Drug interactions with diet

Chronic exposure to CS2 leads to hepatic enlargement and disturbance of liver antitoxic function, with possible synergistic interactions with diet or drugs also to increased retinal arterial pressure and retinal microaneurysms. There is some evidence of hearing impairment over time. 

Because of their lack of selectivity and their irreversible inhibition of MAO, the first MAOIs to be developed presented a high risk of adverse interactions with dietary tyramine (see Chapter 20). However, more recently, drugs which are selective for and, more importantly, reversible inhibitors of MAO-A (RIMAs) have been developed (e.g. moclobemide). These drugs are proving to be highly effective antidepressants which avoid the need for a tyramine-free diet. 

In addition to this serious diet-drug interaction, irreversible MAOIs also potentiate the effects of sympathomimetic drugs like ephedrine found in over-the-counter cold remedies and recreational stimulants like amphetamine. The MAOIs also interact with drugs that increase synaptic concentrations of 5-HT, such as the tricyclic antidepressant clomipramine and the herbal SSRI antidepressant St John s wort (Hypericum spp.). The resulting serotonin syndrome is characterised by hyperthermia and muscle rigidity. While devoid of these side effects the reversible MAO-A inhibitor moclobemide has yet to establish itself as a first-line alternative to the SSRIs. 

Additional ADRs linked to diet pills include psychosis myocardial ischemia drug interactions, such as the interaction of fenfluramine with imipramine, fenfluramine with amitriptyline or desipramine, or the toxic reaction between fluoxetine and phentermine and the release of serotonin while inhibiting its reuptake, contributing to hyperserotonin reactions. When the next craze takes hold of patients and their physicians, hopefully physicians and pharmacists will take a more vocal position and recommend restraint, xmtil some proof of efficacy and lack of toxicity is shown for new faddish off-label combinations. 

Not long after their introduction, it was discovered that MAOIs could have serious and sometimes fatal interactions with other medications and foods that have high levels of tyramine. Tyramine is found in foods like cheese, wine, beer, liver, and even chocolate, and can increase blood pressure. MAOIs interact with certain medications and foods, raising blood pressure so much that fatal results can occur. To be used safely, these drugs must be taken with a restricted diet. 

When polypharmacy is necessary, the drugs which are prescribed may have effects on the body which may be greater or less than any one taken by itself. In addition, the drugs may have interactions with the constituents of the diet. The following are the general types of interactions which may occur and a brief discussion of what action is causing them. 

Drugs and the contents of our diet can interact with any of these various processes and impair, or even sometimes enhance, the production of neurotransmitters, as well as impair their storage into synaptic vesicles, alter their release from neurons,... 

MAOI and SSRI are acronyms for two types of antidepression medication. MAOI stands for monoamine oxidase inhibitor. MAOIs must be prescribed and used with caution because they tend to dangerously interact with other types of drugs.Today, other forms of antidepressants are usually prescribed for depression patients first. If those medicines do not work, MAOIs are sometimes used with caution. People taking MAOIs have to restrict their diets and watch what other drugs and medicines they take in order to prevent interactions. SSRI, an antidepressant that is more commonly used, stands for selective serotonin reuptake inhibitor.They are generally able to be tolerated by more people and can be used for more minor depressive illnesses. 

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