High-fat meal

Amprenavir (APV, Agenerase) is the most recently approved HIV protease inhibitor. It is smaller and stereochemically less complex than the other drugs in this class. Adsorption of this compound was found to be impaired by high fat meals. Common side effects of Amprenavir are nausea, vomiting, diarrhea, rash and a tingling sensation around the mouth. 

Zaleplon should not be given with a high fat meal or snack because fat interferes with absorption of the drug. 

Avoid high fat meal (AUO I 21%) can be taken with or without food... 

Fig. 3 Mean serum erythromycin levels in healthy volunteers given 500 mg of erythromycin stearate with 20 mL of water (A), 250 ml of water ( ), or 250 mL of water immediately after a high-carbohydrate meal (0)> 250 mL of water immediately after a high-fat meal ( ), and 250 mL of water immediately after a high-protein meal (A). (From Ref. 6.). 

The side effects of orlistat are extremely unpleasant. Patients may experience abdominal pain, gas, and discomfort when taking this drug the abdominal problems that occur are even more intense after the patient eats a high-fat meal. Since orlistat is a lipase inhibitor, it prevents fat from being absorbed by the body. Thus, the fat in food comes out of the body in the stool, causing these side effects ... 

Barringer TA, Hatcher L and Sasser HC. 2008. Potential benefits on impairment of endothelial function after a high-fat meal of 4 weeks of flavonoid supplementation. eCAM 1-6. 

Chylomicroiis leave the lymph and enter the peripheral blood where the thoracic duct joins the left subdavian vein, thus initially bypassing the hver. After a high-fat meal, chylomicrons cause serum to become turbid or milky. While in the blood, chylomicrons acquire apoC-II and apoE from HDL particles. 

These studies were generally carried out at bile-acid concentrations that occur naturally in humans e.g. for colon cells, after a high-fat meal for esophageal cells, in individuals with repeated heartburn due to duodeno-gastroesophageal reflux or in cholestatic liver disorders). Taken together, these studies indicate that induction of apoptosis by bile acid is likely a frequent challenge for cells throughout the GI tract. 

A//SOLD/P/A/E. Administer nisoldipine orally once daily. Avoid administration with a high fat meal. Avoid grapefruit products before and after dosing. Swallow whole do not bite, divide, or crush. 

Bioavailability of felodipine is not affected by food, but increased more than 2-fold when taken with doubly concentrated grapefruit juice vs water or orange juice. High-fat meals and grapefruit juice with nisoldipine should be avoided. 

Drug/Food interactions Food significantly reduces the bioavailability of captopril by 30% to 40%. Administer captopril 1 hour before meals. The rate and extent of quinapril absorption are diminished moderately (25% to 30%) when administered during a high-fat meal. The rate, but not extent, of ramipril and fosinopril absorption is reduced by food. Food does not reduce the Gl absorption of benazepril, enalapril, and lisinopril. 

Effect of food (high-fat meal) Cmax reduced by 29% Tp-iax increased by 1 h No effect Cmax reduced by 18% to 50%... 

Drug/Food interactions When taken with a high-fat meal, the rate of sildenafil absorption is reduced, with a mean delay in T ax minutes and a mean reduction in C ax 29%. High-fat meals caused a reduction in C ax vardenafil by 18% to 50%. 

One 160 mg tablet is comparable to two 80 mg tablets when taken on an empty stomach. However, with a high-fat meal there is a 25% greater peak plasma concentration following one 160 mg tablet. Use dietary caution when patients are initially titrated to 160 mg tablets. 

Take zaleplon immediately before bedtime or after going to bed and experiencing difficulty falling asleep. Taking it with or immediately after a heavy, high-fat meal results in slower absorption and would be expected to reduce the effect of zaleplon on sleep latency. 

Dosage The recommended dose of ramelteon is 8 mg taken within 30 minutes of going to bed. It is recommended that ramelteon not be taken with or immediately after a high-fat meal. After taking ramelteon, patients should confine their activities to those necessary to prepare for food. 

Drug/Food interactions A high-fat meal decreases the rate, but not the extent (AUC), of tiagabine absorption. 

Drugs that may interact with pilocarpine include beta blockers and anticholinergics. Drug/Food interactions The rate of absorption of pilocarpine is decreased when taken with a high-fat meal. Maximum concentration is decreased and time to reach maximum concentration is increased. 

Sparfloxacin - Sparfloxacin is well absorbed following oral administration. Steady-state concentration was achieved on the first day by giving a loading dose that was double the daily dose. Oral absorption of sparfloxacin is unaffected by administration with milk or food, including high-fat meals. Sparfloxacin distributed well into the body. It penetrates well into body fluids and tissues. Sparfloxacin is metabolized by the liver. It is excreted in the feces (50%) and urine (50%). 

Drug/Food interactions High-fat meals slow the rate of absorption without influencing the extent. 

Absorption - Absolute bioavailability of oral ganciclovir under fasting conditions was approximately 5% following food it was 6% to 9%. When given with a high-fat meal, steady-state AUC increased and there was a significant... 

Drug/Food interactions When valganciclovir tablets were administered with a high-fat meal containing about 600 total calories (31.1 g fat, 51.6 g carbohydrates, and 22.2 g protein) at a dose of 875 mg once daily to 16 HIV-positive subjects, the steady-state ganciclovir AUC increased by 30% (95% Cl 12% to 51%), and the Cmax... 

Drug/Food interactions Oral administration of entecavir 0.5 mg with a standard high-fat meal or a light meal resulted in a delay in absorption, a decrease in Cmax-... 

Tipranavir, coadministered with ritonavir 200 mg, should be taken with food. Bioavailability is increased with a high-fat meal. Swallow the capsules whole. Do not chew the capsules. 

Amprenavir may be taken with or without food however, a high-fat meal decreases the absorption of amprenavir and should be avoided. Advise adult and pediatric patients not to take supplemental vitamin E since the vitamin E content of amprenavir capsules and oral solution exceeds the Reference Daily Intake (adults, 30 units pediatrics, approximately 10 units). 

Administration of tenofovir disoproxil following a high-fat meal increases the... 

Drug/Food interactions Administration of food with A/eora/decreases the ADC and Cmax of cyclosporine. A high-fat meal consumed within 30 minutes of Neoral administration decreased the AUC by 13% and Cmax by 33%. The effects of a low-fat meal were similar. In addition, do not take cyclosporine simultaneously with grapefruit juice unless specifically instructed to do so trough cyclosporine concentrations may be increased. 

Absorption - Because of its high lipophilicity, oral absorption of isotretinoin is enhanced when given with a high-fat meal. In a crossover study, 74 healthy adult subjects received a single 80 mg oral dose (two 40 mg capsules) of isotretinoin under fasted and fed conditions. Peak plasma concentration (Cmax)... 

Efavirenz (Sustiva) [Antiretroviral/NNRTI] Uses Hiv infxns Action Antiretroviral nonnucleoside RTI Dose Adults. 600 mg/d PO qhs Feds. See package insert avoid high-fat meals Caution [D, ] CDC recommends HIV-infected mothers not breast-feed Contra Component sensitivity Disp Caps SE Somnolence, vivid dreams, dizziness, rash, N/V/D Interactions T Effects W/ ritonavir T effects OF CNS depressants, ergot derivatives, midazolam, ritonavir, simvastatin, triazolam, warfarin X effects W/ carbamazepine, phenobarbital, rifabutin, rifampin, saquinavir, St. John s wort i effects OF amprenavir, carbamazepine, clarithromycin, indinavir, phenobarbital, saquinavir, warfarin may alter effectiveness OF OCPs EMS Concurrent EtOH usage can t CNS d ression OD May cause muscle contractions and adverse CNS effects activated charcoal may be effective... 

In 1995 the FDA approved saquinavir, the first protease inhibitor, for use in combination with other nucleoside analogue medications. In 1999 a soft gel capsule formulation of saquinavir with considerably improved absorption characteristics was developed. Ritonavir and indinavir have been approved for use alone or in combination with nucleoside analogue medications in people with advanced HIV disease. Nelfinavir is the first protease inhibitor labeled for use in children. Amprenavir is the newest of the protease inhibitors. Amprenavir can be taken with or without food, but it should not be taken with a high-fat meal because the fat content may decrease the absorption of the drug. The most disturbing adverse reactions to protease inhibitors consist of the lipodystrophy syndrome with severe hyperlipidemia and unpredictable fat redistributions over the body... 

Ribavirin can be administered as an aerosol using a small-particle aerosol generator. When administered by this route, the drug has only minimal systemic absorption, with drug concentrations in respiratory tract secretions approximately 100 times as high as those found in plasma. Oral absorption is rapid, and first-pass metabolism is extensive ribavirin s oral bioavailability is 64% and can be increased by administration with a high-fat meal. Steady-state levels are reached after 4 weeks. 

ADH, alcohol dehydrogenase F+, food (high-fat meal) increases absorption F—, food interferes with absorption FPM, extensive first pass metabolism GT, glucuronyl transferase H , dosage adjustment in patients with hepatic impairment has not been studied ND, not determined R, dosage adjustment is necessary in patients with renal impairment. 

---