Common drug interactions

Medicines can treat and even cure ones ills, but they must be used correctly and their effects monitored particularly when one takes more than one prescription,
herb or over-the-counter treatment at a time. The following chart lists widely used drugs and their possible interactions with other medications, herbal supplements,
food and alcohol. The list is by no means comprehensive. Patients should always discuss their treatments with each of their doctors and pharmacists.

ARTHRITIS AND PAIN RELIEVERS

CATEGORY

DRUG NAME

BRAND NAME

FOOD

ALCOHOL

ANALGESICS/
ANTIPYRETICS

Acetaminophen

Tylenol
Tempra

Take on an
empty stomach.

Increases risk for

liver damage or
stomach bleeding.

St. Johns
wort

Increases risk for Do not take with other

liver damage or
pain relievers.
stomach bleeding.

Ginkgo and
others that
impede clotting

NONSTEROIDAL Aspirin
Ibuprofen
ANTIINFLAMMATOR- Naproxen
IES (NSAIDS):
CORTICOSTEROIDS

Ketoprofen
Nabumetone

MethylPrednisolone
prednisolone Cortisone
Hydrocortisone acetate
Prednisone

Codeine
NARCOTIC
(PRESCRIPTION) Morphine
Oxycodone
ANALGESICS

Meperidine
Hydrocodone

Bayer
Ecotrin
Motrin
Advil
Anaprox

Aleve
Naprosyn
Orudis
Relafen
St. Joseph

Take with food or

milk to decrease
stomach irritation.

Medrol
Cortone
Deltasone

Pediapred
Prerlone
Cortef

Take with food or

milk to decrease
stomach irritation.

Tylenol No. 2
Tylenol No. 3
Tylenol No. 4
Roxanol
MS Contin

Percocet
Roxicet
Demerol
Vicodin
Lorcet

DRUG

HERB

Particularly with certain

cholesterol-lowering medications
such as cholestyramine; raises
blood sugar.
Avoid because of
sedative effects.

Valerian, St.
Johns wort, kava
kava and others

Increases sedative
effects of other
medications.

CARDIOVASCULAR
DIURETICS

Furosemide Bumetamide
Triamterene Metolazone
Hydrochloro- Spironolactone
thiazide

Lasix
Dyazide
Maxzide
HydroDIURIL

Dyrenium
Bumex
Zaroxolyn
Aldactone

Can cause loss of

potassium, calcium
and magnesium, or
potassium overload.

With cardiovascular and

analgesic medications.

ANGIOTENSIN
CONVERTING
ENZYME (ACE)
INHIBITORS

Captopril
Enalapril
Lisinopril

Quinapril
Moexipril
Benazepril

Capoten
Vasotec
Prinivil
Zestril

Accupril
Univasc
Lotensin

Some should not be

taken with meals; may
dangerously increase
potassium.

Increases
drowsiness.

BETA
BLOCKERS

Atenolol
Metoprolol

Propranolol
Nadolol

Tenormin
Lopressor
Inderal

Corgard
Toprol

Take with or
without food.

With propranolol With many medications; may

or Inderal, may
cause excessive drowsiness.
dangerously lower
blood pressure.

ANGIOTENSIN
II RECEPTOR
BLOCKERS

Candesartan
Irbesartan
Losartan

Olmesartan
Telmisartan
Valsartan

Avapro
Atacand
Cozaar

Benicar
Micardis
Diovan

Take with or without

food; avoid potassium
overload.

CALCIUM
CHANNEL
BLOCKERS
(CCBs)

Amlodipine
Felodipine
Diltiazem

Verapamil
Nifedipine
Isradipine

Nifedical
Norvasc
Plendil
Cardizem
Tiazac
Calan

Covera-HS
Verelan
Adalat
Cardia
Dynacirc

Do not take with

grapefruit or grapefruit
juice; take with or
without food or milk.

HMG-CoA
REDUCTASE
INHIBITORS
(STATINS)

Atorvastatin
Fluvastatin
Locastatin

Pravastatin
Simvastatin

Lipitor
Lescol
Mevacor

Pravachol
Zocor

Do not take with

grapefruit or
grapefruit juice.

NITRATES

Isosorbide dinitrate
Isosorbide mononitrate
Nitroglycerin

Isordil
Imdur
Sorbitrate

Nitro
Nitro-Dur
TransdermNitro

ANTICOAGULANTS

Warfarin

Coumadin

Do not take with potassium

supplements or diuretics, with
lithium, tetracycline and many
other medications.

Yohimbe, ephedra,
dong quai,
ginseng, garlic
Ephedra, yohimbe,
ginseng, licorice

With ACE inhibitors, beta blockers,

antacids, diuretics, some antibiotics
and pain relievers, potassium
supplements, other medications.

Dong quai,
ephedra,
yohimbe,
ginseng, garlic

Interferes with
effectiveness
and creates
side effects.

Do not take with other blood

pressure medications; with
some antibiotics, pain relievers,
stomach and antidepressant
medications.

St. Johns wort,

dong quai,
ephedra,
yohimbe, ginseng,
garlic

May increase
risk for liver
damage.

Risk of muscle damage when taken

with certain cholesterol-lowering
medications; rapid heartbeat with
amiodarone; with some antibiotics
and other medications.

With Viagra can

Avoid may
dangerously lower increase heart rate
and prove fatal.
blood pressure.
Monitor consumption of
vitamin K foods such as
broccoli, spinach or kale
to keep drug levels
balanced; grapefruit
juice and nutrient drinks
block or decrease
concentrations.

Avoid

Do not take with pain relievers

or antibiotics, cholestyramine or
amiodarone; many restrictions
with other medications.

Do not take with

vitamin E and
herbals that
decrease clotting
such as ginkgo
biloba, feverfew,
ginseng and
others.

Avoid because
of risk of
hypoglycemia, or
low blood sugar.

With many medications, including

over-the-counter remedies with
a high sugar (sucrose, glucose)
content.

Garlic,
chromium,
gymnema

DIABETES TYPE 2
DIABETES
(TYPE 2)

Glimepiride
Pioglitazone
Rosiglitazone

Amaryl Micronase
Metformin
Take with or without
Avandia Glucophage
Glyburide
food; often taken at
Sulfonylureas DiaBeta Glucophage XR breakfast.

ANTIBACTERIALS
CEPHALOSPORINS

Cefaclor
Cefadroxil
Cefixime

MACROLIDES

Azithromycin Erythromycin Zithromax

Clarithromycin plus Sulfisox- Biaxin
Erythromycin azole
E-Mycin

NITROIMIDAZOLE

Metronidazole

Flagyl

PENICILLIN

Penicillin V
Amoxicillin
Ampicillin

Veetids
Trimox
Amoxil

Principen
Omnipen

Take on an empty
stomach unless stomach
upset ensues.

With many medications.

QUINOLONES

Ciprofloxacin
Levofloxacin
Ofloxacin

Cipro
Levaquin
Floxin

Tequin
Avelox

Take on an empty
stomach or an hour or
two after eating. Do not
take with calcium-rich
foods such as milk or
yogurt, iron pills or
antacids.

Increases sun sensitivity; with

Dong quai,
cimetidine, also with blood
St. Johns wort
thinners, pain relievers, diabetes
and other medications.

SULFONAMIDES

Sulfamethoxazole
plus trimethoprim

Bactrim
Septra

Take on an empty
stomach unless
stomach upset ensues.

Increases sun sensitivity; with

Dong quai,
warfarin, anticonvulsants, antiSt. Johns wort
arrhythmics and other medications.

TETRACYCLINES

Tetracycline
Doxycycline

Minocycline

Achromycin
Sumycin

Vibramycin
Minocin

Take on empty stomach

unless stomach upset
ensues; do not take with
dairy products, antacids
or iron supplements.

Increases sun sensitivity;

with warfarin.

Dong quai,
St. Johns wort

Alprazolam

Ativan
Valium

Xanax

Caffeine reduces
anti-anxiety effect
of medication.

Increases
drowsiness and
risk of seizures.

With levodopa and oral

contraceptives; antacids
may reduce concentrations.

Kava kava, gotu

kola, St. Johns
wort and others
Ginseng may
interact to cause
insomnia or
hallucinations;
with St. Johns
wort, SAMe and
others

Cefprozil
Cephalexin
Cefdinir

Gatifloxacin
Moxifloxacin

Ceclor
Ceclor CD
Duricef
Suprax

Cefzil
Keflex
Keftab
Omnicef

Take on an empty
stomach unless
stomach upset ensues.

May lose effectiveness if taken

with antacids or antibiotics.

Ery-Tab
Eryc
Pediazole

Take on an empty
stomach unless stomach
upset ensues.

Increases sun sensitivity; risk of

irregular heartbeat if taken with
Propulsid; interacts with antiarrhythmics and other medications.
Avoid for at least With warfarin.
three days after
prescription; may
cause nausea,
cramps, headache
and flushing.
Several herbs
change
concentrations.

MOOD DISORDERS
BENZODIAZEPINES

Lorazepam
Diazepam

MONOAMINE
OXIDASE
(MAO)
INHIBITORS

Phenelzine
Tranylcypromine

Nardil
Parnate

Potentially fatal
increases in blood
pressure if food or
alcohol containing
tyramine is ingested,
found in some cheeses,
yogurt, sour cream, liver,
cured meats, raisins, soy
sauce, avocados,
caffeine and more.

Potentially fatal
increases in
blood pressure
if food or alcohol
containing
tyramine is
ingested.

With prescribed and overthe-counter medications.

SELECTIVE
SEROTONIN
REUPTAKE
INHIBITORS
(SSRIs)

Cilalopram
Paroxetine
Sertraline
Fluoxetine

Celexa
Paxil
Zoloft
Prozac

Take with or
without food.

Increases
drowsiness and
dizziness, feelings
of depression.

Never take with Pimozide,

St. Johns wort,
Marplan, Nardil, Parnate or other kava kava,
mood disorder medications, which SAMe, valerian
can be fatal; interacts with
warfarin, antibiotics, asthma,
stomach and other medications.

TRICYCLIC
ANTIDEPRESSANTS
(TCAs)

Desipramine
Nortriptyline
Amitriptyline

Tofranil
Pamelor
Vivactil

Take with or without

food; do not take with
grapefruit or
grapefruit juice.

Avoid. Increases
drowsiness.

Increases effects of warfarin;

do not take with other antidepressants; can cause toxic
concentrations with certain
cardiovascular medications; with
asthma and other medications.

Zantac
Zantac 75
Axid
Axid AR

Take with or without

food; caffeine may
irritate stomach.

May irritate
stomach and make
stomach healing
more difficult.

Cimetidine can interact with

St. Johns
asthma, blood-thinners, antifungals wort
and seizure medications; do not
take with other antacids.

Protonix
Nexium

Take on an empty
stomach; caffeine may
irritate stomach.

May irritate
stomach and make
stomach healing
more difficult.

May interfere with warfarin and

St. Johns
phenytoin; do not take with other wort
antacids; with antidepressants,
antifungals and other medications.

Protriptyline
Elavil
Clomipramine Anafranil
Imipramine
Aventyl
Norpramin

Valerian,
St. Johns wort,
SAMe,
kava kava

STOMACH DISORDERS
HISTAMINE
BLOCKERS

Cimetidine
Famotidine
Ranitidine
Nizatadine

PROTON
PUMP
INHIBITORS

Lansoprazole
Omeprazole
Rabeprazole

Tagamet
Tagamet HB
Pepcid
Pepcid AC
Pantoprazole Prilosec
Esomeprazole Prevacid
Aciphex

SOURCES: Annie Beauchamp, doctoral candidate in pharmacy, University of Florida College of Pharmacy; U.S. Food and Drug Administration;
www.drugs.com; www.drugdigest.org; American Pharmacists Association; www.rxlist.com; Cornell Illustrated Encyclopedia of Health.

Compiled by SUSAN ASCHOFF,

Times staff writer / Times art