapefruit and its juice its characteristic bitterness. The situation turned out to be so serious that the US Food and Drug Administration (FDA) now mandatorily requires all new drugs to be tested for compatibility with grapefruit juice.
Rules and exclusions
Medicines are very heterogeneous in their physicochemical properties, plus it is necessary to take into account the peculiarities of some dosage forms, so there are times when the drug needs to be taken with something very specific. Or, conversely, it is impossible.
Milk. They are advised to drink medicines with indomethacin, mefenamof acid and reserpine, otherwise they can damage the gastrointestinal mucosa. But the drug dimethyloxobutylphosphonyldimethylate, in addition to the furious name, has a bitter taste, which is smoothed out by milk. But it is categorically impossible to drink anything with milk antibiotics of the tetracycline group, lincomycin, as well as all drugs containing caffeine, including combined painkillers - the active principles are neutralized by the calcium contained in milk.
Tea. The tannin contained in it is able to form insoluble compounds and causes many of the active substances of drugs to precipitate. One of the most famous examples is the binding of iron by tannin. Compounds not assimilated by the body are formed when tea comes into contact with nitrogen-containing drugs: papaverine, codeine, caffeine, euphyllin, belladonna preparations, cardiac glycosides. Therefore, "pills from the head" and tea should be as far apart as possible.
Mineral water. It is washed down with erythromycin (any alkaline will do - Borjomi, Essentuki No. 4, No. 17, etc.) and iodine preparations. But if this is not indicated in the instructions, it is better not to use mineral water - for example, water with a high calcium content blocks the absorption of ibandronic acid preparations.
Sour fruit or vegetable juices. Strongly not suitable for antacids, as well as cardiac glycosides and sulfonamides. These drugs are alkaline by their chemical nature, and organic acids, which are rich in such juices, neutralize them.
Sugary carbonated drinks contain a significant amount of active chemical compounds that can react with drugs. First of all, they are incompatible with antacids, diacarb, calcium preparations.
The only universal means for washing down pills is water. But not with ice, but at room temperature in an amount of up to 1 glass. All cases when the medicine needs to be washed down with something other than water are indicated in the instructions for use.
Alcoholic surprises
Of course, it is difficult to imagine a patient drinking a cough pill with vodka. But surely people allow themselves, having taken any drug, to immediately go to the festive table and raise a glass to their health …
What can be observed in the body at this moment?
The teturam-like effect is the most unpleasant. Clonidine, metronidazole, cephalosporins, griseofulvin, sulfonamides, nitrofurans, ketoconazole and some other drugs block aldehyde dehydrogenase, the 2nd enzyme in the alcohol processing chain. As a result, acetaldehyde circulates in the blood for a long time, causing a real poisoning. In the case of a large dose of alcohol and severe individual sensitivity, the case may end in the intensive care unit.
Perversion of the effects of some drugs. Take, for example, antidepressants from the monoamine oxidase inhibitor (MAO) group. This enzyme destroys in our body biological substances from the group of monoamines - adrenaline, norepinephrine, serotonin, melatonin, histamine, dopamine. Blocking monoamine oxidase allows them to circulate in the blood longer, raising vitality, increasing blood pressure, mood, which ultimately allows the patient to overcome depression.
Alcohol is a depressant, that is, already an antagonist of these drugs. However, there are two more subtle pitfalls. Firstly, alcohol intake stimulates the release of additional amounts of adrenaline, as a result of which tachycardia develops and blood pressure rises. Secondly, some types of beer and wine contain tyramine, an adrenergic agonist. Under normal conditions, this substance is destroyed in the intestine, but while taking MAO inhibitors, it can enter the bloodstream and raise blood pressure even more.
Another example is an increase in the hepatotoxicity of metatrexate or paracetamol. Alcohol while taking these drugs is more likely to lead to drug-induced hepatitis.
